[Question #13409] Follow up

1 days ago

Hi Docs, since my last question, my PCP is exploring balanitis as a cause of my symptoms and has prescribed betamethasone steroid cream for a period. However my partner has started spotting between periods which has spiked my anxiety again so I’m looking for some reassurance.

1. Does her spotting affect Dr Hook’s assessment that I didn’t contract something from the oral exposure and pass it to my partner before clearing it (since I didn’t test until 3 months later)

2. Which STIs can cause a stricture? How common is this a consequence of STIs? I’m not so sure my split stream is intermittent so much as less pronounced some times. It sometimes starts split and then straightens or vice versa.

3. Can STIs cause a stricture without having caused discharge?

4. Can you have NGU without discharge?

5. Given that STIs are cleared by the system (I didn’t know this before visiting your website) how often do they cause strictures before clearing?

6. Can you offer me any other reassurance or probabilities that I haven’t caused harm to my partner?

Edward W. Hook M.D.

23 hours ago

I'm sorry to see that you have been unable to move forward. Your follow-up suggests that you continue to over-focus on looking for signs of an STI. Spotting is a non-specific finding with many possible causes. If it is troublesome to her, she should see her own doctor. Responses below:

1. Does her spotting affect Dr Hook’s assessment that I didn’t contract something from the oral exposure and pass it to my partner before clearing it (since I didn’t test until 3 months later)

No change in my assessment

Any source of ongoing inflammation can cause a stricture. This included STIs, stones and other urological problems. As I said before, if you are worried, see a urologist.

3. Can STIs cause a stricture without having caused discharge?

It would be uncommon. Most STI-related inflammation is associated with a discharge

4. Can you have NGU without discharge?

Yes

5. Given that STIs are cleared by the system (I didn’t know this before visiting your website) how often do they cause strictures before clearing?

Almost never, if at all.

6. Can you offer me any other reassurance or probabilities that I haven’t caused harm to my partner?

I've tried to do that. You are having trouble accepting my efforts to reassure you despite the low risk nature of your causal encounter and your negative tests.

EWH

---

21 hours ago

Thanks for the response Dr Hook. I acknowledge that I am over focused on an STI, largely because I didn’t have these issues before the exposure. My PCP wants to see first if balanitis is the cause before referring me to urology.

I didn’t appreciate that any inflammation can cause a stricture, or did you mean it can cause split stream? I am clearly very ignorant about most of these issues and am grateful for the information and advice.

I am also surprised, now knowing that you can have NGU without discharge - that the GUM clinic declined to test me for NGU on the basis that I had no discharge. Do you think that was because I had already tested negative for Chlamydia?

1. As I mentioned before, when they declined, I used an at home UTI test to check for leukocytes which was negative. Is that valid or helpful in knowing I didn’t have NGU?

2. Is Non chlamydia NGU a common cause of strictures?

3. The other person tested negative for vaginal Chl, Gon and Trich - I know Chl is a rare risk via oral and Gon if acquired from oral is rarely asymptomatic but is it uncommon for someone to have these orally and not vaginally? Perhaps some odds or statistics around this will help me put this behind me.

I recognise that I would have to be extremely unlucky to have caught something in this instance (Orla being the only remaining risk based on her tests) passed it on and cleared before testing. I do appreciate your efforts to reassure me and recognise that my concerns are now in the ‘what if’ realms. Hard to switch that off but this is helping and I’m working on it.

Edward W. Hook M.D.

20 hours ago

I really think you’re overthinking this. Many of our clients in your situation get wrapped up in looking for signs and windows up going down “ rabbit holes “ over symptoms that are previously unnoticed natural occurrences. A stricture would not start as a split stream at the beginning of urination and then ressole or the reverse.

1. In you had NGU you would have detectable leukocytes

2. No

3. This is a what if question that serves no purpose.

One reply remaining. After that the thread will be closed and further anxiety driven questions may be deleted without a response. EWH

---

2 hours ago

Thanks Dr Hook,

Yes, I am overthinking this which is why I've come back to try and get myself into a better place based on expert advice while I follow the process wth my GP. My last questions then:

1. Do urethral STIs (excluding HIV, Syphilis and HSV) always clear themselves if untreated or do they sometimes require antibiotics?

2. I know there is no exact data but in your experience is clearance often before 12 weeks for males or can it take longer?

3. If any urethral inflammation can cause stricture, can that include NGU from UU? I'm assuming not but I know it can be a NGU cause.

4. Your position is that it is unlikely or even impossible that I had an STI and cleared it before testing. Can you humour me with a probability or percentage? This will help a lot.

5. You have clearly had patients with concerns like mine - have any turned out to have STI caused issues later?

Thank you again for the service and I will work to move forward with my PCP on the balanitis/urine issues.