[Question #12668] Potential risk?

6 months ago

Four months ago I went out with a female relative of my wife. I got very drunk and have no memory after about 1am. I didnt go home that night but returned around 7am, waking up undressed in her house with her in another room. Ive been told nothing happened, but Im not sure. I had sex with my wife the next day. About a week later, I experienced testicle pain and penile redness; my GP diagnosed epididymo-orchitis and prescribed 10 days of doxycycline. Around day 4, I began suspecting an STI and was tested for chlam and gon (negative), I felt a discharge sensation despite my penis appearing dry. Four weeks after finishing doxy, my symptoms returned, and repeat tests (now including trich and Mgen) were negative. Meanwhile, my wife now has an increased, slightly yellow discharge. Could this be an STI I unknowingly treated, and is my wife at risk?

H. Hunter Handsfield, MD

6 months ago

Welcome to the forum. Thank you for your confidence in our services.

Of course I cannot judge whether you had sex during your black-out interval; you were there and I wasn't. However, from what you say it sounds pretty unlikely.

I'm sorry to hear about your epididymitis (or epididymo-orchitis, really the same thing). You don't say your age, but under age 35, most cases are due to gonorrhea or chlamydia. Over 35, most are due to non-STI urinary tract infection bacteria (like E. coli and others). Regardless of your age, it is unfortunate you were not tested for all these before starting treatment. However, that the doctor or clinic you saw treated you with doxycycline suggests they suspected chlamydia or other STI; doxycycline usually would not be the preferred drug for non-STD epididymitis. That said, testing 4 days after starting treatment usually would be positive for gonorrhea or chlamydia -- so most likely neither was the cause. Also against these is your apparent lack of sexual exposure. (That said, are you confident your wife hasn't been having sex with others? I'm not assuming that, but obviously it's a logical question.)

As for the apparent recurrence of epididymitis, at least this time you were tested for STIs with negative results -- presumably including gonorrhea and chlamydia, in addition to trichomonas and Mycoplasma genitalium. (Neither trich nor M gen have been reported to cause epididymitis.) And recurrent STD-related epididymitis is very rare if it occurs at all. However, recurrence is quite frequent for the non-STD causes, often because there is an occult infection in the prostate gland. I certainly hope this time you were tested for UTI bacteria -- if not, shame on your doctor(s)! What treatment were you given and how is it going?

But now we also have to contend with your wife's symptoms. If not done already, you and she need to have a senstive discussion about her STD risks, if any, and perhaps your own. All women with new or unexplained vaginal discharge should be professionally evaluated, even without a partner's history like yours; and yellow discharge could go along with an infection of some sort. She should be evaluated by a well trained physician who understands STDs, urinary tract infections, and genital health.

All things considered, I believe it unlikely that any STI is responsible for your infections or your wife's symptoms. But I would enjoy hearing more: your and your wife's ages; how you are now being treated; what your urinalysis showed; whether a non-STD urine culture was done to check for UTI bacteria; and the results of complete gynecologic exam of your wife, including STI testing. In the meantime, I hope these comments have been helpful.

HHH, MD

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6 months ago

Thank you for your reply. I am 30 and my wife is 28. this is the first time in my life I had ever blacked out from being drunk so I think this could be a huge overreaction on my part mixed with some coincidence.

I left out my original urinalysis due to the character limit but I was tested for UTI during my GP visit via dipstick and also a lab urinalysis. Both tests did not show an increase in WBC however there was a slight increase in squamous epi cells (I’m not entirely sure what this is) the culture also revealed no bacteria. My wife also had the same results 2 days after.

I’m hoping this would be enough to statistically rule out that an infection could be the cause.

The time frame of doctors appointment was 12 days after potential exposure so from what I gather this also would be within the applicable window periods for conclusivity.

I am not currently receiving further treatment as my symptoms can be rather ‘come and go’ so to speak. I am also very confident my wife has not had sex with anybody else. She is fully aware of my concerns relating to the night and is taking confidence in my test results.

I will suggest to my wife she goes for a full evaluation also. Thank you for your time it is very appreciated.

H. Hunter Handsfield, MD

6 months ago

Glad to hear UA and culture were done initially. Epithelial cells are normal on urinalysis, and the absence of WBC plus negative culture make epididiyfitis a lot less likely. Did you have typical symptoms and signs? That is, enlargement and marked tenderness of a single testicle? Or perhaps both testicles and not so severe? Was testicular ultrasound done? How experienced is your GP in epididymitis diagnosis and management? If bilateral and not severe, I'm now thinking more along the lines of genitally focused anxiety -- which is very common after a sexually related stressful event. What do you think?---
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6 months ago

Hi Dr Handsfield.

I guess the best way to describe it would have been a full bilateral throb but alternating between sides, never both at the same time. I did not notice any obvious swelling however there was tenderness to the touch of the epididymis, but this could have been due to aggressive checking also.

A testicular ultrasound was done but due to NHS wait times it was during the period where my symptoms had subsided completely, this also was identical to the base ultrasound I had received about 6 months prior whilst exploring possible infertility. I am unsure what my GPs experience is with this however we have discussed sending me to a urologist if symptoms continue.

I certainly think genitally focused anxiety could be the culprit here, I’ve had suspicions of this ever since the feeling of discharge despite being dry came about. I did start to obsess over checking myself every time I felt anything which I guess could also create additional symptoms by itself.

For the most part I do believe I’m lacking the obvious STI symptoms, it very rarely hurts to pass urine and if it does at all it may only be for one or 2 voids a day as opposed to every time. It’s my understanding that if an infection was present this would not be intermittent but rather every single time I passed urine and the slight sting could be an effect of obsessively checking myself?

H. Hunter Handsfield, MD

6 months ago

"full bilateral throb but alternating between sides, never both at the same time" and "did not notice obvious swelling" make it very unlikely you had epididymits at all. And regardless of the delay, the ultrasound confirms that conclusion. I'm sorry you didn't mention your own suspicion of genitally focused anxiety at the outset. Finally, yes: uncomfortable urination would be continuous if you had a urethral infection.

All is well. No more worries, no more testing, and for sure no further antibiotic treatment.

That completes the two follow-up exchanges included with each question and so ends this thread. Best wishes and stay safe.

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