[Question #234] STD possibility and Extreme anxiety

36 months ago
I am off 2,000 miles away from home, completing an Accelerated Bachelors in Nursing degree, thus my stress levels have been off the charts. I had casual sex approx. 1mo. 10 days ago and during the condom broke, but due to being intoxicated, kept going. I know that being in the medical field I should know better, but what happened happened and I regret it. May be worth noting but during sex I did notice some vaginal bleeding, but she was not concerned, and It seemed it was most likely menstrual. She was an early 20's college FM with no hx of drug use. She was my buddies friend and he told me he knows she's a 'good' girl and doesn't usually sleep around Approx 35 hrs after, I noticed I had some urethral tingling and very slight redness around my external meatus. It persisted, so I went to urgent care where I was tx prophylactically with a Zythro 1g and a Rocephin IM. The Chlamydia, Gonorrhea and UA results all came back neg later. 10 days later I returned with persistent tingle (no pain, just irritating, like a drop of urine was coming out) and gave a UA and had a urethral swab done for Herpes as I was very concerned about it. MD told me that my s/s were not Herpes related and that no virus produces s/s in 30 hours, but I insisted. They also sent the sample for growth culture/yeast, All neg. I started having daily anxiety. I saw a urologist 25 days from initial encounter where a quick physical was performed and he assured me I was fine, stated I likely had referred irritation from prostatitis due to chronic stress and new acute stress (from sex/regret), sitting 12 hours a day, bad diet, no exercise, and D/C propecia (for hair) 2 days after the sex. I felt better but 2 days later anxiety attacks ensued so I retuned to Urg. care with nothing remarkable noted. Since, the tingle has subsided and very slight urethral soreness and very small redness remains. I have been having panic attacks that I have Herpes or HIV and have become a hypochondriac. Is my worrying warranted?
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Welcome to our Forum.  I hope that what I am about to say, validating what you have already heard from two other physicians, will help you to move forward.  You had bad luck- your condom broke during a casual sexual encounter with a new partner.  This may have put you at risk for STI but the important question for you to reflect on is how big is that risk and for which STIs.  The answer is that the risk of acquiring an STI from any single encounter with any partner is low and in your case following the treatment you have received and the passage of time, it is now time to work to put this event behind you and move forward without further concern. 

I cannot know whether the partner you describe had an STI or not.  Your friend seems to think she was rather low risk.  Irrespective, the fact of the matter is that most people do no have STIs and even when they do, the risk for infection following a single exposure to an infected partner is also low- less than 1 in five such exposures to infected partners (statistically she was not infected) lead to infections in most cases.  Thus, even without other measures, I would estimate your risk for an STI as far lower than a 2 or 3% chance. Then you were treated with ceftriaxone and azithromycin which would cure gonorrhea, chlamydia, NGU, and prevent syphilis, lowering your risk still further.  Finally, you raise the question of herpes.  Even if she had herpes, again the risk of infection from a single encounter is low- now probably less than 1% for this disease IF she were infected (which you do not know).  If you had newly acquired herpes and were going to develop lesions, you would have almost certainly done so by now, more that 5 weeks ago.

Finally there is the possible redness and soreness.  I suspect this may relate to repeated self examination and hyper vigilance on your part rather than any disease process. 

I hope you will agree that I have now made a case that you did not acquire STI from this exposure.  I also hope my comments and the facts I have presented will allow you to move forward without concern.  EWH

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36 months ago
Dr. Hook, thank very much for the explanation and clarity. I understand that the persistence of my concern, despite numerous physician visits, stems from regret and guilt. Your response has definitely helped to get me headed in the right direction to move on. 

I know that your an STD expert, but just out of curiosity, do you think that prostatitis, given the quick onset of my symptoms after my exposure and the precipitating factors is a possibility? 

Also I will be returing home soon from college and I was very afraid that I may infect my long time girlfriend with something. I know this stemmed from guilt, but in your opinion is it safe to continue sex with my girlfriend?
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

With all due respect the physician that you spoke to, prostatitis in someone under the age of 30 (not sure of your age but seems that you may be in this category) is quite unusual.  Further, the symptoms you describe are not really suggestive of prostatitis either.  I am quite skeptical that you have or had prostatitis.

concerning sex with your GF on return home, I would not be concerned.  You tests are negative.  It is time for you to move forward without concern.  EWH

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