[Question #3080] Question about oral and ngu and antibiotics false neg

38 months ago
 Hello doc, I am 50 yr old straight guy .  I have a long time steady partner however I did have an indiscretion about 6-7 weeks ago  with a female who I received  unprotected oral from on 2  separate occasions just a couple days apart.. She is known to have  multiple partners polyamorist.. either way about 7-10 days after I  had  slightly rough intercourse with my primary partner following morning woke up with very sore penis felt like from  deep within the base by the scrotum and perineum..  very mild discomfort upon urinating zero discharge couple days later started a script of ciprofloxacin 500 mg 2x day for 7 days.  I was very worried pain finally started to subside by the end of  week I was still scared so went and got gonorrhea/ chlamydia testing  via urine sample  both returned negative.  This was approximately 3-4 weeks ago  and I am still experiencing discomfort/pain albeit mild in Penis tip, perineum ,testes  General groin pelvic floor area..  my worry is that I received false negative results due to the Cipro. Should I get retested?  If I had ngu could  the symptoms persist for several weeks?  Just to recap I’m not in lots of pain,  just  maybe slight pain general vague discomfort in my pelvis, penis, perineum.  If the healing process is happening slowly  I don’t mind Patiently waiting..  just want to be sure I don’t have an infection that is coming back.  I’m human  had a lapse in judgment and have learned my lesson have asked higher power for forgiveness etc..  just would like to know I’m OK and can move on..  thank you again!   
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

The bottom line is that I'm confident you have no STD from the oral sex exposures. Oral sex is safe sex -- not completely risk free, but with low risk for all STDs and zero for some. Your symptoms are not typical for any known STD and you needn't worry about false negative test results. When antibiotics make STD tests negative, they do so because they have cured the infection; it is rare for them to simply suppress positive testing. In any case, chlamydia is rarely if ever acquired by oral sex, and gonorrhea would have caused pus dripping from the penis; I'm very confident you do not have either one and never did.

As for the exact cause of your symptoms, that's a harder question. In many men with such problems, the explanation is psychological -- anxiety magnifying minor symptoms or even normal body sensations that otherwise would be ignored or not even noticed. But the good news is that few if any patients with such symptoms ever turn out to have anything serious:  no cancer, no fertility impairment, nothing that ever seriously harms them. Or, equally important, their sex partners.

So I'm glad to hear you don't mind "patiently waiting", which is exactly what I recommend to my patients with similar symptoms. I've never seen anyone come to harm as a result. You should continue your life as normal, including sex with your regular partner. And don't beat yourself up over a couple of very human decisions, no matter how much you now regret them.

I hope this has helped. Let me know if anything isn't clear.

HHH, MD

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38 months ago
Dear Dr H,
Thank  you so much for your kind reply!  Everything was super clear, easy to understand,  and your bedside manner was awesome!  I will brief with a few minor questions, then I will indeed move on, and give things time to resolve.  I have forgiven myself, and the lessons learned..:)  
 For my pain it was very real for 7-10 days.  I am now assuming The most likely would be NGU..  and  or possibly a very mildly sprained suspensory ligament..   if you recall, this  all started the day after I had forceful intercourse with my primary partner, and I do recall pressing quite hard, Initially,without penetration a few times…  in either case   NGU or mild sprain, Could either of these cause  symptoms of  ongoing  general vague pain? sometimes dull sometimes slightly more pronounced in perineum,  lower abdomen and sometimes radiating to anus or testicles etc. none of this is very specific pain, and it  does seem to fluctuate and radiate throughout all of these areas sometimes mild sometimes more intense, but always fluctuating basically I just don’t feel 100 percent yet..  I have been very healthy up until these incidents.. thank you for reassuring me no stds are to blame..  should I be worried about a prostate problem?   Or  do you believe  that all of these vague fluctuating, radiating, vague dull pains,  will resolve with  some additional time, it’s only been approximately 4-6 weeks..  And yes of course, I don’t mind time as long as we’re pretty sure no serious  issue exists..  dr. thank you again for everything! Happy holidays to you and your family! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
I don't doubt the pain was real, and I never implied otherwise. Tensions headaches are definitely painful and the pain is real, but nobody questions that they originate with stress, anxiety, etc (hence the name!). The pain results from increased tension in scalp and neck muscles. The same likely applies in genitally focused anxiety. In any case, NGU does not cause pain of this sort. Any discomfort with NGU is typically limited to an itchy or burning sensation when passing urine (and only then), plus discharge from the penis -- and even among these, discharge is the main symptom.

As for physical strain (which is what I think you mean by "sprain"), of course that can cause muscle pain, and there is no reason this cannot apply to the genital area, perhaps following vigorous sex. I can't say that's the cause in your case, but it makes more sense than the possibilty of an infection from the oral sex event.

The other possibility is that you have a prostate problem, unrelated to either of the sexual events -- but perhaps with initial symptoms triggered by it. You're at an age when prostatitis becomes common. If your pain continues, I suggest you see a urologist. But prostatitis is not an STD, nor is it believed to be caused by sexual exposures or activities.

My experience is that pain of this sort typically does resolve once it becomes clear to the patient -- at an psychological level as well as intellectually -- that it's not harmful and not an indicator of anything serious. Most humans live large portions of their lives, at one time or another, with various unexplained aches and pains. Most of us tolerate them without difficulty once we know they aren't serious. In this regard, the genital area is no different than the ankle that still hurts long after the sprain has healed; low back pain; various muscular aches; and (as mentioned) tension headaches.

Does that help?

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38 months ago
Dr H,

Your answers have helped tremendously!  It is my hope that others will benefit from our correspondence as well. I’ll give things time and I’m sure things will undoubtedly resolve on their own.  Sometimes it just helps being told that there is no cause for worry or fear.  Often times, that alone is enough, to get us on track to recovery..   It’s been quite awhile so after the holidays. I’ll plan a full physical with my doctor.  Thanks Again for all!


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for the thanks. I'm glad to have helped.

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