Hello,

- Received unprotected oral sex from two female CSW on 1/17 and 1/18.

- Began to experience penis tip discomfort and some testicular pain after returning back home on 1/20. Symptoms persisted for a couple days, but did not see any lesions, feel any intense pain urinating (only minimal discomfort) and no lesions or bumps or discharge. 

-On advice from a doctor friend I took 2x Doxycycline 100mg caps on 1/22/25. The following day I saw my PCP and he prescribed me Azithromycin 500mg and administered ceftriaxone in the buttocks. I was told to refrain from sexual activity with my long term partner which I complied with. During the period 1/20-2/1 I refrained from any sexual activity with my long term partner, outside of french kissing.

-After resuming sexual contact I started to feel penis discomfort on the tip, beginning on the evening of 2/2 and continuing into 2/4. I visited my PCP and after examining my penis and confirming no bumps/lesions he suggested it is was possible the sexual encounter with my partner introduced some bacteria that was irritating my urinary tract, given the antibiotic dose I took.-I tested for NGU and gonorrhea and thrichomanas vaginalis on 2/4 and received negative results on 2/5.-These symptoms proceeded to go away by 2/6. I resumed sexual activity at that point. From that date through 2/23, my long term partner was also taking a separate dose of antibiotics to treat BV. 

-From 2/12-2/17 we traveled to Mexico, during which I used the same toothbrush I used while I was on the trip with my CSW encounter.

-On the evening of 2/23 I began to experience penis tip discomfort again... not dissimilar to the previous two occurrences. No other symptoms or legions. This has continued through 2/27 with symptoms improving mildly over the days.

My question to the Drs - is it possible that I gave my partner and STI through kissing during the antibiotic period from 1/20-2/1 and then got reinfected? Alternatively, could bacteria from my toothbrush or time in Mexico have disrupted my urinary tract. Are there other STIs that are potentially to blame? Please advise very concerned. 

As we discussed at that time, the symptoms you reported after your sex tourism adventure were nonspecific, i.e. did not suggest any STI. For reassurance, I suggested you have a urine test for gonorrhea and chlamydia. Did you do that? What was the result? You didn't mention the doxycycline treatment, but maybe that was after you asked your forum question? I would have advised against doxycycline, at least until after you were tested. I also would have advised against the azithromycin and ceftriaxone as adminstered by your PCP -- especially if this also was done without prior testing.

I don't understand what your doctor was thinking in his advice about "some bacteria irritating my urinary tract" or how that might have been related to the antibiotic treatment -- but maybe this was just a misunderstanding? Anyway, at this stage it is exceedingly unlikely, as it always was, that any STI explains your symptoms. If you recall our previous conversation -- or go back and re-read it -- I thought then the most likely explanation to be genitally focused anxiety, magnifying minor symptoms or even normal body sensations that otherwise would not be bothersome or might not even notice. That seems even more likely now, especially with these symptoms recurring after resuming sex with your regular partner. Or perhaps you have prostatitis, or the male chronic pelvic pain syndrome (CPPS). (Google it for more information -- spell it out -- the Wikipedia article is very good. Pain referred to the tip of the penis is very common in all three of these situations, i.e. prostatitis, CPPS, and genitally focused anxiety.

In reply to your closing questions, there is no realistic chance you ever had an STI, that you infected your partner by either sex or kissing, and not are reinfected. I am confident you have no infection at all. (Some prostatitis is due to bacterial infection, but most is not). And no, neither your toothbrush nor Mexico travel could have caused any sort of infection in your urinary tract.

If your symptoms continue, I would advise continuing to work with your PCP; or if s/he is not very experienced in genital infections, prostatitis, and so on, see a urologist. Either way, consider printing out this discussion as a possible framework for discussion with them. But you can put aside any and all worries about any STI.

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

HHH, MD

Appreciate your response and framework for discussing with my PCP. Your words are very reassuring, as I work toward treating these symptoms.

To answer your question I tested on 2/4 for NGU and gonorrhea and received negative results on both. I had similar symptoms in btwn finishing antibiotics and resuming sexual activity, which then disappeared and came back this past weekend.