In April, I had an unprotected experience with an exotic dancer. I was very shaken up by it and immediately worried I contracted an STD. Three days later, I began having a burning in my urethra and pain in the inner part of my right leg half way between the knee and groin. I went to urgent care and the physician did a urinalysis, which showed a high white blood cell count (6-10), a high red blood cell count (3-5) and trace bacteria. I received 250mg of Rocephin and Zithromax 250mg. I was also given Phenazopyridine. The burning cleared up in a matter of days, and the STD results came back negative. I have subsequently been retested multiple times, including a Western Blot for Herpes. The problem is that the leg pain has grown worse. It is a deep pain that quickly spread from my right leg to my left, into my groin and buttocks. I have the pain nearly all day and it is unbearable at times. This has been going on for 133 days. I also developed Episcleritis, which when away after about two months. I have had imaging done, and have seen a neurologist, a urologist and a rheumatologist. Generally, no one knows what is causing the pain. I am okay believing that the leg/groin/buttocks pain is psychosomatic (though it is so intense this is sometimes hard to do), but I cannot help but think about the urinalysis results. Here are my questions: (1) Could I have picked up some bacteria or virus from my encounter that would not have shown up on an STD that caused my urinalysis results and caused this leg pain? (2) If not, why would I have had a high white blood cell count and bacteria in my urine? (3) If this is psychological, in your experience, do these symptoms eventually subside? (4) The pain in the groin, thighs and buttocks feels very tight, at time like I have been hit with a bat. Have you ever heard of a similar somatoform disorder?

Thank you for your help.

Edward W. Hook M.D.

96 months ago

Welcome to our Forum. I'll be glad to comment. The timing of your urethral symptoms and the presence of WBCs in the urinalysis are suggestive or a urethral infection and, based on your STD results, this was likely to be non-chlamydial non-gonococcal urethritis (NGU) caused by bacteria acquired during your encounter. This sort of non-chlamydial NGU is not clearly an STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications. When treated, non-chlamydial NGU typically resolves quickly. The dose of azithromycin you received (250 mg) is lower than what is recommended for NGU (a single 1.0 gram dose is the recommended amount) but some would even argue that it is not necessary to treat non-CT NGU. Your pain syndrome is not something that is typically associated with urethral infections and may be unrelated or reflect hyper-awareness of sensations that were there before. It is unlikely to be an STI of any sort including (before you ask) herpes. At this stage in your evaluation, were you my patient I would have asked a neurologist to evaluate you as you have already done. This does not sound like an STI. As for your specific questions:

(1) Could I have picked up some bacteria or virus from my encounter that would not have shown up on an STD that caused my urinalysis results and caused this leg pain?

See above. This is not something I would consider.

(2) If not, why would I have had a high white blood cell count and bacteria in my urine?

Again, see above. Your urethral infection may well be unrelated to your leg and thigh pain.

(3) If this is psychological, in your experience, do these symptoms eventually subside?

Yes, sometimes with help. Antidepressant medications are sometimes administered but I am unaware of any studies documenting that they are (or are not) effective. Counseling may help. No matter what you do, my advice is to work with a doctor that you feel confident in so that he/she can follow you and your course over time. Each time you see a new doctor, they are likely to start over again and that is typically not effective or an efficient use of your time or resources

(4) The pain in the groin, thighs and buttocks feels very tight, at time like I have been hit with a bat. Have you ever heard of a similar somatoform disorder?

This is not my field but this is not something that I have heard of before.

I hope these comments are helpful. Your prior tests for STIs appear to rule out ongoing, active STIs. I see no reason for further testing or treatment related to the situation you have described. I hope this perspective will be helpful to you. EWH

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