[Question #366] Received Unprotected Oral Sex and STD risk

34 months ago
Hello Doctors, and community,
I have a lengthy scenario here but I will try and keep it concise.  I am a married man and had a very regrettable sexual encounter outside of my marriage with another married woman who performed oral sex on me until I ejaculated into her mouth.  I am laden with guilt and regret from this experience and also do not want to loose my wife.  This encounter was on the night of October 17th.  Everything seemed okay for about a month and then I noticed a slight burning sensation from my penis.  On November 20th I opted for STD testing.  I gave a blood and urine sample and was tested for Gonorrhea, Chlamydia, Syphillis, Herpes 1 and 2, HIV and the Hepatitis's.  All of these results came back negative.
I then notice what seemed to be a rash develop on my penis from roughly the tip of my penis to about 1/4 down the shaft.  Wrapped all the way around my penis.  I then went to my GP for a physical and told them of the icy/hot feeling occasionally on my penis.  She looked at it and did not see anything of concern.  I gave a urine sample that went for culture and was cleared of any UTIs.  I then went back to my doctor on about December 9th or so for blood work.  The rash was a bit more prevalent, but has no ulcers or lesions or anything.  I had more STD testing.  Tested for Gonorrhea, Chlamydia, Syphillis, Herpes 1 and 2 and HIV.  Again all negative.  The doctor did not want to test for Herpes but I insisted.  I have never had any burning urination, and I have never had any noticeable discharge.  I went to a dermatologist, he said he did not see anything that would associate to STD's and gave me some Hydrocortisone Butyrate 0.1% and see what that does over the next 2 weeks.
It has been 2 months since the encounter.  I have had a rash for 4 weeks.  My penis tip at times seems irritated but then that is not consistent.  I was never tested for NGU.  Things like Trich and Ureaplasma.  Should I test for that?  I have had two tests for STDs one 4 weeks after e
34 months ago
My apologies, it looks like the rest of my statements were cut off.  So basically I have tested at the 4 week mark all negative, I tested like 7 weeks after all negative.  I have had this rash for 4 weeks.  I went to the dermatologist today and he said that it did not look like a STD related rash.  So I start my 2 week regiment of Hydrocortizone as of tonight.  But yeah, I am still paranoid.  
1) Should I go to a urologist for NGU testing (trich, ureaplasma, etc..)?
2) What is the risk to my wife?  ( We have not had sex now for over a month)  Health wise she seems fine.

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to the Forum.  Your post was cut off when you exceeded the character limit specified in the introductory section of this Forum.  The encounter your describe was low risk (few STIs are transmitted through receipt of oral sex), you have now been examined by two trained professionals who saw no reason for concern about STI, and in my opinion, without the benefit of being able to examine you, the rash and other symptoms you describe do not raise any concern for STIs for me either. 

It sounds like you may have already had sex with your wife over a month ago.  If so, further abstinence makes little sense to me, given your multiple negative tests and the absence of symptoms. Testing for ureaplasma is not advisable since there are conflicting data about this organism's role as an STI and most experts feel it is simply an organism which is normally present in the genital tract.  As for trich, this too is unlikely and I see no reason for testing in your situation.  As Ai consider your symptoms however, I do wonder just how frequently you are examining yourself- it is not at all unusual for repeated self-examination to lead to local irritation which might cause for the rash and the possible irritation of the tip of your penis. 

My advice- try to work through your guild, stop testing and self examination and try to move forward.  EWH

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34 months ago
Thank you for your quick reply doctor.  I appreciate all of your information.  I most admit, once I start feeling the rash come on, I freaked out and start to obsessively search the internet for causes.  With that, I came across multiple stories of STDs and symptoms.  I then began to obsess over my penis and would self examine quite a bit.  I couldn't wait to get to sleep because that would offer relief (because I was asleep).  I am still concerned about my health and my wife's.  I will do what the dermatologist has suggested and see if there is any progress.  I hope everything goes back to normal.
34 months ago
Quick follow up here.  I am almost to the end of treating with the steroid cream and there has been little change to the rash.  When I urinate it does not burn although after urination sometimes there seems to be a slight burning sensation.  Very slight.  Should I follow up with a urologist after the steroid cream treatment and swab?  Perhaps I have some very mild form of NGU.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
A portion of medical care involves providing a treatment and observing its effect.  I would suggest you go back to the provider who prescribed the steroid cream so he/she can assess the change and recommend next steps (if need be) for you.  I would not go to see a new doctor.  EWH
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34 months ago
Another question here. I am not sure the limit of replies.  Another follow up question on NGU and Urethritis.  I am scheduling a follow up visit with the Dermatologist on Monday.  So if I have had two STD tests come back clean where the full panel of stuff was tested with Urine and Blood (tested at 4.5 weeks and 7 weeks) and I had a normal urine culture come back clean... Does that mean I am clear of any NGU or Urethritis?  My urethral opening, well the lips of the penis seem to swell up every now and then and then return to seemingly normal.  I am on the fence for also seeing a urologist and getting a swab done.  I am not sure if my penis tip is like this due to the rash, or if there is still an undiagnosed potential STD lurking around.  Again I have abstained from sex with my wife because I am a bit scared.  The dermatologist said I could resume sex with her... But the look of my penis at the moment makes me not want to.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
As per Forum policy, this third reply will be the final reply.  If you have further questions you will need to start with a new question.

Your earlier negative tests and normal urinalysis makes NGU very unlikely.  I see no need for further testing of any sort.  Like your doctor, I do not see any reason for you to abstain from unprotected sex with your wife.

I think you are paying entirely too much attention to your penis.  It is time for you to move on without concern.  EWH
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