First, congratulations on the amazing work, this site is very helpful!

I’m back here after a question that Dr Hunter kindly answered last year.

I’m male, 39y from the west coast of Canada.

Since then here is my history: Last year my last exposure was on 18/10 with a CSW that I have been before and we had protected vaginal sex and unprotected oral sex (fellatio). 

After this exposures I was tested twice:

26/10 - Gonorrhea,/Chlamydia (Oral swab and urine), HIV and Syphilis

05/12 - Gonorrhea/Chlamydia (Urine), HIV and Syphilis

All came back negative. At this time I was ready to move on and have unprotected sex with my wife again. Since my last test I had sex with my wife once, unprotected vaginal and oral (fellatio), but I don’t remember exactly when,  probably before January. And I had three exposures outside my marriage: two massages with masturbation (no sex) and last week (09/02) I went for a massage and end up having protected vaginal and protected oral (fellatio) with a CSW (and some kissing too).

Two days ago I started feeling a slight burn in my penis, discomfort, but no pain during while urinating or discharge that I noticed. The burn I feel more after urinating and it comes and go during the day. The tip of my penis is slightly red and I’m uncircumcised.

With this my anxiety came back and I’m very nervours about it. I went to a Dr. yesterday and he said that because there is no discharge and the way the head of my penis has this minor irritation, he doesn’t think it is an STD. He thinks I have Balantis, but to make sure and make my anxiety feel better, he gave me a lab requisition for a full STD panel (gono/clham, HIV and Syph) and urinanalisys.

I guess my question is, after the protected exposure last week, how likely I could have acquired gonorrhea or Chlamydia? I’m sure that the condom didn’t fail and I remember taking it off.

Could I have gotten NGU from the unprotected sex with my wife? 

I’ll get tested Monday and I’m just trying to put my mind at ease. My

I agree exactly with the doctor you saw yesterday. Intermitting pain or burning in the penis is generally not an STD symptoms, especially when there is no discharge and no discomfort during urination. Balanitis is usually pretty obvious on examination, and it's a garden variety condition that almost all physicians would recognize and accurately diagnose. So I see no reason to doubt your doctor's assessment. As we discussed last time, condoms work, so your more recent exposures were low risk for gonorrhea and chlamydia. You don't have NGU, based on your history and your doctor's evaluation. If you did, I suppose you could have acquired it from your wife, but probably not, especially if she hasn't had any other sex partners recently.

As you imply, feel free to be tested again for common STDs if the anticipated negative results would be more reassuring than my and your doctor's reassurance. If you do that, you can expect negative results. A urine test for gonorrhea and chlamydia will be valid at any time, but of course blood tests (e.g. for HIV and syphilis) need to be delayed until 6 weeks after exposure.

My main advice is that you consider professional counseling. Your on and off relationship with your wife, especially after your comment 3 months ago that you and she were back together, and the implication that had gotten your need for extramarital sex out of your system but obviously have not, plus your anxieties about obvious low risk sexual exposures all add up to evidence of pretty substantial psychological issues. I suggest it from compassion, not criticism. In the meantime, do your best to separate your feelings about your marriage and your sexual choices from disease risk from those choices. They aren't the same.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thank you for your answer!

As you anticipated, my tests results were all negative. I started using the cream that the Doctor prescribed me and now everything is normal again.

I know my anxiety is getting the best of me and I am seeking professional counseling, I know I've been with signs of depression and need help.

I just want to use my follow up question to clarify one thing about Syphilis testing. As you mentioned before, Syphilis testing is valid anytime after six weeks after exposure, but Syphilis seems to be a very tricky bacteria, and unlike HIV/Gonorrhea/Chlamydia, it seems depending on the type of test, you can get false negatives after having the disease for awhile. So my question is,  will the RPR test always be positive after the 6 weeks after the exposure? Some websites say that after 6 weeks it is likely to be detected, but to be sure you need to be tested after 90 days. Are they being overly conservative?

Your doctor probably was just being careful and conservative in ordering the STD tests. He probably discerned your anxiety about STDs (either indirectly or because you discussed it) and believed the anticipated negative results would help reassure you about it. If you remain uncertain, ask him about it.