[Question #1674] Slight burning urethra one week after exposure

43 months ago
Hello,  Over the past year I have had 10 encounters with escorts.  All included protected vaginal sex and most protected oral.  It is my last encounter which worries me. I started protected vaginal sex and took the condom off for the escort to perform oral.  As I had too much to drink I couldn't remember every aspect of the encounter and was worried over a possible exposure.  This concern was heightened ... in the week after the encounter I began to notice some discomfort while urinating, it wasn't awful but was worse first thing in the morning then seemed to clear (Never any discharge).  I went to my clinic and urine sample came back with elevate white blood cells and some red.  As a precaution I also received 1 gram azithromycin and an antibiotic shot (can't remember the name).   They also tested for gonorrhea and chlamydia, as well as syphilis, hiv, and hpv.  I am awaiting results but with my anxiety was looking for some reassurance or thoughts.

- How concerned over Hiv should I be?  The escort was in her thirties/forties and African American.  I will likely reach out to ensure that all vaginal intercourse remained protected... it didn't seem logical that she would start unprotected after putting the condom on initially.
- If one doesn't immediately remove a condom might that increase std risk?

Thanks for the response.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to the Forum.  I'll be pleased to comment.

Your history, in terms of symptoms, their onset, your urine findings, and your exposure is classic for non-chlamydial NGU (non gonococcal urethritis).  Following genital exposure, NGU may be caused by chlamydia but following oral sex what is thought to happen with oral sex where chlamydia is almost never present is that "normal" oral bacterial from a partner get introduced into the urethra where they are "recognized" by the body as being foreign and therefore cause mild inflammation.  The treatment for this syndrome is azithromycin which was one of the antibiotics you received (the other was likely ceftriaxone, a cephalosporin antibiotic used to treat gonorrhea). 

I predict that your urine tests for gonorrhea and chlamydia will be negative and that your symptoms will resolve with the treatment you received.

HIV is not a concern.  There are no cases in which HIV has been proven to be acquired by receipt of oral sex, even if your partner was infected which is unlikely )most commercial sex workers do not have HIV).

Finally, there is no data that I am aware of as to why keeping a condom on after sex would lead to the symptoms you describe.

I hope these comments are helpful to you.  EWH

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43 months ago
Hello Doctor.  Well as you predicted the tests for gonorrhea and chlamydia as well as HIV came back negative.  Still awaiting the syphilis and hpv results, but I am not concerned there.  The burning while urinating has gone as well.  One quick follow up though.  I have also noticed recently that my penis is sore when I get an erection... not always but I have noticed it recently.  Not sure if this is related?  The nurse also said they didn't detect any bacteria, so I was thinking this might relate to my prostrate?  I will be following up with the clinic and plan to have a regular physical next month in any case.  Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Penile soreness with erection is not a sign of STI.  If your signs continue, I would suggest you seek the opinion of a urologist.  STIs however are not a concern.  EWH
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