[Question #3320] Two Negative Urine Tests but Really Worried About Current Symptoms

38 months ago

I received unprotected oral sex from someone with gonorrhea.  I had a NAAT urine test done 3 weeks post-exposure and was not experiencing symptoms.  Later in the day after the test, I experienced burning after urination which lasted a few days.  During this time, I developed pain in my left testicle and it feels like either they have swollen or my scrotum has shrunk.   The NAAT test was negative.  My urine sample was given about 1 hr 15 minutes after previously urinating and I urinated 4 or 5 times prior to the test around Noon.  I drink a lot of water.

A week after the NAAT test I went and had another test done.  This time it was a DNA Probe.  This too came back negative.  I was given 1000mg of Azithromycin.  A week later the pain in my testicles had not resolved.  I am now feeling pain in my left leg.  I went back to a different doctor who did a prostate & testicle exam.  He did not note swelling in either.  I was put on Levaquin 5 days ago.  Things may be getting better but it is hard to tell.  There is no pain in the morning but by afternoon, evening it is much greater.  I have not had any discharge at all at any time. I experience some discomfort post-urination for 1 hr after ejaculation.  Erections are difficult.

I have two negative urine tests of different types.  A urine culture and test was done for UTI on Monday which was positive for trace blood, trace leukocytes, and negative for nitrites.   The doctor's said he will call if the antibiotic does not match the culture.  It is now Friday and no call.  I've been a complete nervous wreck and have lost 15 lbs during this ordeal.  If there is a gonorrhea infection in my testicles or epididymis is it possible that it would not show in a urine test?  Or can I rely on these urine tests and assume there is a coincidence in timing and some other possible cause?    I am following up with a urologist next week but I need to sleep and breathe calmly again. I had a vasectomy 3 years ago and a PMH of UTI and prostatitis. 

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to our Forum.  I'll be glad to comment.  You do not mention whether or not your partner had gonorrhea of the throat or genital infection.  Either way, at this time, it is unlikely that you have an STI or need further STI-related treatment at this time.  since my assessment is informed by synthesis of a number of factors, let me list my reasons:

1.  No matter where your partner's infection was, most unptotected exposures do not lead to infection.  Infection rates following receipt of oral sex are lower than infection rates following genital exposures.
2.  Your tests are negative, not once but twice.  Current urine based urine diagnostic tests for gonorrhea and chlamydia are amongst the most sensitive tests ever available to clinicians and after two tests, you can be confident of your results.
3.  Even if you were infected, the azithromycin you took would reliably cure chlamydia and about 70% of gonorrhea and virtually all chlamydia.  Levaquin is also highly active against both gonorrhea and chlamydia.

So, what could be going on.  Following becoming aware of, or worried about, a possible STI anxiety is quite normal. Anxiety leads to "hyper-awareness" ad the tendency to become aware of normal sensations which are otherwise overlooked.  Anxiety also can lead to weight loss and frequent urination.  At this time, my advice is to believe your test results and move forward.  I see no need for further testing or therapy for STI.  I hope this explanation is helpful to you. EWH
---
38 months ago
Thank you, Doctor.  Surely an anxiety-driven response was in the back of my mind.  I guess my biggest concern was the general lack of symptoms or fleeting symptoms in my urethra and the fear that the bacteria would not make it to the urine such that it would be detected in any test.  
38 months ago
Dr. Hook,

If the infection were limited to my testicles or epididymis and was not present in my urethra would it still be detectable through a urine test? 
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Sorry for the delayed response,.  I missed your earlier follow-up.  You characterized the response as "anxiety-driven" and I must say, I have to agree.  If you had gonorrhea( no evidence that you do), and it had spread to the testicles or epididymis, it would have been symptomatic (I have never heard of asymptomatic epididymitis) and would still be detectable with the testing you had.  You do not have gonorrhea from the events you described above.  Really.  EWH
---
37 months ago
Dr. Hook,  thank you and your colleagues on this site for your time and courtesy answering questions and allaying fears.  I saved my final question just as a followup.   I had a followup appointment with a urologist.  He ordered ultrasounds which did not show any abnormalities.  He ordered further urine tests including for STI's.   The third and final STI test was a uroprobe (spelling?) PCR test.   That's three negative tests (NAAT, DNA Probe, and UroProbe).  Frankly, I was ready, willing, able to rest on two negative tests and was not happy that the urologist put me through extraordinary anxiety for a third.   I have not slept or eaten well in a month.   His staff was judgmental.  He thought everything was in my head. 

I have an appointment with a psychiatrist in a few weeks.  I am ready to move on with my life and get the mental health treatment I need.  I will still refrain from sexual activity until this pain and discomfort resolves just to be sure but I expect you would tell me that I do not have to.  

So here is my third question:  Will you and your colleagues please continue to keep up the good work you do on this forum? 
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Thanks for your kind words.  Although I do not like to hear that the urologist's staff was less than professional in their interactions, I am glad that his further, in-person testing showed nothing of concern.   Despite the anxiety it produced, I am likewise pleased that his supplementary testing was negative.  This should provide confidence that you were not infected.

I am also pleased that you are going to see a mental health professional.  You are not crazy.  You had a misstep and are worried about its potential effect on you and future (or present loved ones).  Our society attaches far too much stigma to STIs and that is not good for anyone.  You are not the first, or even in the minority.   I hope your interaction with the psychiatrist goes well

We will continue our efforts going forward. 

As you know, with this 3rd response, as per Forum guidelines, this interaction will need to end. There will be no further replies and this thread will be closed later today.  Take care.  EWH
---