[Question #2578] std?

43 months ago
Hello drs. I am a 29 yr old male, 19 and 20 days ago i had two unprotected oral sex encounters with a female whos hiv status is negative and the other is probably negative as well but i dont know her lifestyle. Last wednesday i woke up went to urinate but felt like i couldnt completely empty my bladder and it hurt to force it, not stinging. That afternoon i developed slight chills maybe a low grade fever and drenching night sweats sunday night, i dont know if it had to do with me having chills and overdoing it with the blankets( id like your input on this please) . My urine test showed positive nitrates,20,000wbc,and moderate bacteria, i had an ultrasound yesterday which showed my bladder and prostate at a normal stage no inflammation. My symptoms were always urge to urinate with very little coming out No burning or stinging No discharge Some constipation Pain trying to force bowel movements And inflammed feeling when trying to urinate What do you make of all this i am feeling well today urinating properly as i have taken a shot of ceftriaxone and taking levaquin, do you think this was an std?the symptoms started at around 10-12 days post exposure(unprotected oral sex) My culture tests arent due till thursday and i am somewhat nervous
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question.

You obviously have some sort of acute lower urinary tract inflammation. However, your symptoms are not typical for any STD; you seem to know that discharge or burning/stinging pain on urination would be expected. Your symptoms strongly suggest acute prostatitis, which is generally not an STD and not acquired sexually. That said, gonorrhea -- which can be acquired by oral sex -- rarely causes acute prostatitis, so that has to be considered a possibility. However, gonorrhea typically causes symptoms within 2-5 days. Chlamydia isn't known to cause this sort of problem, and is uncommonly acquired by oral sex. Similarly, nongonococcal urethritis (NGU) isn't known to cause prostatitis or the sorts of symptoms you have. However, the timing (10-12 days after exposure) could go along with this.

I'm not sure how much weight to put on the ultrasound showing an apparently normal prostate -- that's something you'll have to discuss with the doctor you're seeing. What did your s/he say? The ceftriaxone shot suggests they were thinking about possible gonorrhea, but levofloxacin (Levaquin) suggests they are thinking more along the lines of a non-STD urinary tract infection -- although it would also be effective against the STDs mentioned. OTOH, such UTIs are uncommon in healthy men your age. Have you had any other sexual exposures recently, e.g. with a regular partner? And in particular, have you been the insertive partner in anal sex with anybody in the past few weeks? Non-STD UTIs are easily acquired by anal sex.

Presumably you have been tested for gonorrhea, chlamydia, and non-STD UTI bacteria. It will be interesting to know those results in a couple of days. In the meantime, you're on excellent treatment and it sounds like your symptoms are improving, which is a good sign. I look forward to hearing the missing information and to your test results. In the meantime, I hope this information is somewhat helpful.

HHH, MD

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43 months ago
That is what has me confused dr...I have not had any sort of sexual contact with my wife who is 4 months pregnant, the only sex i have is with a female who had an hiv test at my wish and is negative and I know she only has sex and sexual encounters with me as naive as it may sound.  And i do not engage in anal with anybody or anything unprotected all my sex is protected, the funny thing is right after the ceftriaxone shot maybe within a few hours i was fine but then again this was the 6th day of my infection.....but to my understanding i never showed signs of an std my dr said the ultrasound looked perfectly normal bladder and prostate and i asked more than once what he thought and he said he didnt think it was a venerial disease he said it was just a urinary infection.....


Not trying to shift too much but i have another question, two months ago i visited a massage parlor and received a happy ending the female insterted a finger rectally and massaged my prostate....for the next week i felt a strange sensation like itching....is there a way to acquire hiv this way? Like if she had someone elses semen on her hand or cuts?


I will update you on thursday with the lab results
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Thanks for the clarification. Although non STD UTIs are uncommon in men your age, they happen from time to time. Anal sex is one possibility, but obviously not in your case. The massage events of 2 months ago could not have caused any STD or the kind of problems you have.

There is no point in speculating further until your test results are available. There's nothing more I can say until then, and no additional information you might think of is likely to change my opinions or advice until I know the test results. At this point, the important thing is that you're improving with antibiotic treatment. Each question on this forum includes two follow-up comments/questions and replies, so you have one more coming. Let's hold off on more discussion until your test results are available. I look forward to hearing about in a couple of days.

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43 months ago
Hwy doc i know i said id wait till thursday but this is very alarming i decided to check my semen and upon ejaculation it seemed normal until i noticed some yellowish strains like thin elongated clumps in there maybe about 5-10 give or take....what do you make of this im starting to think this is definitely and std :/
43 months ago
Disregard i will post my results in 1 hour they are ready
43 months ago
It states more than 100,000 Echerica coli
43 months ago
Adding on, i tested hiv negative in april...since then i have had for protected sex encounters with a confirmed hiv negative woman and the incident at the massage parlor abd about 4 random unprotected oral sex....should i test again?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
E. coli is the most common cause of non-STD UTIs. You should have had STD testing as well. Any results on those? No big deal if not; there is no realistic chance you have both an STD plus the E coli UTI, and as noted above you were at little or no risk for them.

For sure your UTI has nothing to do with the sexual encounter above. However, as already discussed, UTIs are uncommon in otherwise healthy men your age, and sometimes they result from a previously unknown urinary tract abnormality -- kidney stone, previously unknown urethral or ureteral stricture, etc. Although this is getting beyond the STD-limited advice normal on this forum, as an infectious diseases specialist I would strongly recommend continuing beyond the ultrasound to identify potential urinary tract anomalies. If your current physician is a urologist, s/he will know the drill. You should also ask whether your apparently normal prostate could still be the source of the UTI:  asymptomatic bacterial prostatitis, often caused by E. coli, sometimes "breaks out" to cause an overt UTI.

Such infections have nothing to do with HIV, and you are at little or no risk for it. OTOH, since HIV and your sexual exposures are obviously on your mind, it might be wise to be retested for reassurance. A negative blood test probably will be more reasuring on that score than my analysis based on probabilities and statistics.

Anyway, for sure no STD or HIV issues here, so that will conclude this thread. Best wishes and stay safe.
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