[Question #1407] STD

46 months ago
Hi, I am a 47 year old man.  I received oral sex from a female sex worker two months ago.  I got very sick afterwards.  Naseau, pit in my stomach, penis discomfort, tired, no appetite, body temperature was off (always felt cold when it wasn't cold out).  Also noticed a worm or maggot in my stool once which scared the heck out of me.   
Shortly after the exposure, I tested negative for Gonnorhea, Siphylis, Trichomonasis, Chalmydia, HIV, and Herpes 2 (did have a positive, Herpes 1 result but I know from a long time ago).  Also did an Ova / Parasite test which came back negative because of the worm in stool.
Dr. put my on Flagyl for 7 days, which helped symptoms, but they just came right back after meds stopped.
Then Dr. tried one day of Ciprofloaxcin (500 mg - 2 pills), followed by 10 days of doxycycline.   The doxycline didnt do anything and the penis symptoms came back so strong so after 5 days of the doxy the Dr. switched me to 5 days of Zithromax (Z Pac).  That also helped, but symptoms came right back when meds ended.
Then he put me on Ciprofloaxcin (500 mg 2 times a day) for 7 days which helped, but again symptoms in penis came back right after.  Now I'm on Cipro for another 10 days.  It helps with the symptoms in penis (pinching, itch feeling towards tip of penis), but I can tell it is not eliminating whatever this is! The penis symptoms have remained the worst and I guess it would be called urethritis or NGU.  It is very uncomfortable and lasts most of the day.
I have researched a lot to try and figure out what is causing this and I believe it must be an antibiotic resistant mycoplasma or ureaplasma, but the urologist doesnt seem to know much about that.  He says the meds I took should have cleared up whatever bacterial infection I had, but that doesnt seem to be the case.   I did a self test online (NAAT) which actually came back negative for mycoplasma, but I understand that this is common, especially when you are currently taking antibiotics which I am doing now.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum.

Unfortunately, I don't think I can help much. Oral sex doesn't cause any STDs that could explain your symptoms; and your various negative tests are valid and reliable. Obviously there's no way you could have acquired an intestinal infection, parasitic or otherwise, by an oral sex exposure. (Such infections don't travel through the body to infect other organ systems.) Finally, you have been treated with all the drugs that would take care of any conceivable bacterial STD from this event.

You don't describe either symptoms or an examination or test results to support a diagnosis of NGU. All ureaplasmas are susceptible to one or more of the antibiotics you received; and the only potentially resistant mycoplasma is M. genitalium, which isn't carried in the oral area and therefore has not been know to be acquired by oral sex. In any case, the negative test you had for some sort of mycoplasma probably is reliable. Antibiotics usually do not turn tests falsely negative; they turn tests negative because they eradicate the infection. In other words, the negative result means you don't have it now, whether or not you did before (but probably you did not).

So you can rest assured you have no STD from the exposure 2 months ago (and probably never did). You are of an age when prostate problems become common, so that's something to address with your doctor. Most prostate problems in older men don't respond to antibiotics, and are not due to any known STDs. And your gastrointestinal symptoms are also unrelated to the sexual exposure. I recommend against any further STD testing or attempts at treatment. Continue to work with your doctor and any specialist(s) he may recommend, such as a urologist and/or gastroenterologist.

I hope this has been helpful. Let me know if anything isn't clear.

HHH, MD

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46 months ago

Thank you so much for your thoughtful and thorough reply Doctor.  Your response, and all of your other public ones, have been very helpful to me.   My Doctor did do the rectal exam of my prostate and did not think there was any issue with it.   In trying to figure out some explanation for my symptoms, I did have two follow up questions for you which are as follows:

1.  Is there any risk of HIV exposure here?  I ask because my negative test was only a few week post exposure.  Obviously I will retest after 3 months to be sure, but do I have anything to worry about?  I felt certain I caught something from this sex worker and obviously don't want HIV to be the explanation of all of my symptoms. 

2.  Is it possible that anxiety can cause the myriad of symptoms I have described below?  I have been very anxious, embarrassed, depressed and guilt ridden (I am thankfully still married to a wonderful and very forgiving woman for almost 20 years) and wonder if these symptoms can be brought out by my emotions.  While I understand the emotions could cause maybe shakes, naseau, etc., I don't see how it could lead to such specific symptoms like I have in my penis.  That is a real "tightness" or pain in the penis, along with a sharp, painful, pinching sensation.  It can get pretty strong and uncomfortable which has led me to be convinced that I HAVE to  have an infection.  Also, the symptoms seem to get much worse as soon as the antibiotic runs out (at least the Cipro, as I did say the doxy didn't help at all - the pain in the penis was so bad I had to stop the doxy). 

3.  Is it at all relevant that the sex worker was a Korean female?  I say that because in trying to figure out what this is, and in convincing myself it must be mycolplasma genitalium, I notice in many of the studies that there is a strain of MG that is very resistant to even Moxifloaxcin (again I have only taken Ciprofloaxcin), and that such an antibiotic resistant strain is most prevalent in Asia.  So I have myself convinced that I was unfortunate enough to run into this strain that will not respond to any of the antibiotics, even the flouroqonine ones.

4.  My urologist seems to think that the symptoms will just subside over time.  Do you agree with that?  I know it was something, which hopefully is gone, and if so, do you agree that the symptoms I feel will gradually fade.  I ask because these symptoms that I have are very real and its depressing to think of living with them for the rest of life, particularly if there is no answer as to what the cause was.

Thank you again so much for your help and I wish you a Happy Thanksgiving! 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
1) No significant HIV risk. There has never been a scientiically proved case of HIV transmission mouth to penis, even though some infected people have claimed to be so infected. Even based on those claims, CDC once estimated the risk, if the oral partner has HIV, at 1 in 20,000. That's equivalent to receiving BJs by infected persons once daily for 55 years before transmission might be expected.

2) Most of your symptoms indeed are consistent with the physical manifestations of anxiety. But I'm not making any such diagnosis. However, I'll point out that whenever someone suspects his or her own symptoms have a psychological origin, usually s/he is right.

3) The sex worker's ethnicity or country of origin is irrelevant. M. genitalium has never been reported to cause symptoms like yours. When it causes symptoms in men, they are identical to garden variety cases of NGU, i.e. discharge as the main symptoms, somtimes but not always with painful urination; and no reported cases of any of the many sensations you report. Lack of response to the antibiotics so far is almost certainly not because you have an infection resistant to all those drugs. It's because you had no infection to begin with.

4) I agree with your urologist. The way I put it is that once someone finally becomes confident that not all symptoms mean disease and that nothing serious is wrong, symptoms generally fade away or become a tolerable background issue.

Thanks for the thanks. I'm glad to have helped. Happy TG to you as well.

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