[Question #2895] Stop worrying about STD - Chlamydia?

93 months ago

Hi famous doctors. So here is my case :
The only risk I have are protected vaginal intercourse 2 years ago and receiving unprotected oral sex April last year. Since then, I have freaked about STDs and test:
1. HIV antibody rapid test at 3 weeks, 4 weeks, 5 weeks, 2 months, 3 months, 6 months, and 1 year past 6 months ALL NEGATIVE
2. HIV PCR test at 5 weeks NEGATIVE
3. Antibody HCV and HBV at 1.5 year NEGATIVE
4. Syphillis at 1.5 year NEGATIVE
5. Gonnorhea swab(microscope) at 1.5 year NEGATIVE
6. Chlamydia PCR (urethra swab) at 1.5 year NEGATIVE
7. HSV 2 1.5 years IgG negative IgM positive borderline then repeated 2 weeks afterward for confirmatory IgG NEGATIVE 0.09 (which is very small negative number) I never have any herpes symptoms, and 2 of my std clinic doctor and Nurse Terri Warren (HSV expert) said that the risk I had and IgG negative 2x is indicative of HSV 2 free and I should move on and ignore the commonly false positive borderline IgM which is banned by CDC anyways.

But, last month I had a weird sensation inside my penis shaft (urethra)and around prostate and urinary frequency and urinary mild pain that has been on and off until now. (1 week symptomatic, another asymptomatic) on and off. And also I noticed since last month if I ejaculate, my semen would be like there is a globule-like yellowish thing. I searched online that this globule like thing apparently is normal and my doctor said also it was normal. My doctor felt my prostate and did a semen culture test and it came out that there is pain when touched at the prostate and diagnosed me with prostatitis. The semen culture test said there is Staphylococcus Haemolyticus(but I read it is more likely a contaminant?) and prescribed 2 weeks of levoflaxin. Since the symptoms still persists, I was given Bactrim for 3.5 weeks, with no improvement. As of right now the symptoms are dissapearing but I fear that It might come back.

My questions are :
1. Should my STD worry be over with all the tests I have done? Am I free of STD with all of my tests being negative? And is the PCR Urethra Swab Chlamydia accurate enough to rule out chlamydia?
2. If I had clamydia I read that levoflaxin would most likely kill it. Should I test more of chlamydia or any std if you are my doctor?
3. My STD clinic doctor said that i have enough testing. Should I just focused on the diagnosis of prostatitis and move on regarding STDs?

93 months ago

Right now I also have like sensitivity in the scrotum skin (but nothing when I see it). It causes pain when the skin vigorously touches my underwear. Should I also ignore this and be certain that it is not STD?

H. Hunter Handsfield, MD

93 months ago

Welcome back to the forum, but sorry to see you found it necessary despite the repeated, reasoned, science-based reassurance you had from Terri in two different threads. But I'm happy to clear up these final questions.

First I will reemphasize the main thing Terri said: The HSV IgM antibody test is a terrible test that often gives false positive results. True STD and herpes experts never request it. You had a false positive result that does not indicate you have HSV2. Second, as she also said, the symptoms you described to her are not at all suggestive of herpes or any other STD.

As for your possible prostatitis, I agree Staph hemolyticus probably is a contaminant. Massaging the prostate gland is always somewhat tender or overtly painful, so that alone doesn't mean prostatitis is present. In any case, I'm not surprised levofloxacin and bactrim made no difference in your symptoms. Most prostatitis is not due to any bacterial infetion, and therefore antibiotics usually don't help. They're often tried, so it was reasonable for your doctor to prescribe them. But absence of improvement means any further antibiotic treatment almost certainly will not help and you shouldn't try.

You should Google "chronic pelvic pain syndrome" and start your reading with the very good Wikipedia article. Also see information on it from Stanford University dept of Urology. You'll find that most pain like yours isn't true prostatitis at all. You'll also see it's not at all harmful, either to affected men or their partners. Many if not all cases probably are the result of genitally focused anxiety, with pain originating from pelvic muscle tension -- and not from the prostate. (This is exactly the same mechanism that explains pain in tension headaches, just a different part of the body.) You might discuss all this with your doctor -- you could print out this thread as a framework for discussion.

To your specific questions:

1) For sure your STD worries should be over. You definitely have nothing you caught from any sex partner.

2) For sure you did not have chlamydia. But if somehow you did, both levofloxacin and bactrim would have cured it.

3) Yes, you should follow that advice.

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

HHH, MD

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93 months ago

Thank you, Dr. Hansfield for the answer and information provided. Glad to know that I can move on with STD's.

Just want to make sure a few things :

1. I did a urethra swab PCR. Is the accuracy the same with urine? I've been reading that urine is the choice for PCR chlamydia in testing from websites. Is the test acceptable to rule out chlamydia?
2. In the culture, it is written that my "Staph hemolyticus" was resistant to levofloxacin. If I have chlamydia, would it be also resistant to levofloxacin thus not killing it?

3. I'm afraid of bacteria because as I said when I ejaculate there kinda like agglutination (clumping of sperm) that is particularly seen when I don't ejaculate for a few days. If I ejaculate every other day, it would appear but only in minimal amounts. I noticed this after my scare of chlamydia. I read this is due to some kind of antibody due to infection. Is this normal, or due to some kind of infection?

4. Do you have any suggestion if this non-bacterial prostatitis, what can I do to treat it?
5. I also read about chlamydia causing prostatitis that was hard to treat and to diagnose. Is this too far-fetched and unnecessary worry?

I am ready to move on and accept the answer of a credible, well-knowed doctor.
Thank you

H. Hunter Handsfield, MD

93 months ago

1) Urine is the main recommendation because some men find urethral swabs painful. Testing by swab is actually slightly more accurate than urine.

2) That the staph was resistant to levofloxacin says nothing about chlamydia, which is never resistant to levo.

3) You are spending too much time on the internet and digging too deep, and you are being attracted to information that tends to inflame your fears. The appearance of your semen most likely is varying only with the frequency of ejaculation and not due to an infection of any kind.

4) We don't get into advice about non-STD problems like prostatitis (or CPPS -- did you do the reading I suggested?). Most men with this problem just have to learn to live with their symptoms. Once they become confident that it's nothing harmful, the symptoms often fade away. Beyond that, you'll have to speak with your doctor.

5) For 40+ years there has been speculation that chlamydia might cause prostatitis, but there is no scientific evidence for it. In any case, your chlamydia tests were negative and you have received antibiotics that would have cleared chlamydia if you had it.

I am confident your current symptoms have nothing at all to do with whatever sexual exposure you had over a year ago. Let it go. I too hope you are able to move on and stop worrying about all this; I hope this discussion allows you to do so.

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93 months ago

Just as of right now, as I am relaxed and ready to move on, suddenly there is some kind of a tightening and/or sharp pain (rarely) on my scrotum skin (primarily when it scrubs or pinched by movement). I've been experiencing this kind of feeling before 4 weeks ago and it disappeared completely beforehand in a week. I also felt anxious when this happens (don't know anxious is the cause or the result of this pain). When I searched online, it came up with epididymitis.

1. Are epididymitis' symptoms similar of that I describe?

2. Can epididymitis appear and be gone like I describe 4 weeks earlier and show up again today?
3. Or do you think this is just an anxiety-driven symptoms? Tbh I felt happy and relaxed when this happens....

This is the last of my question. I want to thank you for your help, and information.

93 months ago

The pain is somewhat in the scrotum (the skin like acute 1 sec if the scrotum shrinks... ) not in the testicles inside or the epididimis.... I also experience low grade fever and nausea (not sure if this is related)....

H. Hunter Handsfield, MD

93 months ago

These pain locations are typical for CPPS or prostatitis -- typically felt anywhere from the tip of the penis to deep inside the rectum and all parts between, including testicles, upper-inner thighs, and lower back. (The prostate is a visceral organ -- and pain from any viscera, e.g. stomach or intestinces, tends to be diffuse, difficult to localized, and often felt prominently in areas that are not actually affected by whatever is wrong.) Nausea goes along with visceraln pain, but is alsso very psychological: if you're not vomiting and your appetite is OK (e.g. you're not losing weight), it's probaby unimportant. Finally, hard to know what you mean by low grade fever. If your temperature is consistently over about 99.5F or 37.8C, then you would meet criteria for fever. But occasional temps in that range are enitrely normla. 98.6F or 37C are not the top normal body temperatures, just the average in the population or in any person over the course of a day. We all have occasional body temperatures above these numbers from time to time.

That comletes the two follow-up comments and replies included with each thread, and so concludes this discussion. Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last; future new questions about this exposure or symptoms or your fears about chlamydia or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

Continue to work with your doctors. Best wishes and stay safe.

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