[Question #13441] Intermittent Symptoms and Testing

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1 months ago
3/31: Unprotected sex (50)m (58)F. Old friend, divorced, don't know her habits but she is very healthy looking. 
Symptoms: 4-5 months after: CPPS like pain in multiple places, post void dysuria. Has subsided
Testing: 7 day neg CT, GC, Trich. 5 month negative GC CT, negative self- dipstick
5 month symptom: Potential Discharge. Crotch watch, 1-2 small specs (eraser sized)of apparent discharge in underwear intermittent. Most days none. Never had morning discharge. Unsure what it even is if anything. One time only noticed clear fluid like precum after sitting for a while at work. Can't milk it, never see anything otherwise. Could it be urine or something else? 
1) Can discharge as a symptom start that late after exposure? 
2) Can discharge be intermittent?
What does discharge usually look like? Copious amounts? Colored? 
4) Can cpps (muscle tension) cause intermittent leakage? 
5) Would std discharge be crusty and smelly? None of that applies here. 
I am obviously very focused on this and know anxiety is driving the bus. Any other recommended testing? 

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H. Hunter Handsfield, MD
1 months ago
Welcome to the forum. I'm happy to help.

Sometimes there's enough information in the title one choose for their question to answer in pretty accurately. Based on your title and our long experience on the forum, neither HIV nor any STI is a likely cause of symptoms that come and go ("intermittent"); and it is impossible to have HIV and test negative. So unless there is a surprise as I read on, most likely you do not have HIV or other STI and can look to other causes.

Now I have read the rest. Guess what?

As just implied, most forum questions like yours concern HIV, but the points are valid for the STIs that could conceivably cause the symptoms you have had. First, you describe a sexual exposure at very low risk:  STIs like gonorrhea, chlamydia, trichomonas and M. genitalilum are rare in women her age. Second, if you had acquired a urethral infection, you would have expected symptoms in a few days to two weeks, not 4-5 months later. Third, CPPS symptoms -- like vague pain, urinary urgency, etc -- do not fit with STI. The only symptoms of urethral STIs like gonorrhea, chlamydia or NGU are discharge and urethral pain during urination. (My forum colleague Dr. Hook was the lead investigator on one of the main research studies on this topic.) Lastly, if you cannot actually see cloudy mucus or pus coming from your urethra, you have no discharge that matters or could indicate an STI. A bit of clear fluid usually is either urine, as you mention, or pre-ejaculate fluids (pre-cum) if it occurs after sexual arousal or an erection.

Those comments pretty well cover your specific questions, but to be explicit:

1. No. Such late onset of symptoms is not known to occur with any STI.
2. STI urethral discharge can be intermittent, meaning there sometimes during the day but not every minute. Occasional appearance every few days doesn't fit at all.
3,5. See above:  usually mucus-like and cloudy; or thick and yellow (i.e. pus). (Pus might be "crusty and smelly.")
4. CPPS and prostate issues certainly can do this. STIs do not.

Do not have any more STI tests. If you are not in the care of a urologist, that should be your next step. If you already are in such care, discuss (again?) with that doctor. But you can and should put aside any and all concerns about the sexual exposure (and a sexual decision) that you apparently regret. Don't confuse those emotions with disease risk:  they aren't the same!

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

HHH, MD

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