I returned back on Monday evening and woke up with a tingly feeling in the penis on Tuesday morning. During the entire day I felt a tingle sensation and had to urinate frequently throughout the day. By the end of the day these sensations started to taper away. This morning I woke up with no tingle, but a slight burn sensation after peeing. I've also been experiencing some pangs in the testes (i take a min/fin dose for my hair loss, so experience similar symptoms to this throughout the year).

I have monogamous partner of two years that I would not like to infect and does not know about my indiscretions. I am concerned whether I may have contracted something, what the most likely culprits are, and when is too early to start treatment and diagnosis. I would also like to know how long I should make excuses to refrain from sexual activity to prevent infection to my partner. 

Very nervous and anxious that I have contracted something that is irreversible and will ruin my relationship. Any counsel would be helpful. 

You certainly have not made an "irreversible" mistake. You were wise to use a condom for vaginal sex. Oral sex, even unprotected, is low risk for all STDs and very close to zero risk for some, including HIV. And your symptoms do not fit with any STD. Most likely your anxieties about the exposure and a sexual decision you apparently regret are making you more aware of minor symptoms or normal body sensations that otherwise you would ignore or perhaps not even notice.

The main STD risks from oral sex are gonorrhea, nongonococcal urethritis (NGU, often probably due to normal oral bacteria and generally harmless), and herpes due to herpes simplex virus type 1 (HSV1). All of these cause symptoms like penile discharge and sores, which usually would have started by now. Depending on where you were during these exposures and the nature of your partners, syphilis could be an issue. For example, female escorts (expensive sex workers by appointment) are much less likely to have transmissible STD than brothel workers, bar pick-ups, and the like. As implied above, you were at little or no risk for HIV because of the condom for the vaginal exposure and lack of transmission risk from receiving oral sex.

For reassurance you could have a urine test for gonorrhea and chlamydia, which are valid after 4-5 days so you could be tested now. (Chlamydia is almost zero risk in this situation, but is automatically included with gonorrhea testing.) You also could have blood tests for HIV and syphilis, but these are not valid until 6 weeks. HSV testing is not recommended; the tests are pretty unreliable in absence of obvious symptoms.

But all in all, the chance you have any of these probably is under one chance in several thousand -- but again, perhaps dependent on where you are and more detail about your sex partners.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I’m hoping you are correct as I have not experienced any of the major symptoms yet, and it’s mainly anxiety driven?

A couple follow-up questions:

- a physician friend prescribed me DOXY-PEP with 200mg up front and 100mg every 12 hours x 4. He said this should help kill any bacteria, and the extra doses were to replicate the effect of taking it within 72 hours of exposure. Seemed a little fishy to me - will this have any efficacy? 

- how long would you suggest I wait until resuming sex with my monogamous partner 

- can anxiety trigger sensitivity in the penis head and pangs in the balls? 

There is no need to wait at all. If somehow I were in your situation, I would not wait at all to have sex with my wife, especially after doxy-PEP.

As for your last question, the answer is a resounding YES! Just scan this forum for hundreds of discussions about genitally focused anxiety symptoms.