[Question #3837] Prostatitis/Ureaplasma/Oral Sex

36 months ago
Hi Doctors, In researching oral sex risks, symptoms, and prostate problems, I came across some interesting information that I'd like to ask about for everyone here who could benefit from it. My situation appears to be very similar to many, many other men; prostate problems following an oral sex event. In fact, there are LOTS of cases of men whose complaints are exactly the same on prostatitis forums. It's frightening. While I'll save my particular symptom time frame for a follow up, Id like to ask the following: 

1) Can prostate infections be the result of oral sex? If so, how common is it?
 1A) Can prostate infections result from analingus?
2) In regards to oral sex, can ureaplasma and mycoplasma be transmitted to the male urethra, and ultimately to the prostate? There seems to be conflicting information online about this; possible, not possible, not studied??
3) If these bacteria were indeed transmitted through oral means, would there most likely be a NGU type infection along with it? Could these be transmitted without discharge, urinary burning, etc? 
4) If these bacteria are in many people's genital tracks, why would these issues appear to be so prevalent in oral sex events vs vaginal sex? 
5) Does a CSW vs a non-CSW make a difference with oral bacteria? One could assume they may have poor oral hygiene, or is the risk greater because of exposures prior to oneself? Further, doesn't saliva do a good job at neutralizing most bacteria? 

A lot of men are complaining about this syndrome after seeing a csw, however not all of them regret the experience to solely attribute it to guilt. Some of these people have been suffering with chronic prostatitis for a long time, and can't get relief from doctors. Urologists don't seem overly interested in searching for something that's difficult to find, and different cocktails of antibiotics don't always seem to work. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
The is your third post on this topic in the past two weeks.  Many of your questions are repetitive and some seem to have been generated based on things you have read on the internet.  Prostate infections are poorly understood even by urologists however the best science-based information (not stuff found on the internet which is often incorrect and has no basis on scientific studies) is that little if any prostatitis is related to STI pathogens and, as you know from having read about CPPS, many persons with prostate symptoms do not have identifiable pathogens detected to guide treatment.  Our Forum asks clients not to ask repetitive questions as our answers do not change and the value of reading repetitive posts for others we wish to serve is small.  I will address these questions but, please consider yourself warned about further repetitive posts.

1) Can prostate infections be the result of oral sex? If so, how common is it?
There are no systematically performed, methodologically sound studies that suggest that prostatitis is meaningfully caused by oral sex.

 1A) Can prostate infections result from analingus?
Same answer as above and still less logical as to how this would occur.

2) In regards to oral sex, can ureaplasma and mycoplasma be transmitted to the male urethra, and ultimately to the prostate? There seems to be conflicting information online about this; possible, not possible, not studied??
Ureaplasmas and mycoplasmas are part of the NORMAL bacterial flora found in the genital tract of men and women.  They were studied exhaustively in the 1970's and no clear evidence that they were causes o STI pathology were found.  Studies since that time have repeatedly confirmed this.

3) If these bacteria were indeed transmitted through oral means, would there most likely be a NGU type infection along with it? Could these be transmitted without discharge, urinary burning, etc? 
Yes.  NGU is the most common clinical syndrome which occurs following receipt of oral sex.  While classical STI pathogens cause a small proportion of oral sex-related NGU, in most cases it appears that the irritation is a consequence of the introduction of a partner's oral bacteria into the urethra of a persons receiving oral sex which are recognized as "foreign" and cause self-limited urethritis.  There are no data that such infections frequently cause complications or are transmitted to sexual partners to cause disease.  I suspect that asymptomatic colonization can occur as well.

4) If these bacteria are in many people's genital tracks, why would these issues appear to be so prevalent in oral sex events vs vaginal sex? 
No sure I follow the question.  NGU associated with non-classical STI pathogens certainly occurs regularly following genital-genital sexual contact as well as receipt of oral sex.

5) Does a CSW vs a non-CSW make a difference with oral bacteria? One could assume they may have poor oral hygiene, or is the risk greater because of exposures prior to oneself? Further, doesn't saliva do a good job at neutralizing most bacteria? 
There are no data on this topic.  Which bacteria colonize persons genital tracts are no doubt a function of many factors including who they perform oral sex on.

I hope these responses will be helpful although based on your repetitive questions, my guess is that it may not be.  I will also point out once again that repeated internet searches on this topic are likely to be misleading. My responses and assessment however are not going to change.  EWH

---
36 months ago
I understand your frustration. Thank you for being kind. When you answered #1 below, did you mean that no studies proved a connection, or the studies have not been prevalent, hence no data? I am trying to assist another discussion in the prostatitis forum. 

You say that asymptomatic colonization of NGU could indeed happen, however Dr H says that if men don't show discharge, he doesn't even test or treat them. If indeed asymptomatic in terms of discharge and dysuria, is it safe to just carry on and try to forget about it? You have said that a partner does not have to be treated, and my main issue here is my partner's health, as well as discovery over one really stupid error in judgement. 

Finally, without trying to be repetitive, these symptoms are causing me great grief. Would you advise they will go away with time?
Penis: tip discomfort, red raised meatus, burning inside (all intermittent over the course of 11 weeks to date)
Pelvic: Burning perineum, inner thighs, sit bones, anus, and tailbone. Replaced by golf ball feeling in prostate at week 11. (all intermittent)
3 std tests out to 6 weeks, negative
3 in-office UA's, all negative except 1 had trace blood, but the same sample was negative on next test. 
Urologist is guessing and giving me Cipro, I'm not taking it as it wouldn't do anything for NGU anyhow. 

Does this sound like NGU, perhaps not with the typical discharge symptom, but indeed a bacterial reaction in my penis and prostate? If so, will it just go away or should I seek a different prescription? I'll try to let this go now......Thanks again for your patience. 



Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
My only frustration is my inability to convince you that you do not have NGU and that your problems are not an STI.  Your follow-up questions indicate that you have misunderstood what I told you.  Efforts to correct this below:

"When you answered #1 below, did you mean that no studies proved a connection, or the studies have not been prevalent, hence no data."
EWH- There are lots of studies and lots of data, NONE of them suggest that STIs are important contributors to prostatitis or prostate symptoms

"... asymptomatic colonization of NGU ..."
EWH  The urethra can bee asymptomatically colonized with both normal and disease-causing bacteria.  None of this is NGU.  NGU is a clinical syndrome for which symptoms include urethral discharge and/or burning on urination.

Ignoring your urologists suggestions is a mistake.  You do not have NGU.  Sometimes dealing with clinical problems involves good faith trial and error.  Your steadfast and mistaken understanding that you have NGU is interfering with your care.  In most individuals with unexplained genitourinary symptoms, the symptoms do either go away on their own or declare themselves through clinical evolution.  Ignoring your urologists advice and suggested therapy does not help you. 

Again, this DOES NOT sound like NGU.  My advice now, as before is to work with your urologist to address your concerns.  if you are not comfortable with him, try a different one.  EWH
---
36 months ago
Thank you, I will take your message to heart. One final question before I go. If for whatever reason this could be NGU from oral sex, will anything show up on my wife’s pap smear? She is scheduled to get one in a week, and I was concerned that some sort of bacteria would show up. 

Thiat is all, and again, thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Stop!!  There is no evidence that you have NGU. You have negative tests, your symptoms do not match.  Further, there is no reason to worry that your wife's forthcoming PAP smear will be abnormal, reflecting your dalliance.

this will end this thread.  Further, more questions on this topic may be deleted without comment should you return with further repetitive, guilt-driven posts.  EWH
---