[Question #1781] Epididymitis and STD

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85 months ago
Hello Doctor,

I posted on this board before but unfortunatly  forgot my user name so had to create another one.

So, long story short, last July (about 7 month ago). I had a protected sex with CSW. Protected oral and vaginal. After that , I tested full panel 7 days later and 1 month later. All tests came back negative. I never developed any real symptoms but had some itching, light burning on a tip of the penis after peeing which one of the doctors here attributed to anxiety and after getting second negative result I dismissed(also, think it was anxiety). All the "symptomes" passed shortly after.

Present day, At the beginning of the week I felt pain in my testicles. It would come and go, was more of discomfort than pain and mostly while sitting down. After 3 days , I went to a general doctor abd after a physical exam he said that it is epidymitis because my testes are slightly swollen. He ordered a urine test for gonorrhea and chlamidya and also an ultrasound. He also said that most of the times this kind of pain is due an STD. Therefore, I have few questions:

1.  If these tests come back positive, is it possible that epididymitis is due an episode 7 month ago? I am in a committed and exclusive relationship and I am certain that my gf didnt cheat on me, so, need to know if it is possible that tests at the time were false.

2. If the tests come back negative, how reliable are they given the situation and could there be any other cause for epididymitis. I just came back from vacation on which I was driving offroad a lot, surfing and plus the flight, could it be the cause?

3. I called th ultrasound clinic and it seems that i will not be able to get an ultrasound there till at least april. In case of negative results, how urgent would it be to get these ultrasound done? Can it wait till april or should i try to find another clinic?

Thank you so much for your time
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H. Hunter Handsfield, MD
85 months ago
Welcome back to the forum. Try to keep this username handy:  multiple accounts are against forum policy, and so are repeated anxiety driven questions. (Not implying this is that kind of question --- your concerns seem straighforward and not unreasonable.)

While we try to avoid challenging users' own doctors, I strongly doubt you have epididymitis, for several reasons. Epididymitis doesn't cause on and off discomfort of the sort you describe; it would be continuous. And even with a highly experienced urologist or STD expert, an exam finding that both testes are "slightly swollen" is highly unreliable. I would not feel at all confident about my own exam with such a finding. Further, infectious epididymitis is rarely bilateral -- almost always a single testicle. When it happens, the involved testicle typically is very painful and obviously swollen. (Only half jokingly, STD specialists speak of diagnosing epididymitis by the way affected men are walking, protecting the painful organ.)  An incubation period of 7 months is untenable. If in fact you have some form of epidiymitis, I would ask what drugs you are taking:  bilateral epididymitis usually is the result of an allergic drug reaction, well documented for a very few drugs. Sexually acquired epididymitis is due only to gonorrhea or chlamydia, either of which would have probably caused other symptoms long before now, i.e. abnormal penile discharge. Finally, on top of all this, the chance you acquired gonorrhea from the condom-protected exposures described is extremely low -- truly zero if there wasn't some lapse in condom use, such as partial penetration before applying the condom.

As all this implies, I also disagree with your doctor's statement about most such pain being due to STDs. Prostatitis, or the related syndrome called the male chronic pelvic pain syndrome (CPPS), are the most common causes of such discomfort -- if any cause at all can be found. Usually nothing abnormal is found on careful exam and all lab testing. Some such cases probably are primarily psychogenic -- you can google CPPS (spell it out) for good descriptions, including a quite good Wikipedia article.

Those commetns pretty well cover your specific questions, but to be explicit:

1) I cannot imagine your gonorrhea or chlamydia tests being positive; and if they are, I would not necessarily blame either one for these symptoms.

2) I suppose physical activity and travel could be partly responsible for these symptoms. Whatever the cause, I doubt it's anything serious. (Once again, read up on CPPS.)

3) I doubt I would have recommended ultrasound, and woudl be surprised if abnormal. But I'm not the one who examined you. If it's done at all, it shouldn't wait several weeks. I'm pretty sure your doctor could intervene to work with the ultrasound clinic about the need for a prompt study.

In brief summary, I very much doubt this is related to the sexual exposure 7 months ago -- unless perhaps through a psychological connection, i.e. anxiety over a regretted sexual decision. But in all honesty, even this doesn't seem likely. It doesn't sound like you've been stewing over that event all these months. But if you have, this may be a consideration, i.e. nothing more than genitally focused anxiety.

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