[Question #1590] UTI or STD?

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89 months ago
I'm a male, been married 5 years.

Recently I have had an itch inside my penis. Sort of.. If I ignore it, I don't feel bothered, but when I pinch my penis to squeeze the urethra it feels as tho I am "scrathing" and itch. Also, in the morning, and if I havent peed in a while, a very small amount of what seems like seminal fluid (clear/white) can sit right at the end of my penis. After a long time I can see sports in my underwear. Also, if I squeeze out my penis (sort of like milk it), this also "scratches an itch" and I can squeeze out some white/clear discharge/fluid/seminal fluid. throughout the day my penis can feel cold, if that makes any sense.

I went to the doc and described this, but I lied to him (I freaked out in the room and couldn't admit stuff). That I had only been with my wife.

Recently I received oral from a sex work with no condom (probably 4-6 weeks ago)
Also had sex briefly WITH a condom. (same encounter)

I also had a HJ release from a massage parlor about 3 weeks ago. 

He said it sounded like a yeast infection and gave me difulcan. He also inspected my penis and said "Yea you are fine" (which I assume meant I didn't have anything that would manifest into something visual).

I have taken the Difulcan yesterday. I feel different but symptoms remain.

They took a urine sample and will send to lab for STD tests. But Im going crazy thinking I may lose my family. I'm a moron. He said they did a quick test and there were "some white blood cells". I asked what that means, and he sort of shrugged it off as it could be many things.

Anyway.... Sound like an STD? Chlamydia? non-CHl. NGU? Gonorrhea? Could this be a UTI? I do feel like I want to urine more, but I assume its because of my nerves.

-Scared, and very stupid, dude.

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H. Hunter Handsfield, MD
89 months ago
Welcome to the forum. Thanks for your question.

Probably you have nongonococcal urethritis (NGU), an STD you acquired during your encounter with the commercial sex worker 4-6 weeks ago. Your symptoms are typical -- the presence of discharge, including underwear staining in addition to the small amount you see in the morning, is the most important, but it also fits with the itching situation in your penis and with the elevated white blood cells they found. The timing is a bit late -- typical onset would be 1-3 weeks, but 4+ weeks isn't rare. Contrary to your doctor's tentative diagnosis, yeast infection is very unlikely; yeast rarely causes this sort of problem. And non-STD UTIs are rare in men under 50 years old and the symptoms typically are different (more severe pain during urination, no discharge). I don't expect your symptoms to clear up on fluconazole (diflucan) and would not have prescribed it.

The probable specific source was the oral sex. It's unlikely from the condom protected sex, unless there was brief vaginal insertion before you applied the condom. Hand-genital contact is no risk at all. Your STD tests probably will be negative. While there is a slight chance testing will detect chlamydia, or even less likely, gonorrhea, the specific cause of NGU is unknown in over half of all cases, and probably in 90% of cases acquired by oral sex. But don't assume negative tests mean no STD:  NGU is always an STD.  

Assuming your test results are negative, as expected, you need treatment with either azithromycin (single dose) or doxycycline (7 days). Most experts slightly prefer doxy these days.

Have you had unprotected sex with your wife since the commercial exposure 4-6 weeks ago? If so, she also will need examination and treatment, meaning you'll have to explain the whole situation to her. The actual risk to her may be very low:  NGU from oral sex may be due to entirely normal oral bacteria that would not harm her, and is not known to cause important health problems in women. However, this is controversial and there is no way to know for certain, so standard practice is always to treat the partners of men with NGU.

As implied by some of my comments, there is evidence your current doctor is not up to speed on STDs and their evaluation in men. If you can find an STD experts -- e.g. if there is a public health department STD clinic in your area, or a planned parenthood clinic -- you might get more expert care. Or if in general you consider your doctor good and you get along well with him, consider printing out this thread (perhaps without this paragraph). He might have reacted differently with the truth of your sexual activities (about which you need to 'fess up) and might actually know the ropes very well.

Sorry that most of this isn't what you were hoping to hear, but I hope the information is helpful. At least you'll for sure be on the right track. And in the long run, this is not likely to be dangerous. NGU that isn't caused by chlamydia is for the most part harmless both in affected men and for their sex partners. That's probably especially so for NGU acquried by oral sex. Don't get me wrong -- your wife still needs treatment, if exposed since your commercial sex event -- but important complications are very unlikely.

Let me know if anything isn't clear -- and perhaps be prepared to report the next steps after your test results are available. Best wishes--  HHH, MD