[Question #1583] Received Oral Sex

45 months ago
Dear Drs:

Last Thursday (12/22) I received oral sex from another male, including ejaculation.  On Saturday (12/24), I received oral sex from another male, including ejaculation.  Both partners claimed to be disease free, but who knows.  I quickly began having some unusual symptoms after the second encounter, which included slight tingling in urethra, frequent urges to go to the bathroom, etc. I have not had any discharge of any kind.  I would also say that I have not had any significant burning on urination.  I did see a doctor on 12/27, but didn't have the guts to tell him of these encounters given I am married.  That said, doc ordered standard urinalysis and culture,  but no specific UTI tests.  The results today were all normal.  No WBCs in urine etc.  The symptoms have not worsened, which leads me to believe perhaps the anxiety of the whole thing is manifesting itself into actual physical symptoms.  

Wanted to get your thoughts on the likelihood of STI given the facts above and the results of the urinalysis.

Thanks for your help and counsel!
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to our Forum.   I'll be pleased to comment.  STIs are relatively uncommon follow receipt of oral sex both because most people do not have STIs and also because the efficiency of transmission were an STI present is rather low.  When STIs occur following receipt of oral sex they are most commonly either gonorrhea or non-chlamydial NGU due to the introduction of bacteria from the mouth into the urethra.  From what you describe, neither is likely to be present in you.    If gonorrhea was present there would most likely be an obvious urethral discharge and burning on urination, neither of which you have. the presentation of non-chlamydial NGU may be more subtle but your symptoms appear to have begun sooner than is the case for non-chlamydial NGU which usually occurs at -10 days after exposure.  Even more importantly, your urinalysis showed no signed of inflammation (i.e. WBCs in the urine).  Finally, frequency and urination are much more common manifestations of anxiety than of STI. 

Were I you, at this point I would not be concerned and would move forward without consideration of further testing.  I hope this perspective is helpful to you.  EWH

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45 months ago
Thanks!  Appreciate your response, and this definitely sets my mind at ease.  Just a couple of final follow ups (I promise not to perseverate on this!):

1.  Given the timing outlined in my original post, you believe there is a high probability that WBCs would be present in my urine if an infection was present?

2.  Is there some non-infectious causes of urethritis symptoms following oral sex?  I only ask because I do have some symptoms, although they are not the type of pain and discomfort that I would expect for a significant bacterial infection.

Thanks again for your advice!  I really appreciate it.


 
45 months ago
Dr Hook:  Just wanted to make sure my follow up questions have been seen.  Thanks again your help!
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Sorry for the delay.  Missed your follow-up.  As I answer them however, I should point out that they are a bit redundant.  I will try to provide a little more detail. 

1.  Correct.  NGU is DEFINED by the presence of the WBCs which indicate inflammation of the urethra.  The absence of WBCs in your urine is a strong indication that you do not have NGU.  The urine test is slightly less sensitive than the results of a swab inserted into your urethra but given that the symptoms you report are not symptoms typical of NGU, there is little chance that the discomfort associated with a urethral swab would add any useful information.

2.  As I said above, your symptoms are in no way suggestive of NGU.  Urinary frequency and tingling however are common symptoms of genitally focused anxiety. 

I really think you are worrying more than is needed.  EWH

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45 months ago
Thanks Dr. Hook!

Appreciate your response.  I am moving on.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Good decision.  I'm pleased my comments were helpful.  EWH---