[Question #3799] Don't know diagnosis, also not sure if safe to have sex as told by specialists

32 months ago

Had 1st ever 2 unprotected vaginal sex w/ new partner w/ bacterial vaginosis (very strong rotten fish odor during sex) on Dec. 17-18. On Dec 26, developed mild urethral discomfort at base of penis—persists until today. Pain levels 1 to 2 over 10. No other symptoms such as dysuria, sores, discharge, flu symptoms, and etc. All viral STD except HPV clear. No syphilis test.

Have taken many urinalysis. All had small presence of bacteria except 2 most recent urinalysis on May 31 & June 1 where there are moderate presence of bacteria—also around the time when pain level went up from 1 to 2. Had urine culture on May 26, tagged as no growth, although when I asked lab, they just throw away samples not tagged as significant infections despite presence of bacteria without determining purpose of culture (below 10,000 CFU).

Taken 3g Fosfomycin (FT) on Jan. 29. Relieved symptoms entirely for entire Feb. & relapsed Mar. until today. Took 1g Metronidazole & 1g Azithromycin on April 4, no relief at all. Did personal urine culture on selective & differential MacConkey agar, found bacteria in urine most likely E. Coli or Klebsiella (due to lactose fermentation & pink colonies). Due to Fosfomycin inhibiting, no effect of NGU antibiotics, common bacteria, & culture. Most likely gram negative bacteria. Do not know if I have mild NGU, prostatitis, or UTI. One of my concerns is: I ejaculated into my partner today because I was told it’s safe to have sex given I don’t have STD bacteria, is it, really?

Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Welcome to our Forum. I'll try to help by providing some information and comments however additional information from you would also be helpful.  Are you currently in medical care? and if so, have you been seen repeatedly by the same health care provider or by several different persons?  Was your new partner the person you contnue to have sex with or was this a casual partner who you are no longer sexually active with?  Were you tested for the most common STIs such as gonorrhea and chlamydia?

Comments:
1.  There is no evidence at present that men whose partners have bacterial vaginosis need therapy or develop symptoms when exposed.  

2.  You mention mild discomfort at the base of your penis but no lesions.  Discomfort of this sort in typically not due to STIs but may be a manifestation for prostatitis.   Prostatitis is best diagnosed by a trained clinician and may require a rectal exam and urine cultures for diagnosis.  the duration of your symptoms is uncharacteristic of any STI. 

3.  You have taken several medications which are active against several STIs with little relief.  Metronidazole is appropriate therapy for trichomoniasis.  Azithromycin would cure chlamydial infection or non-gonococcal urethritis. 

4. Your partial response to fosfomycin and the presence of bacteria which grew on MacConkey agar is most compatible with a urinary tract infection or prostatitis, not with an STI.  UTIs in men, as well as prostatitis typically require several weeks of therapy to resolve.

Nothing you have mentioned suggests a need to worry about an STI or a need to abstain from sex with your regular partner.  Nothing more to add until I hear more from you  regarding the question I have asked.  I hope these comments however are helpful.  EWH

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32 months ago
I've seen 5 urologists. The first 1 just took a urinalysis and when he saw nothing he just said nothing can be seen and just asked me to wait for viral STD tests. I never came back to this one. The second one was the one who gave me the antibiotics he's the one I go to the most. He asked me to get a urine culture, which I did only recently as mentioned, but there was no growth. I was not tested for gonorrhea and chlamydia because there are no urine tests in our country. Only urine cultures which I know not always tests for STD's because all they always assume is for UTI bacteria, but they don't tell us that so i'm not sure. Also since I have taken 1g Azithromycin shouldn't have chlamydia already been ruled out right now--as well as other bacteria such as ureaplasma spp. and mycoplasma spp.? I don't know about gonorrhea although I heard it's common for men to have discharge and  I do know Azithromycin is a drug used in combination with another one to treat gonorrhea. The third one just said (without any further tests such as obtaining prostatic fluids) that I had chronic pelvic pain syndrome and just said to take anti-inflammatory because my pain level was low. The fourth urologist (not exactly a urologist but he deals with urologist diseases--Dr. Feliciano's clinic of a well known pioneer of prostatitis treatment) said my prostate was not boggy. No white blood cells in EPS as well as urine after prostatic massage. Although they asked me to come back for 2 weeks to get regular prostatic massages to find the pathogen (assuming it is really prostatis). The fifth urologist just kept laughing and asked me to get an ultrasound before anything else. He also didn't know you could gram stain a urine culture and only thought you could only gram stain a swab. The one antibiotic I did not take as prescribed by my second urologist was a fluoroquinolone called ofloxacin. I did not want to take it because of the side effects, but looks like i'm out of options. I wanted to take fosfomycin in the long term but it was not in the standards of the doctors. More or less those summarizes the medical care portion. I only had unprotected sex once with that new partner I mentioned--also the first unprotected encounter in my life (also my first time to experience genital pains in my 23 years alive and it's been 6 months) . Right now I have a new partner. 

About bacterial vaginosis not causing symptoms, I am not 100% sure but i'm quite confident it did to me. There was no oral sex or any other means of getting bacteria in. Unless by random chance i've developed some other disease that can't be determined (and i'm pretty sure it's not genital focused anxiety. Because if it were, I would've been cured supposedly when I knew I was HIV free as well as the other viral STDs). I read bacterial vaginosis is an overgrowth of pathogenic anaerobic bacteria--including E. Coli especially when the female has contaminants from partners or from the rectal area. Also it was the 1st pains in the urinary tract that I have ever felt and occurred 1 week after the unprotected sexual exposure. People don't know what causes women to develop bacterial vaginosis but what the articles say they know is that females develop bacterial vaginosis when they switch sex partners. The only explanation I can think of are cases like mine where the infection is mild and is not an STD bacteria such as E. Coli. But i'm not experienced in these things and are only based on my logical assumptions so if you say it is safe then I would believe so because I am more concerned about my partner catching a disease. 


32 months ago
I forgot to mention that I asked the lab for the cultures, but they said they discard them when infections do not reach 10,000 CFU and immediately mark them as no growth which is the standard for a significant infection (probably for UTIs only but not for chronic pains that only release small amounts of bacteria, possibly)
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Thanks for the additional information.  I'm glad you are seeing a medical professional and would urge you to choose one that you feel good about and stay with him to address the problem.  Some of your understanding of BV is incorrect.  BV is a syndrome which occurs when bacterial normally present in the vagina get out of balance, allowing some to grow to high concentrations and others to be overgrown.  E. coli is not a prominent part of BV, nor is it an STI.  It does cause UTIs and prostatitis however. 

Despite the coincidental time relationship to your casual sexual encounter, there is nothing that you have indicated that makes me concerns about any STI.  Sorry I do not have more to suggest other than that you keep seeing the urologist you favor.  Sometimes in medicine a certain amount of trial and error is needed to solve the problem.

I see no reason to worry about your wife and unprotected sex with her related to the events you have described.  EWH
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32 months ago
Despite having no syphilis test and gonorrhea test I believe I can rule those out right?  Also thank you for explaining bacterial vaginosis. What people post online is quite different sometimes--where it can be caused by wiping from back to front for women when rectal bacteria is introduced into the vaginal flora. 
32 months ago
I forgot to mention that the pain increases (although quite tolerable still) whenever I have sex. Just to add
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Yes, I do believe you are alright and that there is no need for testing for syphilis or gonorrhea.  Sometimes the internet is not a good place to go for information as much of what is present there is misinterpreted or taken out of context.

That the pain increases slightly with sex still does not suggest that this is an STI.  It may be related to your genito-urinary tract but that is something best discussed with a urologist.

This is my 3rd response to this thread.  Therefore, as per forum guidelines, this thread will be closed later today.  Take care.  Please do not worry further that your symptoms could be an STI. EWH
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32 months ago
Thank you Dr. Hook. I do notice that there are a lot of discrepancies among websites on the internet. But I also read a lot of journals and I try to cross check them depending on how much time I have. When it comes to learning, the internet is the best information I can get hold of. After my experiences with several doctors I have learned to research and converse with my doctors to see if they know what they're really doing and if my understanding is correct.