[Question #13677] Semi protected oral, sti or anxiety

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1 months ago
About 2 weeks ago I visited a massage parlor and received oral sex with plastic wrap. It got vigorous towards the end but when she took off I saw no tears (in a dim room).  I understand this is low to no risk. I have bad anxiety and ocd and the very next morning felt burning or tingling around the ridge of my penis, the tip and perineum and anus. Never really at the same time always off and on. A week later it escalated as anxiety worsened. The burning, tingling or pain comes and goes. No burning during urination, absolutely no discharge. I’ve had this happen a decade ago with a handjob, same experience tested neg on all sti.

My question being does this sound like sti or just anxiety? Can I assume anxiety with no discharge? Would testing at 13 days be accurate?

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

Thanks for apparently reading other discussions with similar questions, which I assume from your understanding your exposure was low risk:  I agree. Also thanks for acknowledging your OCD and anxiety. As for your sy mpotms, they are typical for anxiety elevating your awareness of trivial symptoms or even normal body sensations that otherwise would not be bothersome or maybe not even noticed. When an STI or other lower urinary tract infection is present, the symptoms never are intermittent but are present continually; that's one of the main factors arguing against an infection. So does absence of burning during urination and visible urethral discharge. (I'll also point out that when someone suspects their own symptoms are due to anxiety or other psychological factor, usually they are right!)

From a medical/risk standpoint, you do not need to be tested. On the other hand, I fully understand that testing for reassurance alone -- even when the risk is nil -- can be beneficial. Many persons in your situation are reassured as much or more by negative test results as by professional opinion, no matter how expert. So although I personally would not be tested in your situation, feel free to do it if you wish. Sufficient time has passed for reliable results for standard testing in this situation (i.e. a urine test for gonorreha and chlamydia).  You also could have blood tests for syphilis and HIV 6 weeks after the event, but these are so exceedingly unlikely that I don't think it's worthwhile even for reassurance. But this too is an option if you wish.

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

HHH, MD
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1 months ago
Thank you. I do occasionally have trouble starting to urinate and maybe some mild discomfort, but I’m assuming that’s probably me overthinking I hope. I’ve had chemical urethritis from soap, so that very sharp sensation is what I assume an sti feels like. I thought I saw a post with Dr. Hook saying that only 1-2% of urethral gonorrhea infections do not have discharge correct? 
Your reply has helped a lot, I carry a lot of stress and tension (I’m working on it) and have a seated job so that area is always tight as well. I’m hoping the immense guilt of this situation has just tightened my pelvic floor muscles like crazy, causing the sensations I’m feeling. Sometimes it burns, sometimes it tingles like a pleasant release of that makes sense. 
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H. Hunter Handsfield, MD
1 months ago
These additional urinary symptoms do not fit with any STI and, as you suggest yourself, likely are just increased awareness of these sensations. Indeed soap is very irritating inside the urethra.

I would put the chance of urethral gonorrhea without symptoms even lower than 1-2%. That's the maximum possible and probably applied in distant past years, but the strains of gonorrhea bacteria that are most likely to cause asymptomatic infection now are rare. (This is something I know a lot about. This link is to the largest and most extensive study ever done on this topic and is still valid even though it's 50 years old. Note the first author. https://pubmed.ncbi.nlm.nih.gov/4202519/)

As I said above, you are welcome to have a urine gonorrhea test. If you do so, it will be negative.
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