[Question #12352] Unsure of symptoms

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8 months ago
Hello, I'm about to go for an STI test soon, but I wanted to ask beforehand.

I'm male and 9 and 16 days ago, I had protected condom sex with two different sex workers. Both times I had sex, I was trying to avoid inserting my penis all the way into their vagina, to avoid skin to skin contact or any part of my penis touching their vagina or making contact with their skin.

8 days ago, I noticed a buildup of smegma under my foreskin - there was quite a lot. I cleaned it off with warm water and a little soap.

6 days ago, I was masturbating. About an hour after that, I went to urinate and upon finishing, I squeezed my penis and some white semen like, but looked like some pus as well, came out of my urethra. This has happened once.

I have no pain during urination, no pain otherwise, but I do need to pee a lot. I haven't had any discharge since. I check every morning, I keep trying to squeeze more out, but nothing.

My concern is that I have Chlamydia or Gonorrhea. I do have Herpes Type 2.

Any ideas?
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8 months ago
I forgot to mention as well, I am on a prescription for Tamsulosin which is known to cause retrograde ejaculation. I do notice my urine has white particles on it almost every time I urinate.
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Edward W. Hook M.D.
8 months ago
Welcome back to the Forum. Thanks for your continued confidence in our service.  I'll be glad to comment

As long as they do not break, condom protected sex is safe sex.  While I understand the efforts you took to avoid skin-to-skin contact, not only was your risk for gonorrhea, chlamydia, trichomonas and HIV virtually zero but the already miniscule risk of lesions diseases (in your case, syphilis since you already have HSV-2) was reduced by more than 60%.  When you combine these facts with the fact that most CSWs do not have STIs, and most single exposures (or even 2) with infected partners do not lead to infection make your risk negligible.  I do not feel strongly that you need testing but I also understand the comfort that comes from a negative test.  You can test for gonorrhea and chlamydia using a urine test any time more than 3 days after your encounter and anticipate conclusive results which, I am confident, will be negative.

The white particles you describe are non-specific.  A good step in evaluating them would be to get a urinalysis when you go for your gonorrhea and chlamydia tests.  

I hope that this information is helpful.  Please don't worry.  EWH
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8 months ago
Thank you Edward for your prompt response - and believe me when I say the continued confidence comes from having comfort from qualified professional answers - the alarming alternative is Reddit where you'll be convinced you have a week to live by the time you're finished seeking their advice.

Just as a follow up, I was hoping to get some guidance as I try to determine what the cause of the white discharge was - and much like Reddit, search engines will not give direct answers, so if you could assist with the following, it would be appreciated:

1. Unprotected sex with a woman (who turns out has a yeast infection)?
2. Balanitis?
3. Smegma entering the urethra and causing a UTI?
4. Retrograde ejaculation causing it?
5. Soap entering the urethra?
6. Leftover semen in the urethra from earlier masturbation?

In your professional opinion and experience (understanding it's impossible without proper testing), if you had to diagnose it, what would you say it is?

Apologies if the questions / circumstances I've outlined above seem idiotic or ludicrous.

Thank you again for your help.
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Edward W. Hook M.D.
8 months ago
While I agree with your comments about REDDIT, ,I suggested a urinalysis above because that is the first step in sorting our the origin of the particles you describe.  More information is needed.  Of the things you list a UTI (or prostatitis) is most likely but you need more information.  I would not be at all worried about numbers 1, 3 or 5.

You have 1 follow up remaining.  EWH
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8 months ago
Hello again Edward,

I saved my final response until my official report arrived and for the benefit of others who may be reading later.

The tests for Chlamydia and Gonorrhea both returned negative as you predicted.

The actual cause of the discharge remains unknown, but is something to monitor from here onwards.

Thank you again for your reassurance and expertise.
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Edward W. Hook M.D.
8 months ago
Thanks for sharing your results.  I trust this has resolved any concerns you might have.  If your discharge returns or worsens, it is probably time to see a urologist

Closing the thread now. EWH
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