[Question #3689] Chlamydia/Gonorrhea Concern

35 months ago
Hello,

About 7 months ago I recieved and gave oral sex to a stripper. I had a small cut on my penis. 2 days after I began to feel soreness in my left testicle and tingling in my scrotum. It got worse over the following two days, so I went to an urgent care clinic. They said I clearly had Chlamydia and/or Gonorrhea and gave me the standard treatment for both. My symptoms got better, and two tests (7 weeks and 3 months) confirmed I was STD free. The tingling continued for months, but a doctor told me it was likely residual from the cured infection.

Over the past couple months I have recieved hand jobs (no oral contact by either party) from 3 different sex workers. After my most recent encounter, within hours my left testicle was slightly sore. I assumed this to be anxiety surrounding a bad decision, given that contracting an STD without oral, anal, or vaginal sex is, as I've read, extremely low risk. However now 4 days later the pain has grown more persistent. I also feel the tingling in my scrotum.

I was certain at first that I had genitally focused anxiety, but now the pain and tingling are undeniable. Is this likely another Chlamydia/Gonorrhea infection? Any chance it is from anxiety or maybe a UTI? Should I get tested immediately? Thanks


Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Thanks for your questions,.  I'll do my best to help.  A question first- were you tested at the time you were initially treated?.  Also, did you have discharging form your penis?  "Clearly gonorrhea or chlamydia..." is not 100% accurate without testing.  All too often testing does not occur in persons who come to this forum and it leaves us wondering how to move forward.  The good news is that your symptoms improved with treatment.

Tingling, particularly tingling that goes on for long periods without other signs or symptoms is typically not indicative of STI.  It does however correlate with increased attention and heightened sensitivity as persons who worry about STIs look for them.  By way of example, in the same way, we note that while we are usually not aware of it, when we start to think about how it feels to have a shirt collar or sleeve touch our skin we become aware of their presence as "tingling" or itching.  OTOH, what is going on, as you point out seems to be different and is probably unrelated to the tingling you were experiencing in the past. 

Receipt of masturbation in the way you describe is not a risk factor for STI.  What is more likely is that your earlier testicular infection may have left residual scarring which can lead to pain and sometimes even predispose to infection from the bacteria that normally colonize the genital tract.  With your pain progressing, my advice would be to seek medical attention.  If the health care provider you see feels that treatment is warranted, I would recommend testing for gonorrhea, chlamydia and a urine test for other UTI bacteria before starting therapy in order to guide further decision making if your symptoms persist or do not resolve completely. 

I hope this comment is helpful.  Please keep us posted on what you decide to do and what the health care providers say.  EWH
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35 months ago
Dr. Hook,

Thank you for your help. I was never tested and never had discharge. My doctor at an urgent care concluded that I had Gonhorrhea and/or Chlamydia based on my testicular pain and tingling that emerged two days after an unprotected oral encounter.

I will seek medical attention and request urine tests for Gonorrhea, Chlamydia, and UTI bacteria. 

Based on my history, would you say it's likely that my current testicular pain is the result of a UTI? Is it possible or likely that what I thought was Gonorrhea and/or Chlamydia seven months ago was also a UTI? 

Thanks again.

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Thanks for the additional information.  It is very helpful.  I think your plan for testing is a good one and would add that I would be quite surprised if your tests for STIs (gonorrhea or chlamydia) were positive.  I think the UTI is a possibility and if this is what it turns out to be, suspect it is unrelated to any of the recent sexual activity (receipt of masturbation) that you describe. 

Please keep me appraised of what you find.  Our patients and clients continue to teach us.  EWH
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35 months ago
Dr. Hook,

Thanks again for your help. A couple more questions-- my symptoms began on Sunday morning and have slowly grown worse since then. Should I try to start a standard UTI antibiotic treatment when I get my tests, or should I wait until I recieve the results? I am concerned that if this a UTI then my infection could spread to my kidneys if I don't start treatment until potentially next week once the results come in. Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Good question. Once your test specimens have been obtained, if your health care provider thinks treatment is indicated, there is no reason to delay initiation of treatment.  I hope however that the specimens for diagnosis however can be obtained before starting therapy.  EWH
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34 months ago
Updates-- I went to an urgent care clinic last Friday and explained my situation. The doctor gave me a shot in my arm and prescribed me 10 days of Doxycycline (100 mg). Before the shot, a urine sample was obtained.

My symptoms began to resolve quickly, and by two days post treatment were almost entirely gone. I feel no symptoms now and continue to take my antibiotics. My urine sample came back negative for gonorrhea, chlamydia, and UTI bacteria (from a urine culture). My results are still being processed for trichomoniasis.

Is trich or another STD a possible cause of my symptoms? One day into minor symptoms I had unprotected sex with my partner and am anxious over the prospect of having to disclose that said partner may need testing. I aim to be careful, but, as stated, have no reason to believe I had any risky sexual exposures before my symptoms developed. In February I had a thorough STD test that was entirely negative, and have been monogamous with a presumably faithful partner since then. 

What are your thoughts on the cause of my symptoms? Does it matter since the issue seems to be resolving? Thanks again for your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Thanks for the additional information.  I'm glad to hear the your symptoms have resolved.  I suspect the shot you received was ceftriaxone.  the combination of ceftriaxone and doxycycline would be expected to cure many UTIs, gonorrhea, chlamydia and NGU.  It would not be expected to effect trichamonas which is occasionally associated with symptoms like yours in men .  I anticipate that your trich test will be negative as well. 

I'm not sure how to resolve the discordance between your symptoms improvement following therapy and negative tests.  The tests typically do not miss things.  You may never know.

With regard to your partner, once you have your negative trich results back, I suggest you tell your partner about your symptoms, that you were thoroughly evaluated  for UTI and STIs and all tests were negative but that treatment made you better.  Because of this, rather than take chances, better for her to be checked as well.  This is all true and may help

As you are probably aware, we provide up to 3 responses to questions.  This is my 4th.  Thus this thread will be closed later today.  EWH
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34 months ago
Thanks again for all your help! 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
You are welcome.  Glad our comments have been helpful.  Take care and stay safe.    EWH ---