[Question #3537] Very worried about burning sensation

34 months ago
Greetings to this wonderful team.

I'll try to be as brief as I can. I'm a 30 years old male, married and monogamous for 4 years now. On Friday March 23, after a very unfortunate series of events, I received unprotected oral sex from a CSW. She did it for 10-15 mins and I ejaculated in her mouth. 

Exactly one week after (Friday March 30), I started to feel a mild burning sensation in my penis, but I didn't pay much attention. However, it has kept going and growing stronger. It has come to a point where is so strong that I almost couldn't sleep last night. 

The burning sensation is very diffuse all over my penis, not in a specific place. Also, is constant and not only when urinating. In fact, it gets better when I urinate. I haven't had discharge or any other symptoms besides the burn. It also seems to get worse as the day goes forward. 

I know that chlamydia is very rarely transmitted orally and that gonhorrea almost always comes with discharge, but I'm very worried for a non specific NGU. 

I thought that it could be genitally focused anxiety, but it has become so strong that there is no way that it can be that. My extreme stress is because if my wife knows about it, I'm pretty sure she is going to leave me. 

I had unprotected sex with her last Sunday, and I don't feel comfortable to have sex with her again until I know what's happening with me. 

So my questions are:

1) How probable is that I got a NGU from this encounter? Do the symptoms suggest an STDS? If it's not consistent with an STD, what else could it be? 

2) I cannot go to get tested. Do I wait for the symptoms to go away on their own? Is there an over the counter medication I can take? When do you suggest it is safe to resume sex with my wife? 

Thank you very much. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to the Forum.  I'll be glad to comment.  What you really need to do is get tested and I suspect that can be accomplished confidentially if you choose to do it.  I will make some general comments and then address your specific questions:

Although most commercial sex workers do not have STIs and oral sex only relatively rarely leads to infection some (but not all) of your symptoms suggest non-chlamydial NGU (while others suggest genitally focused anxiety).  When receipt of oral sex does lead to infection, the most common problems are either gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex.  Your symptoms are not suggestive of gonorrhea which would cause a visible penile discharge by now in over 90% of infected persons.  Chlamydia does occur but is rare.  Your exposure and symptoms are most consistent with non-chlamydial NGU which is not clearly and STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the United Kingdom, many specialists do not treat NGU associated with oral sex.  When treated, oral sex-related NGU typically resolves quickly.  Testing (a urine test for gonorrhea and chlamydia and a gram stain or other test for the presence of penile white blood cells) is the most direct and effective way to sort this out.  with respect to your specific questions:

1) How probable is that I got a NGU from this encounter? Do the symptoms suggest an STDS? If it's not consistent with an STD, what else could it be? 
See above.  The diffuse nature of your discomfort is highly suggestive of the sort of genitally focused anxiety we see when persons feeling guilt and anxiety start to look for genital symptoms. 

2) I cannot go to get tested. Do I wait for the symptoms to go away on their own? Is there an over the counter medication I can take? When do you suggest it is safe to resume sex with my wife?
Self-medication or OTC medications are a formula for confusion mostly.  If your tests are negative resuming unprotected sex with your wife should not be a problem.

I hope these comments are helpful.  EWH

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34 months ago
Thank you Dr. Edward. 

The reason why I cannot go get tested is that I am traveling before the days that the tests need to be ready. If it is a non chlamydial NGU (which I am almost sure it is), how risky would it be to have sex with my wife? Also, I already had unprotected sex with her about 9 days after the possible infection date, but I didn't have any symptoms back then. She hasn't told me about anything abnormal, but do you think she should get tested as well? 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I don't know where you are traveling but testing is available world-wide and results can be given by telephone.  There are no data to suggest that non-chlamydial NGU after oral sex represents a danger to sex partners.  IF you have an STI other than non-chlamydial NGU, there is no evidence that sexual transmission occurs and is a danger to partners. 

IF you had and STI, the likelihood of transmission increases with each sexual encounter and most STIs in women are asymptomatic.  Despite that, in this case, I do not see a reason for her to seek testing related to the events you have described.  EWH
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34 months ago
Hello doctor,

Following up. I took 1.0 g of Azytromycin on Wednesday night and 500 mg of ciprofloxacin yesterday because I was desperate with symptoms. I still have an excruciating burning sensation all the time (not only when urinating) and a lot of sensitivity in the head of my penis. My questions now are:

I still have very bad symptoms, 36 hours after Azytromycin and 24 after de cipro. How long should I wait before getting desperate because symptoms don't go away?

What else is possible, besides a non chlamydial ngu?

Is it normal that a non chlamydial ngu produces such an intense burning sensation for so long? 

What would be the next steps and when, if symptoms persist? 

Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
If you had gonorrhea, chlamydia, or any sort of NGU I would have expected this therapy to have improved and possibly have completely resolved your symptoms over the next 24 hours. your report makes this sound less like an STI.  Your symptoms sound worse, and not better.  This makes this VERY unlikely that this is any of the STIs you have mentioned.  You might see a dermatologist for next steps.

As you know, we typically provide just three responses per question.  I will try to keep this thread up for one more response however if you need it.   EH
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34 months ago
Thank you so much for the additional question. 

As for right now, the burning has started to get better, but a difficulty to start urinating has come now. I will go and have a gonhorrea test tomorrow, because it makes me wonder if the cipro is the one that started making effect. The problem is I'm afraid that a false negative could come up, because I already took the antibiotic. I'm worried that I'll never know if I in fact had gonhorrea, and I had unprotected sex with my wife (only once) before I had symptoms. It would destroy me if she got the gonhorrea from me and I never told her. 

Besides your comment on the previous comment, being realistic. What are the chances of me having any of gonhorrea or NGU. I mean, it's a lot easier to catch gonhorrea from oral sex than a NSU, but on the other hand you have said that 95% of men with gonhorrea present discharge, which I haven't had. I know the odds are a lot in my favor, but the fact that I got the burning symptom and difficulty to pass urine (and frequent urination) is there. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
You are still fixated on the idea that you have an STI- they seems more and more unlikely.  The pain you describe was uncharacteristic, having trouble starting urination is not typical for any STI although it is consistent with a variety of non-STI urology problems like prostatitis or kidney stones. Similarly, urinary frequency is NOT a sign of any STI. I would put your likelihood of having either gonorrhea or NGU at less than 1%, making it 99% likely it is some other, non-STI process which has coincidentally happened at this time.  I see little benefit from a gonorrhea test.  My strong recommendation is that you see a urologist and not worry about the possibility of STI. 

This will now end this thread which will be closed shortly.  Take care.  EWH
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