[Question #13296] Follow-up Question #13279

17 days ago

Hi Dr. Hook,

I have a follow up to previous question.

Testing history from this encounter:

1. Negative gonorrhea/chlamydia test either 3 or 6 days after encounters. (Being rimmed, fingered and my anus was rubbed by penis) Was treated with ceftriaxone and 10 days doxy.

2. Either 9 or 11 days after encounters had prep checkup and tested negative for gonorrhea, chlamydia and microplasm for throat and penis. Tested positive only for anal gonorrhea.

3. Per recommendation, did a TOC 10

Days after treatment and tested negative for anal gonorrhea.

4. I have been experiencing penile symptoms such as numbness around penis head, slightly feel urgency to urinate and some stinging when i urinate after ejaculation. No redness or bumps on penis head. Some discomfort in urethra but it comes and goes.

5. Tested negative today for penile gonorrhea and trichomoniasis as

well as HIV PCR test (probably no risk

For HIV based on encounter)

What could this possibly be? Anxiety induced? Could I have gotten prostatit-as?

17 days ago

Forgot to mention. I do have some pain in middle lower back on both sides.

H. Hunter Handsfield, MD

17 days ago

Welcome back. On account of routine sequencing of questions, this one came to me rather than Dr. Hook. However, I carefully reviewed your last exchange with him, as well as a couple of the earlier ones. I agree with his advice. But I have a question for you: Are you in the US or perhaps elsewhere? Australia or Europe, for example? There are differences in treatment advice in various countries. And even in the US, there are differences of opinion among the experts. While I agree entirely that 7 days doxycycline is sufficient to prevent syphilis after exposure (in fact, a single dose of 200 mg does the trick), some experts or clinics may have more conservative views and recommend 10 days instead of 7. But when I directed the Seattle public health STD clinic for 25 years, my guidelines said 7 days is plenty.

Thanks for summarizing your saga with rectal gonorrhea, although I understood it accurately from reviewing your discussion with Dr. Hook. Going to the only unanswered questions (4 and 5): No STI is known to cause the symptoms you describe, including your back pain; and I have no way to relate those to your experiences with anorectal gonorrhea. There also is no evidence that gonorrhea, trichomonas, prostatitis or HIV can cause such symptoms. (And if I correctly understand you have sex only with men, you can safely assume you will never have trich, which is not known to be transmitted from a source other than vaginal intercourse.) I also agree you have been at little or no risk for HIV and your symptoms certainly don't suggest it.

Even if you had not mentioned anxiety, I would have raised that possibility. And whenever someone suspects their own symptoms have a psychological or emotional origin, usually they are right. Anxiety doesn't create symptoms out of the blue, in my opinion -- but it definitely can magnify minor symptoms or even normal body sensations that otherwise would not be bothersome and perhaps not even noticed.

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

HHH, MD

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17 days ago

Thanks for the detailed response Dr. I rarely play with men and lately foregoing penetration or any kind of oral-penile play. This is why I take prep on demand but usually double dose and get a few days in before any kind of encounter. I am in Europe but the first doctor was not the Sexual Clinic.

last question. Assuming since I had 10 days of doxy and tested negative for Chlamydia at 9 days, nothing to worry about?

H. Hunter Handsfield, MD

17 days ago

Thanks for the clarifications. I'm not sure where I gained the impression you have sex mostly with men. This does make the origin of your anorectal gonorrhea more mysterious, since it is exceedingly rare in heterosexual males. But that appears to be water under the bridge at this point. And as a generalization, some European guidelines are more conservative in their doxycycline dosage recommendations (i.e. more prolonged treatment than advised in North America, Australasia, etc. In any case, 10 days of doxycycline definitely removes any concern about having chlamydia or syphilis.---
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16 days ago

Hi Doctor - my last questions. I do agree probably anxiety related as I have a female partner and played with men. I wasn't overly concerned until I tested positive for anal gonorrhea. Quick recap to save you time. July 16 - I received anal rimming. July 19 - my anus fingered and some minor mutual masterbation with a man. July 21 - my anus fingered. Evening July 21 - anal symptoms of mucus. July 22 - treated with Ceftriaxone and 10 days doxy; tested negative for anal gonorrhea and chlamydia but not quite 3 days. July 28 - prep appointment and tested negative for Gono, Chlamydia and mycoplasma in my thoat and penis. Only tested positive for anal gonorrhea. August 1st - tested negative for anal gonorrhea. August 5th tested negative for penile gonorrhea and chlamydia as well as trich and HIV with an HIV PCR test (10 days after stopping PREP) . On august 1st started to feel some pain in different parts of penis head. Today - on penis shaft notice a pinprick with white that looks like a pimple whitehead. Although I have had some redness on my penis head, it seems to go away if I put Vaseline on it.

1. Since all tests negative, assuming I am completely in the clear? I read that taking medicine could mask symptoms.

2. It is very hot and humid where I live. Wondering if I just having chafing against my underwear/clothing when I exercise. Assuming after 18 days I would have open sores if Herpes (even though was only mutually masterbated for a small amount of time). Would you agree? That's all and thank you dealing with my anxiety related questions. Really did not feel much anxiety until I got the positive test.

H. Hunter Handsfield, MD

16 days ago

1. Yes it seems you are in the clear. All the tests you had were reliable. Treatment "masking" symptoms is rare. What treatment does is prevent or cure symptoms by curing infections; transient suppression (with continuing infection) is a rare result of antibiotic treatment.

2. You're a better judge than I can be about your chafing and the weather.

As you likely know, repeated questions on the same topic are discouraged. This being your second in a week about these same issues, let's make it your last. OK?

I hope the discussions have been helpful.

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