[Question #1972] Two high risk situations and VERY frequent urination

48 months ago
Dear Doctors -- About three months ago, I had two relatively high-risk exposures. I both performed AND received unprotected oral sex from two different FSWs in a country in the middle east. Shortly after these encounters, I began suffering from very frequent urination at night. I get up to urinate every 1.5 to 2 hours per night (sometimes as often as 5 times, but never fewer than 3 times per night...). I've seen several doctors in the country in which I am currently staying. Initially they thought I may have diabetes, but tests came back fine. Then they thought I might have a UTI, but the urinanalysis came back fine. I also did an abdominal ultrasound AND a full prostate exam (including the blood test). I am 41-years old. They've now suggested that I see an endocrinologist, but I do not quite know why. I do not suffer from discharge, painful urination or any other symptoms. It is simply the frequent urination problem. I've been reading online and it is my understanding that frequent urination at night could be a symptom of an STD. However, STD testing here is very expensive and not covered by insurance. My question is: what possible STD's could be related to frequent urination and could have possibly been transmitted via insertive and receptive oral sex? I do not want to run the gamut of tests if I don't have to... because of the cost. Many thanks for your time and help! - Concerned
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome back to the forum. Thanks for your confidence in our services.

You have found mistaken information online. There are no STDs that cuase frequent urination. Once in a while, a man with typical symptoms of urethritis (discharge with painful urination) may also have urinary frequency or urgency. But by themselves, these are not STD symptoms. Also, you had low risk exposures, since STDs are uncommon after oral sex. Your symptoms have nothing to do with the sexual exposures, unless possibly your urinary frequency is the result of anxiety over those events, or shame/guilt over sexual decisions you regret. But not from any infection from those exposures.

It sounds to me like your doctors are on the right track. If you urinate frequently because you are making abnormally large amounts of urine, that does indeed suggest diabetes. And if not the usual kind of diabetes (sugar diabetes), you should ask your doctors about the possibility of diabetes insipidis, which causes abnormally large amounts of urine due to endocrine (hormone) problems. Maybe this is why you have being referred to an endocrinologist. If the urgency and frequency are happening despite small amounts of urine, it suggests a problem with the bladder, prostate gland, etc. In that case, a urologist makes most sense. (You are at the age when many men start to have prostate problems.)

But none of these kinds of probablems is likely to be caused by STDs. To be very safe about STDs, perhaps you should have urine test for gonorrhea and chlamydia. If you do so, I'm sure the results will be negative. But perhaps that much testing would not be very costly, and the negative results might help reassure you. But your main efforts should continue to work with your doctors about non-STD explanations. In the meantime, if you have a regular sex partner, you can safely continue your relations with that person.

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

HHH, MD

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48 months ago
Thank you, Dr. Handsfield! I really appreciate your thorough, clear response!! A quick follow-up: I have a long trip back to a Western country in late May -- insurance and care will be much, much better. Can I wait until late May to take action on potential Diabetes Insipidus (and also wait to get tested for the two less-likely STDs you mentioned, if I am not diagnosed with D.I.)? I've read that (with all three diseases) treatment should begin relatively early, otherwise there is risk of complications, or that treatment won't work, or whatever. I just don't know what relatively early means in the context of those three separate conditions. As I noted, I've already been having symptoms for a few months. Could I already be too late? Thanks! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Since the chance you have any STD is very low, it is safe to wait to have those tests. This forum is limited to STD/HIV advice, and I have virtually no personal experience with diabetes insipidus, so I cannot advise about that aspect. However, some cases are due to pituitary gland tumors, which can be dangerous for reasons other than DI. If your doctors believe DI is a reasonable likelihood, I would think it best to be evaluated without delay.

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