[Question #3745] Receiving Oral

35 months ago
Hello, What are the risks of receiving unprotected oral from a massage lady? I purchased a full online std screening and passed everything at 6 weeks after this event. I'm concerned because I'm getting married in a few weeks and want to be sure that there is nothing that will show up still. Is 6 weeks enough time for testing of all std's? 

I read online about NGU. Why isn't that included in testing panels? I am now over 8 weeks since this happened. 
1. What are the chances of this showing up this late or in the future? Is there a timetable, and is 2 months too far out?
2. My penis is irritated and uncomfortable. Is this a symptom? 
3. I have not noticed any underwear stains, but would there be a difference between leftover urine stains in appearance? 
4. it doesn't burn when I urinate. I assume this is good news this far out?

Please help me understand this one and if there has been enough time passed to consider it being an issue.

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
 Welcome. I'll be glad to help. Now that several weeks have passed since your exposure the odds that you acquired any STI are minuscule.  The most common STIs  which occur following receipt of oral sex or gonorrhea and NGU. You have been tested for gonorrhea and for chlamydia which causes some NGU those those are no longer a concern. 

NGU is a clinical syndrome caused by a number of different bacteria. Following oral sex only a very very small proportion of NGU is caused by chlamydia. The remainder appears to be caused by the bacteria  from a partner to spell which accidentally get into the urethra.  It is not clear that this form of NGU is transmissible two partners or should even be considered a true STI.   Most such NGU also presents with either burning on urination or a penile discharge, neither of which you apparently have.    In my opinion, there is no reason for further testing.   If you are still worried however testing for the presence of white blood cells in your urine or on a swab taken from your penis will  likely prove that you do not have NGU. As I said above I really do not think you need any testing. 

In answer to your specific questions:
1.   There is no specific time table however virtually all STI's that are going to cause symptoms will do so before a month has passed. In your case the fact that you are eight weeks out from your exposure indicates that you are not going to develop symptoms. This should not be a concern. 
2.   I presume that the irritation you are experiencing is external. Perhaps you could describe it a bit more.  M how long has it been present, has it changed, what does it look like, have you been repeatly examining yourself?
3.  Sounds like nothing to worry about here.
4.  Absolutely.  This is good news.

I hope these comments have been helpful.  EWH
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35 months ago
Thank you. The irritation I am referring to is on the tip of my penis and feels like it could be the urethra as well. However, when I squeeze or try to see if there are any pain sensations present it doesn't do so. Further, there are times when I tend to really notice it, and times when I don't if I'm preoccupied. This has been going on for a few weeks now, but again, no burning whatsoever on urination and no discharge that I can see. Sometimes the urethra hole can be more red than at other times. I guess I could summarize as it feeling like something could be wrong, but no strong primary symptoms to prove so. 

I do examine myself multiple times per day, almost multiple times per hour. Is it normal to have a little liquid further down in the urethra? While using my phone flashlight, it appears to have a white tinge to it, but that could very well be the reflection of the light. There is no liquid towards the tip and none that leaks out.  

Finally, I have had sex with my GF and there have been no symptoms from her to report at all. I'm assuming that is good news as well? Would you advise at this point that I can move forward without concern, based on the time frame and description of symptoms? If anything were to come up past this point of 8 weeks, and closer to my wedding day, it would be devastating. 


Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Thanks for the additional information.  Sometimes,  when persons are nervous they are more aware of normal genital sensations then they would be otherwise. This becomes particularly apparent in the situations distractions can resolve the sensations of discomfort. In addition, in your case, repeated self examinations are likely contributing to the irritation.   I would not worry about the irritation but I would urge you to stop the repeated examinations and put your concerns behind you.  EWH---
35 months ago
Thank you again. Lastly, to clarify:

1: Are underwear  stains a certain color? Most of my underwear are dark colored, but I can see a few spots that appear to be stains, however I could  also assume that is urine. Would NGU stains be colored and/or crusty rather than just slightly darker than the fabric? 

2. If there were indeed stains not attributed to urine, would it be safe to assume that discharge from the penis would be visible as well? I have never seen that, and I look fairly often. 

3. Could discomfort/burning/stinging of the penis area alone, presumably the inside, be cause to diagnose NGU, or would discharge and painful urination have to be present, especially over the course of a few weeks? At times, the pelvic area is equal in discomfort, but not every time. Does that matter? Is it possible that nerve endings can cause all of that alone? 

4. I submitted a urinalysis to my GP and he said nothing was abnormal. Is that office test good enough? He didn’t send to lab. I also held my urine for a few hours before submitting. 

5. Any concerns for my regular partner or, with this information, am I safe to continue sex with her?

Thank you for your time and service. This is amazing to be able to do this. My GP seemingly had no idea what I was talking about and called me a Google Doc. 
35 months ago
Doctor,
I had a concerning experience yesterday I wanted to ask about. While urinating first thing in the morning, while sitting down, I adjusted my penis position (which did apply a little pressure) and a white substance came out with urine. It was a fair amount of it. When I put my penis back to a regular position, it seemed to go away. I have not noticed any discharge at any other time, including while urinating as I often check. I do not have colored underwear stains. I do not have pain while urinating.  However, I do believe that I could be experiencing CPPS. I have pain in the perineum, butt, and penis. 

What could be attributed to the white substance coming out with urine? Again, it wasn’t present until I adjusted my penis a certain way. Is it possible that prostate fluid could come out under that circumstance? Does the male ananomy allow that?  I did not ejaculate the day before. 

In respect to NGU, would that much of a white substance come out or is it more so a continuous drip from the penis? Even so, once a urine stream was started, wouldn’t it overtake the white substance making it less noticeable? This experience was a stream of milky colored fluid that seemed to have no end. 

thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Sorry to have not responded to your prior e-mail.  Working through your earlier questions, as well as today's:

1: Are underwear  stains a certain color? Most of my underwear are dark colored, but I can see a few spots that appear to be stains, however I could  also assume that is urine. Would NGU stains be colored and/or crusty rather than just slightly darker than the fabric? 
A few spots of the sort you describe are probably normal.  I would assume what you saw was urine as well.

2. If there were indeed stains not attributed to urine, would it be safe to assume that discharge from the penis would be visible as well? I have never seen that, and I look fairly often. 
Correct.  It seems that you are paying more attention to your genitals than is necessary.  If you were to have significant symptoms, you would know it.  OTOH, when we start to look hard for symptoms, we start to notice otherwise normal variations in our genitalia and noticing normal sensations which went unnoticed in the past.  Please don't overthink this.

3. Could discomfort/burning/stinging of the penis area alone, presumably the inside, be cause to diagnose NGU, or would discharge and painful urination have to be present, especially over the course of a few weeks? At times, the pelvic area is equal in discomfort, but not every time. Does that matter? Is it possible that nerve endings can cause all of that alone? 
Absolutely.  NGU is an imprecise diagnosis and other, non-STI causes of irritation, including repeated self examination, can cause similar findings. 

4. I submitted a urinalysis to my GP and he said nothing was abnormal. Is that office test good enough? He didn’t send to lab. I also held my urine for a few hours before submitting. 
A urinalysis is not the most sensitive test but would probably be abnormal if urethritis were present.  A gram stain of a swab specimen taken directly from the penis is the best test.

5. Any concerns for my regular partner or, with this information, am I safe to continue sex with her?
You asked this before, the answer is the same.  Clear to have sex with your regular partner based on your test results. 

Now on to today's questions:
The "white stuff" may have been prostate secretions which can be expressed from that position or when having a bowel movement.  It is not unusual.  As for the discomfort, most typically men have more normal genital secretions and are more likely to have discomfort the first time they urinate in the morning than later in the day when urination has been more frequent.

I really think your concerns are out of proportion on this situation.  I realize you are worried but you had the tests and they were negative.  You should believe them and move on without concern. 

I hope my comments have been helpful.  This is my 3rd response and, as per Forum guidelines, this thread will now be closed in a few hours and without further responses.  Take care  and please do not worry.  EWH
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