[Question #190] Question for Doctor H.H. Handsfield

95 months ago
Edward W. Hook M.D.
95 months ago
Daniel.  I will be answering your question when it is posted.  FYI, Dr. Handsfield and I have worked together for over 30 years and never disagree on our advice although our verbal styles do vary.  Clients are not permitted to choose who will answer as this depends on our availability.  Right now however, there is no question, just the general term "urethritis".  Please ask a specific question and I will be pleased to reply.  EWH---
95 months ago

Hi Doctor Handsfield,

I had protected sex and unprotected oral with a csw. Next day I began to feel discomfort in the tip of my penis. After 2 weeks i tested negative for gonnerea and chlamydia. 4 weeks negative HIV and Syphillis. 5 weeks PCR tested negative for gonnerea, chlamydia, mycoplasma g, ureaplasma, trichonomas and HPV 1 and 2. I still have a burning sensation at the tip of the penis and in the urethra especially after urination. My other symptoms are tingling burning sensation in legs hands and feet also a little eye discomfort red eyes.The doctor prescribed a week of doxy anyway.My questions are:

1. Is there any other std I have missed that could cause this issue. I am in a relationship and am scared I have passed something on?

2. Could this be some other oral bacteria that is harmless in the mouth but irritates the urethra?

3. Are all my symptoms likely down to guilt anxiety as the urethral pain can be quite bad.

4. Am I safe to have sex with my partner.

5. I have seen a urologist who examined my prostate and it was tender. Im on cipro for that do you think its necessary or could this be CPP.

Thanks in advance

Edward W. Hook M.D.
95 months ago
Thanks Daniel.  Before I answer your specific questions, please let me provide a few generalizations which I hope you will find useful.  First and most importantly, there are no STIs which cause symptoms in less than 24 hours after an exposure.  In a small proportion of the time, symptoms will begin as early as 36-48 hours but typically it takes even longer for symptoms to occur.   Second, oral sex turns out to be, on average, a rather inefficient way to transmit STIs when compared to genital or ano-genital contact.  Finally, our experience is that when persons begin to look carefully for symptoms, it is not at all uncommon for them to start to notice sensations which are normal and overlooked when not focused upon.  This sort of "hyper-acuity" something's further heightened by guilt or anxiety has led many people to mistakenly think they might have an STI.  That said, you did just the right thing to get tested.  Now that you have however and those tests are negative, it is time to put your concerns aside.  You did not get an STI from the exposure you describe.

As for your specific questions:
1.  No you have been tested for all of the major pathogens associated with STIS.  You should believe the results and not worry further that you may have gotten an STI.

2.  It is thought that, on occasion, introduction of oral bacteria in the fashion you describe could cause symptoms.  When it does, it should not be considered a typical STI which puts partners at risk.  If and when this happens, the symptoms typically clear without treatment.

3.  Yes, exactly.  Please see above.

4.  Yes, there is nothing you report that suggests any reason to abstain from unprotected sex with your regular partner.

5. What this is not is an STI.  CPP or the hyper acuity issue I mentioned are possibilities.

I hope these comments help. ,please do not worry further.  EWH
95 months ago

Thanks Dr Hook,

I have some other questions if that's okay.

1. Have you ever come across anyone with symptoms like mine and it has just been anxiety/guilt, I ask this only because the pain in the urethra has lasted for over 2 months and can cause me a lot of discomfort to the point of waking me up at night, can sting quite badly after urination I also get weird stabbing pains there occasionaly. My glands also look angry and redder when I am erect. Knowing that you have would put my mind at further rest?

2. I believe the tests I have are conclusive that I don't have what I tested for, You don't buy into the theory that there's a new viral thing going round which is talked about a lot on the net? My symptoms seem to fit a lot of that ( I know never google symptoms)

3. In your experiences when left to run there course do these pains eventually go away. I can put up with it for the time being as long as I'm not putting anyone else in danger.

Thanks again Doctor 

Edward W. Hook M.D.
95 months ago

We permit a total of three interactions per question.  This is your second.   Let's deal with your questions:

1.  Yes, we have seen many instances of symptoms such as yours which are totally related to anxiety/guilt.  Repeated self-examination can lead to irritation and even swelling of glands.  As your anxiety and concern diminishes, your symptoms are likely to resolve.

2.  No, I do not believe there is a new STI going around that you need to worry about.

3.  Yes, I think that as your are more comfortable your symptoms will resolve.  Perhaps it will help you to point out that often when persons with symptoms such as yours are distracted and otherwise occupied, symptoms are less prominent.  Further, I hope that our interchange will be helpful in moving you forward. 


95 months ago

Hi Doctor,

I have had a now developed a red rash round the inside of the foreskin (I am uncircumsised) on my penis it isn't particularly sore there is also a small cluster of white pimples also not very sore. I know you said not to worry but can anxiety bring out a red rash on your foreskin?

Edward W. Hook M.D.
95 months ago
The rash of the sort you describe may reflect irritation due to repeated self examination or possibly a fungal (yeast) infection which can occur in uncircumcised men.  Further sometimes when anxious, we tend to notice normal findings (like the bumps you describe) which were present but unnoticed until we started to look closely.  Try not to worry.  EWH---