[Question #1629] stds

46 months ago

Hello,

I have an appointment with an infectious disease doctor and I am trying to get some advice for the appointment. Received oral sex in September. Since then, 2 weeks after, head aches with testicle pain, then a month after clear discharge with irritation in urethra, and now irritation with pain. pretty constant for 6 weeks . Pain went away for 5 days but came back right after masturbation. All STD tests negative including 3 swabs and 3 urine tests. Terry said it would be too long for herpes. All urine with and without microscopy no WBCs.  Cystoscopy normal. urologist said the only thing I was treated for is gonorrhea. I received doxy and zithro . Is there any possibility that 6 tests could miss gonorrhea?  What else could it be and what other questions should I ask the Dr?  One day last week, for about 3 hours, little white specs were in the urine and urethra and underwear. It looked like egg whites. Don't know what is was and never came back. I still have headaches, left testicle pain, clear discharge and pain. Its been going on for over 3 months but the pain part about 6 weeks.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome back to thel forum. I reviewed your previous discussions with Terri and agree with her assessment and advice.

Before addressing your current quesitons, I'll just comment that I agree with Terri that although you apparently have HSV1 (despite the variable results of that blood test), there is nothing about your current symptoms that suggest herpes. Half of all adults have positive HSV1 blood tests and I am confident that's not related to your present problem.

As for what is going on here, I doubt you have an infection of any kind. Your symptoms are typical for the male chronic pelvic pain syndrome (CPPS) or non-infectious prostatitis, or at perhaps the acute (i.e. non chronic) version of the same sort of thing. If you google CPPS (spell it out) you'll find plenty of descriptions that match most if not all your symptoms and also describe the overlap with prostatitis. While the scant clear urethral fluid and/or occasional white flecks in the urine could indicate inflammation or infeciton, the absence of WBC in your urine and urethra argue against it.

You misunderstood your urologist, or s/he misspoke about your treatment covering only gonorrhea. Doxycycline and azithromycin in fact are not preferred treatments for gonorrhea (although they usually would treat it effectively); but they are the standard recommedations for chlamydia and for nongonococcal urethritis (NGU). Doxycycline also would cure most bacterial urinary tract or prostate infections. Persistence of symptoms after antibiotic treatment in men with symptoms like yours is not evidence of an infection resistant to those antibiotics, but instead suggests there is no infection at all. Gonorrhea never causes symptoms like yours -- and no, there is no chance 6 gonorrhea tests would miss it.

One thing to discuss with the ID doc is a "three glass" urinalysis and culture (before, during, and immediately after prostate massage by rectal exam), to assure no ongoing prostatitis. Given my analysis above, I doubt this would show anything, but better to leave no stones unturned. Also you might be tested for Mycoplasma genitalium and Trichomonas vaginalis, using PCR tests in both cases. However, these are not known to ever be acquired by oral sex, and I would expect these to also be negative. Finally, it would not be surprising if the ID doc recommends a trial of an antibiotic with good prostate penetration, such as ciprofloxacin or similar (i.e. a fluoroquinolone) for 4-6 weeks, which might help some cases of prostatitis. However, I am not optimistic about it.

The good news in all this is that no serious problem is likely to result. Many men with symptoms like yours just learn to live with them. But no such cases are known to result in anything dangerous:  no cancer, no infertility, no health problems in sex partners.

Finally, you don't mention your current sexual activity. Many experts have come to believe that sexual outlet is good in cases like yours. If you have a regular partner, you can and should be having regular sexual contact. It certainly will not hurt and just might help your symptoms.

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

HHH, MD

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46 months ago

I visited the infectious doctor today. He agrees that herpes would not last that long and the antibiotics  would of cured everything but Trich and asked if I want to be treated for it. I told him I will think about it. Can you get Trich from oral and is the PCR  test reliable instead of just taking meds.  Do you recommend taking the meds?. Is there anything else I should be concerned with?



46 months ago
Is the pcr test urine?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Thanks for the follow-up. I agree with the ID doc about your prior treatment covering most possibilities and that herpes wouldn't cause such prolonged symptoms. (And as I said above, your symptoms don't fit herpes, regardless of duration.) Trichomonas does not infect the mouth and therefore is not known to be transmitted by oral sex. If you go ahead with testing, I would expect a negative result. Even if positive, it would have to be from some previous sexual exposure, would not be a good explanation for your symptoms, so I would not expect treatment to have any effect on your symptoms and I wouldn't recommend treatment. OTOH, it's not a big deal and if your ID doc has recommended it, there's no strong reason not to give it a shot. Just don't expect miracles. And yes, trichomonas PCR is done on urine.

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46 months ago
thanks for the info I'm trying to look online for a testing company . Is trich NAA test the same as pcr and how accurate are these mg and trich tests ? Is pcr the best to get ?   
46 months ago
I forgot to mention my semen has been yellow . Any issues with that ?
46 months ago
More info , just called urologist office to find out if I had a trich test and they said I did at 6 weeks after exposure and it was negative , secretary didn't know what kind of test but said they send urine out and look under microscope for moving Protozoa . I also had  a naa trich  test from an online company 3 weeks  after exposure but before symptoms . 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
The NAAT is reliable evidence against trichomonas. The microscopy test from the doctor's office was meaningless. It misses half of all infections in women and probably 75% or more in men.

Yellow colored semen usually is considered a sign of seminal vesculitis, i.e. infection in the seminal vesicles (semen collecting sacs). It's not usually an STD, and I haven't heard of it being acquired by oral sex -- although I suppose this could happen. If you didn't tell the urologist and/or the ID doc about your yellow semen, you should do so now; perhaps they would suggest a semen culture for bacterial infection. OTOH, any such infection normally would respond to azithromycin and doxycycline, and it may take a few weeks for semen to return to normal. You might mention this to both your urologist and ID doc, but I imagine their advice would be to hold off on further evaluation until and unless the abnormal color persists 2-3 more weeks.

That completes the two follow-up comments and replies included with each question, and so ends this thread. I think the main thing now is to watch and wait, secure in the confidence that you have no untreated STD or any other serious problem that will be harmful for either you or your sex partner(s). Best wishes and stay safe.

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