[Question #1998] Epididymitis

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86 months ago

35 male.

mid January 1 encounter outside of my relationship  with CSW.  Protected Vaginal and unprotected oral(licking shaft and head, no inserted oral). To my knowledge no condom failure. She put on and removed but no change in feeling during acts.  Self Medicated 1g Zithro out of guilt 2 days after encounter.  Resumed unprotected relations with regular partner 1 day after zithro.

2/29 Developed strong symptoms of Epididymitis.  Left testicle extremely sensitive to touch.  Thought I had been hit with a bat if I sat down wrong.

3/1 Urologist diagnoses Epi with no testing, and prescribes Cipro for 14 days.  We did not talk about my exposure because I didn't know what epi was had not had any urethral symptoms.  After diagnosis I did some homework and freaked out about STIs.  Testicular pain resolved to 95% after 4 days of Cipro.  Still a slight tenderness(nothing like onset) but unsure if epi or varicocele which has been present for years.

I understand that without the epi, my risks would be considered extremely low because of the nature of the encounter.  I also understand that my treatments make diagnosis very difficult at this time but I ask this anyways to help relieve anxiety and guilt.

What are the chances I infected my regular partner with 1 exposure, 1 day after zithro and then reinfected myself later? Then developed no urethral symptoms but strong epi symptoms?  The epi timing seems impossible in my guilty state of mind.

Also, if epi is still present but Urethral infections were cleared with antibiotics, will a urine test pick up Gon or Chlam? Would a semen culture be reliable/recommended at all in this case?

Thank you for taking the time to run these forums.  Its amazing to have such experts available to the public



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86 months ago

PS, left out one piece of information. 

4/8 NAAT Urine test neg for both gon/chlam.  This test was obviously preformed after treatments so it has provided me with very little reassurance.

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Edward W. Hook M.D.
86 months ago
Welcome to our Forum.  I will try to help.  I am confident that your urologist has likely made a correct diagnosis but the question is whether or not this was an STI or not.  My guess is that this is not STI-related epididymitis but instead, an infection which arose from your urinary tract independent of the sexual exposure you mention.  My reasons for this include the following:
1.  The exposure was very low risk.  You used a condom for vaginal exposure and having your penis licked is not a risk for STI.
2.  The azithromycin you took would have cured/prevented any infection you might have had,.  Frankly however, I am confident that you did not get any STI from the exposure you describe.  The Cipro would have also had a beneficial effect. 
3.  The time interval of about 6 weeks is excessively long for this to be a sexually acquired urethritis/epididymitis. 

Other related comments:  There is virtually no chance that you acquired an STI, cured it and then reacquired it from your wife without urethritis symptoms.

Regarding your persistent discomfort, epididymitis is a highly inflammatory process and may lead to scarring which, in turn, can lead to either very slow resolution of discomfort and/or continuing discomfort related to scarring resulting from the inflammatory process. 

Believe your test results.  IF gonorrhea or chlamydia were present, I would expect your urine test to be positive.  The epididymis is in direct communication with the urethra and If infection were present it would be detected on a urine test. 

I hope these comments are helpful. EWH
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86 months ago
Thank you Dr. Hook.  That is very helpful. 

I think I had a misconception that Epididymitis would take longer than the typical Gon or Chlam urethral infection to show itself, sort of like PID in women.   What timing would you have expected the epi to show up after a STI exposure if that's what had in fact caused it?




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Edward W. Hook M.D.
86 months ago
Typically when men develop STI-related epididymitis they have obvious signs of urethritis.  There are no studies to inform how long someone would need to be infected before developing epididymitis.  In my experience however it is rather soon (days or a week or so).  In the situation you describe however, with your ingestion of azithromycin it is most unlikely that your epididymitis was related to the encounter you described for all of the reasons I mentioned above.  EWH
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86 months ago
Ok, I think I need to update the story here.  I apologize for the stringing of questions, I'll pay to start a new thread if necessary.  My gf is sick as a dog today.  She has severe stomach cramping.  She informed me that she was treated for a UTI a couple of weeks ago and finished her Macro 4 days ago. Could this be P I D that macrobid helped briefly but now the bacteria is flourishing?  All I can think is that the Epi present in me 8 weeks after the encounter, followed by a uti in gf 10 weeks after my encounter and possible relapse is too coincidental.  Perhaps my memory was hazy and the oral was more intense than licking?  Freaking out here.  Thank you
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Edward W. Hook M.D.
86 months ago
I'm sorry that you are beating yourself up over this and equally sorry that your GF is ill.  Your receipt of oral sex however just does not tie everything together.  The sexual exposure was no risk, the antibiotics you took would have cured most STIs, the interval until you developed epididymitis was too long, and your tests are negative for STIs.  Your guilt is causing you to put 2 and 2 together to come up with 6.  No change in my assessment.  You could test again but I am confident that those tests would also be negative unless there were other exposures that you neglected to mention. 

This is the 3rd reply to your questions. Thus, as per Forum guidelines, this thread will be closed in a few hours.  Take care.  EWH
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86 months ago
Thank you for your thoughtful answers.