[Question #1589] Prostatitis from oral sex?

44 months ago
Hi doctor. After a 3 months I receive unprotected oral sex and protected vaginal sex from CSW. I dont have any symptoms until 40 days after that encounter. First I feel redness and swollen tip of penis but no pain with urination or something else. After a while sometimes I feel weird feeling inside penis, but no discharge or anything. I drink a lot of water and that symptoms fade away. After that I got some symptoms which looks like prostatitis, didnt know that at same time but I realize that later. Night urination, some weird strange in rectum like having a small ball inside, and some pain in right groin. Also I have burning in my urethra, after urination and after ejaculation. Not bad but sometimes it was constant and sometimes fade out. Also sometimes have problem with urination, have mid flow and cant start urination but not always.

I went to urologist and after ultrasound he check everything and tell me that my prostate is little enlarged and that I have prostatitis. I didnt say anything about my unprotected oral because I dont know that can be related. He give me levofloxacin 10 days 500mg once daily. My all symptoms fade away but burning in urethra was still there. They ask me for semen analyses for bacteria which are clean, urine Analise which are clear and normal (no bacteria, WBC in normal range), blood test is good. After that he give me one more treatment of levofloxacin, same 10 days 500mg. I just finished that too, sometimes still have some small symptoms of prostatitis like that "ball" in rectum and some minor urination problems but my biggest problem is burning urethra feeling. I realize that after ejaculation, maybe 1-2 hours after I have clear discharge from my penis which cause that burning sensation. When that discharge gone I dont have burning. But in meantime after urination I have feel that urine stay in my uretrha and cuase burning feel. My doctor said that is prostate fluid because is clear and that is a prostatitis cause burning. Also sometimes I have slight burning urination feel but doctor say that also is prostatitis problem.

After reading forums and some answers I realize that unprotected oral from CSW is a risk for NGU or gonorrhea and maybe chlamydia. I didnt have any STD test because I didnt know that I need it. I never have unprotected vaginal sex in my life and this is first time that I have unprotected oral. I dont know did I catch some bacteria and can that cause prostatitis? Also I read that chlamydia cause discharge, but I have 20x500mg of levofloxacin should that cure chlamydia? Or Gonorrhea?

I dont know what to do now, that urethra burning feeling is really frustrating. Im afraid that some bacteria like gonorrhea and chlamydia is in my prostate and that antibiotics cant kill them all. Or maybe some other bacteria. Can gonorrhea be without symptoms? Do I need some more tests, some STD test? Or just to wait few days after second dose of antibiotics to body clear up it all? Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome to our Forum.  I'll try to help.  It sounds like your urologist is doing all of the right things.  Prostatitis is a challenging and sometimes difficult problem to treat, occasionally requiring repeated, prolonged courses of antibiotic treated.  Fluoroquinolone antibiotics such as levofloxacin are among the drugs most often used to treat prostatitis and your symptoms have improved with treatment.

There is little possibility that your symptoms are related to receipt of oral sex three months ago.  I say this for several reasons including:

1.  Careful studies have shown that prostatitis is almost never an STI.

2.  If you had gotten an STI, either gonorrhea, chlamydia or non-chlamydial NGU, the levofloxacin you took would have treated it.

3.  You have had several tests which show no signs of inflammation (no bacteria or WBC).

4.  If this were due to infection the symptoms would not be intermittent as you describe.

Thus, in summary I see little reason for you to worry that your current symptoms are due to an STI or that STI testing is needed.  sometimes inflammatory illnesses such as prostatitis can cause residual scarring within the prostate and male urinary tract which might lead to the symptoms you describe.  you might discuss this with your urologist.  I would not however be worried that your symptoms are related to receipt of oral sex in the past, nor that they are due to an STI.  I hope this information is helpful to you.  EWH

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44 months ago
Thanks a lot dr. Edward. In my mind STI is responsible for my prostatitis. PCR test from urine (or PRC I dont know how to write) for Chlamydia and Gonorrhea is pretty
expensive here and that is a reason because I didnt test for that and my doctor didnt ask for more testing, I ask several times for some other test he said no. Also I know that prostatitis is a problem, doctor said that I dont need more antibiotics and I will see i next month whats will happen with my symptoms.

Also I read on MedHelp that syphilis is risk. As I said, have protected vaginal and unprotected oral. Oral was short, maybe 40 seconds or 1  minute max and then she put condom and continue with oral sex. Is that brief oral risk for syphilis or protected vaginal and do I need test? I read that syphilis incubation period is 90 days,  its over 90 days and I didnt see any chancre or lesion on my penis (i suppose that chancre will show up on my penis) and dont have any rash or anything on body. Should I test for syphilis?

Thanks for your help and answers.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

As I said above, there is realistically little reason to think that your prostatitis is STI related.  From my perspective there is rarely any reason to test patients with prostatitis for STIs and in your specific situation, following two courses of antibiotics and without WBCs in your urine, I see even less reason for testing.

As for syphilis, I would tend to discount this as well.  I think you may have mis-read something we said on MedHelp in the past.  Certainly it is in no way related to the symptoms you describe and you do not report a sore or a rash from the low risk encounter you have mentioned.  I see no need for syphilis testing either although I am confident that it would be cheaper than paying for PCR testing for gonorrhea and chlamydia. 

If testing would make you feel better, depending on your location, there are often public health clinics which do offer comprehensive testing at little or no exposure.  Where are you writing from?

I hope this is helpful.  EWH

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44 months ago
Its Serbia (Central Europe). Still i must to paid for Syphilis in some private lab. But i believe you that there is no need for test from my low risk situation and I dont have any sore, lesion, rash or whatever related to Syphilis. Thanks for your answers, you clear my mind. I will seek for some more info about prostatitis. Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Your welcome.  I'm pleased you found my comments helpful.  EWH
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44 months ago
Hi doctor, I read something more about syphilis. I dont know can I ask more question but if there is a chance can you please answer me. As I wrote, have unprotected oral and protected vaginal sex with CSW over 3 months ago. Never see any sore or lesion or whatever on my penis and dont have any unusual rash any part of my body. My question is:

- Can I have syphilis without chancre on my penis? As I understand IF there is a risk in my case chancre will be on my penis right?

I can't take anonymously test, I must leave my name and other but I hope that test will be negative. Just want to ask you because you have experience with this, so IF I get syphilis from unportected oral or protected vaginal sex there will be chancre on my penis right?

Thanks

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

If you had acquired syphilis, given your exposure history, if you had acquired syphilis you almost certainly would have developed a penile ulcer which you would have seen.  Given your exposure history and circumstances, there is no reason for you to be worried about syphilis from the exposure you have described.

As I suspect you know, this forum permits up to two follow-up questions following an initial response.  This is that third response and, as a result, this thread will be closed in a few hours.  Take care. EWH

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