[Question #2906] Dr HHH please advise

42 months ago
My timeline is this...this past Thursday October 26th I was out for a bachelor party and my friends hired escorts off the internet.  I am happily married, but got very drunk that evening.  Bad decisions were made and I received an unprotected blowjob for about 10 minutes, and ejaculated into the escorts mouth.  There was no other contact of any kind.  

Since then I've noticed allot of sensitivity in the head of my penis, like the opening/tip area.  I've had no discharge, no discomfort while urinating but increased sensitively in the head/tip after masterbation.   It's like I always kind of "feel" it.  Not stinging or burning, but sensitivity is increased.  I've noticed no physical changes to my penis either (lesions, bumps, etc)

I'm concerned of course about gonorrhea, Chlamydia, and NGU.  I've read these forums and it didn't provide much comfort, as sometimes they are asymptomatic.  What are your thoughts?   I'm trying to avoid sex with my wife while figuring this out.  Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum and thanks for your question. I happened to log in a few minutes after you posted it:  most users should not expect nearly real time replies! Also, for the record I'll remind users that they do not select the expert who will reply. It is only by chance that I am answering your question and not Dr. Hook. Our styles are somewhat different, but our knowledge, opinions, and advice are always pretty much identical.

This was a very low risk exposure. Oral sex is safe sex, with low risk for all STDs and zero (or very close to it) for some. Your prior research is pretty good, except chlamydia is especially low risk for mouth to penile transmission; there has never been a proved transmission of chlamydia mouth to penis. Gonorrhea, NGU, and herpes due to HSV1 (the cause of oral herpes) are the main risks. If you had acquired gonorrhea, you would be discharging pus from your penis by now. (Yes, it can be asymptomatic, but that's the rare exception to the rule.) Herpes likely would cause penile blisters sores by this time, and certainly within a few more days --and anyway, there's a 50% chance you are immune due to past HSV1, usually in childhood. (For sure you are immune if you've ever had known oral herpes.) NGU from oral sex is probably harmless, largely due to normal oral bacteria that cause little or no harm either to the patient or his other partners.

As for your symptoms, they are not typical of these or any other STDs. Most likely this is just anxiety increasing your awareness of otherwise trivial or entirely normal body sensations.

What to do now? Frankly, if put this in personal terms, i.e. if I were in your situation, knowing what I know about STDs, I would not get tested at all and would continue unprotected sex sex with my wife. That said, of course I cannot guarantee you didn't pick something up. For further reassurance, you can be accurately tested now for gonorrhea and chlamydia. You also could consider seeing an STD-knowledgeable physician or clinic, ideally around 10 days after the exposure, for a reassuring (i.e. probably entirely normal) exam. You could also have blood tests for HIV and syphilis at 6 weeks, but I definitely would not recommend holding off on sex at home for that long. The chance of either is too low.

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

HHH, MD

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42 months ago
It's been a few more days.  There is no discharge of any kind. still feeling the sensitivity and discomfort in the urethra.  It flares up after urinating, or after ejaculcating, in which the orgasm itself is extremely intense.  During the act of urinating there is no discomfort really.  Still no physical changes either.  It definitely feels like there's irritation of some kind inside.  My act was one week ago today.  I don't know if this is some sort of brusing inside or due to bacteria from the girls mouth, STI or not.

Either way I emailed my Dr about it, and bless his heart he's not too "up" with STD's (I'm in a small, rural area)  He said we could do a swab, but with no discharge and this discomfort I'd be happy to take the "just in case" Rx for whatever I may have.  You seem to not think I have anything, but with my wife's safety and risk to my marriage I want to take care of this as soon as possible.  I have read (here) that azithromycin and cefixime taken orally can knock out Gonorrhea and Chlamydia, is this true?  What should the appropriate dosage be?  I showed this info to my Dr. and he also said a shot is available, but I have a serious aversion to needles and pass out, plus they don't have that drug there anyway.   I have shown this website to him so he can read up on STI's a little more from Dr's that have experience.  

I want to put this behind me and feel normal down there again and be with my wife, so please if could just comment on this new info I'd appreciate it.  I will save my final comment for if I really need it.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Your symptoms continue to be atypical for any infection (especially the on/off nature, plus absence of discharge).

It is true that the combination of azithromycin and cefixime would cure both gonorrhea and chlamydia. But I strongly recommend against it. Get tested. Your implication that a urethral swab would be uncomfortable is true, which is why most testing in men is now done on urine -- and is just as accurate as a swab test. Just be sure to collect the first ounce or so of urine, not a full cup and not a midstream specimen. (That your physician may not know about urine testing might confirm he's not up to speed on STDs.)

I remain confident you are overreacting out of anxiety over a regretted sexual experience and that your urethral symptoms are just genitally focused anxiety. But if negative testing will help you get past this, have the urine gonorrhea/chlamydia test.

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42 months ago
Dr...I'll try to cover everything as this is my last comment.  It's now 11 days since, and my symptoms have almost completely gone back to normal.  When getting aroused and after ejaculation the head is still very sensitive, and slightly after finishing urination.  no discharge and still  no physical changes.  My problem is what to do next.  My Dr as you said is not well versed in STD treatment, and only has the swab available for testing.  I really don't want to do this, plus it would take a long time.  So he was willing to give me the azith/cefixime Rx just in case it was either chlamydia/gonorrhea/NGU it would knock out all three.  So  I just have some questions please.

1.  once I have the azithromycin and cefixime pills, would I just take all of them at the same time?  I don't want to mess this part up, esp with the dosage.

2.  how long after I take them would I be able to resume intercourse with my partner?

3.  is it somehow possible for the urithra to be bruised somehow?  I never felt what could be considered stinging or burning, it was just hyper, hyper sensitive.  could it have somehow been agitated physically, instead of by some STD?  I ask this considering never having any discharge.  Online it says half of gonorrhea  cases show zero symptoms, but you have said it's 1-2% only.  Get's a little confusing.

4.  you mention a test for syphyllis or HIv...these are necessary for my case?

5.  if generating discharge, would it be noticable as far as on underwear?  

6.  in the event I did have Gon/Chlamydia/NGU...do these clear by themselves ever?  If so, in how long?  if left untreated can the symptoms appear?  I ask this because 11 days in i have no discharge.  If I did would I have had it by now?  could it appear at a later date if left untreated?  or does alleviation of my general symptoms suggest it's not STI related, since it wouldn't get better without medicine?

I appreciuate all your help Dr, will try to make the best decision moving forward, just don't want to leave anything left unsaid,asked.  Thanks for all you do.
42 months ago
Sorry for some of the grammar mistakes, difficult to type long documents on a phone.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
First, I remain skepctical your doctor only has swab testing available, i.e. that he cannot do a urine test. All commercial labs, undoubtedly including the one his office uses, offer both kinds. (In fact, usually it's exactly the same test -- either a swab or urine are acceptable specimens.) However, I agree this is a further sign your doctor isn't up to speed on STDs. Consider finding someone else. Even in smaller communities, usually there are urgent care clinics or other options. A phone call to the health department might help.

Anyway, glad to hear your symptoms are gradually improving. They still don't sound typical for any STD.

1) It is true that these antibiotics would be effective in treating chlamydia, gonorrhea, nongonococcal urethritis (NGU), and syphilis.

2) It is safe to have sex with your wife now. In the unliklye event you have any of these STDs, within 48 hours of treatment, they would be cured (or sufficiently on their way to cure) that they could not be transmitted.

3) Yes, vigorous oral sex could cause irritation and perhaps discomfort like you have experienced -- even without visible bruising.

4) Syphilis and HIV testing are automatic whenever someone is tested for any STDs. There is little or no risk of either one in your case. At this point there is definitely no need for syphilis testing, since the cefixime + azithro would stop the infection early enough that you would never have a positive test. It's up to you whether to have an HIV test at ~6 weeks. If somehow I were in your situation, I wouldn't feel a need to do it.

5) Sometimes urethral discharge stains underwear.

6) Absence of discharge by this time is strong evidence against all three, but not proof. Some cases cause no discharge. NGU from oral sex often is harmless. All three are generally cleared by the immune system over several weeks to a few months. And yes, as I said above, that your symptoms are improving is additoinal evidence you aren't infected.

All things considered, you really shouldn't be worried. Don't confuse your stress over a sexual decision you regret with disease risk fromt hat event. They aren't the same. You really were not at significant risk and all will be well.

I hope the discussion has been helpful. Best wishes.
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