[Question #385] Unprotected Oral Sex and Risk

34 months ago
Experts,

I had a regrettable encounter back on 10/17 of this year where I received unprotected oral sex from a married woman whom I found out was a sex addict.  After discovering this, I asked her, after the fact if she was clean and she assured me she was.  About 3 or so weeks went by seemingly without issue.  I then started to notice a bit of discomfort in my groin.  I would start to get an icy/hot feeling on my penis.  On November 20 (4.5 weeks later) I was screened for STDs.  I gave Urine and Blood and was tested for Gonorrhea, Clamydia, Siphillis, Herpes 1 and 2, HIV and the Hepatities.  All came back negative and normal.  At this time I had stopped sex with my normal partner.   I would still get the icy/hot sensation on my crouch so I went to my GP.  I got a physical and told them about the sensation in my groin.  I did not mention the encounter.  They took a urine same and did a culture and all of that was normal.  A week or so after that I came back and gave blood and said I wanted to test for STD's.  At this point I did develop a rash on my penis (no lesions, or ulcers)  but a rash from my penile tip down about a 1/4 of my penis.  Where the skin folds up a bit when I am not erect.  (I am circumcised).  They did not recommend testing for Herpes but I did.  Tested for Gonorrhea, Clamidiya, Siphillis, Herpes 1 and 2 and HIV.  Again, all results negative.  They referred me to a dermatologist.  I did not tell the dermatologist about my encounter but he knew about my testing and told me that the rash did not look sexual and to clear my mind of stds.  I am currently putting a mild steroid cream on the rash for 2 weeks twice a day.
Questions:
1)  I never did NGU testing.  Should I?  My urethra does seem irritated at times.  (No discharge or pain during urination)
2)  Should I test for Herpes again?  I have heard it can take up to 3 months for antibodies to finally appear?
3)  Syphillis, should I retest, I here that this is called "the great immitator"?
4) What is my overa
34 months ago
Adding because it was cut off:
4) What is my overall risk here?  I am super nervous I caught something.
I have had a rash for 5 weeks now (9 weeks post exposure).
34 months ago
Sorry to keep adding to this.  
But yes I have tested negative for STDs at 4.5 weeks post encounter and negative again 7 weeks post encounter.  Again, adding that for clarification.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to our Forum.  You were cut off from continuing your post when you exceeded the word limit described in the guidelines for access to and use of this forum. 

I will try to help by persuading you that the symptoms you have described and almost certainly not due to any STI.  The sexual exposure you describe, receipt of oral sex is very low risk when compared to vaginal or rectal sexual exposure.  Oral STIs are uncommon (even among partners who may have many other partners) and even when present, in comparison to other sites of infection, are not efficiently transmitted from person to person.  In addition to these facts, you have the evidence provided to you based on negative tests on two occasions when the results will be reliable and the opinion of two other trained health professionals who found no reason to worry about STIs.  To that evidence I will add a few more comments..

The symptoms you describe- an "icey hot" penile sensation is not a typical description of any STI.  Similarly, a dermatologist has inspected your rash and indicated that the rash that is present is not suggestive of an STI.

In answer to your specific questions:

1.  there is no need for additional testing for NGU. Between the chlamydia test you have already had (chlamydia is nto most common proven cause of NGU) and the negative tests for a UTI, this possibility can be excluded.

2.  No, there is no need for further herpes testing.  You did not have an outbreak and by now the vast majority, approaching 90% of persons who acquired herpes would have a positive antibody test by this time.

3.  No, syphilis tests would have been positive by this time.  the "great imitator is diagnosed in persons who it is not expected by the sorts of tests you have already had.

4.   I agree with the doctor who told you that it is time to put your concerns about STIs behind you.  The exposure was very low risk and your testing and clinical evaluations since that time prove that you did not get an STI. Further testing would be a waste of time and money.  EWH

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34 months ago
Thank you for your response Doctor. I do have a follow up question. It's been over 9 weeks post exposure.  My urethra opening at times seems red/pink and irritated. This could be tied to the rash that I am still applying steroid cream too.  Could this be some kind of weird urethritis I developed?  This morning for the first time ever I noticed what seemed to be a bit of clear discharge from my penis. I thought it might be pre-ejaculate of some kind because I have not releived myself in some time.  Again it does not hurt to urinate.  I am also wondering if I caused this rash after some rough masturbation with a toy 3 weeks after my encounter.  The lube I used was apparently for condom use only.  Sorry for the long follow up.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Most men have a small amount of normal urethral discharge.  The amount varies from man to man and from time to time.   Repeated self examination can cause the urethral discharge to increase.  So can the application of chemicals such as creams or heavy manipulation.  I am confident that what you describe does not represent an STI acquired in your exposure 9 weeks ago.  EWH 
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34 months ago
Dr. Hook thank you so much for your time. I definitely appreciate your responses. My final couple of questions.  Would it be worth my while getting any kind of swab test done?  All of my testing was blood work two times, two urine samples for Gonorrhea and Chlamidya and one urine sample that checked for a routine UTI.  If not, then I will get the whole idea of testing out of my mind and continue to tackle this weird skin rash.  My last fear I guess  is if I acquired some sort of weird NGU.  Again I know you say that my clear UTI test and two urine STD tests should suffice.  I guess I am just verifying.  Again thank you for your guidance.
34 months ago
One more thing to add. This morning during my shower I decided to masturbate. When I ejaculated there was a very slight burn sensation. I have noticed this as well and it is only when I ejaculate.  Also my ejaculation seems to be a bit weaker. When my penis becomes flaccid, minutes later more semen leaks out.  I am wondering if somehow I have a bacterial infection in my prostate?  Again no pain during urination.  These last few weeks have been emotionally rough for me.  Also, after I ejaculate the urethra tip does seem a bit irritated.  Sorry for the continual updates.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
I see no need for a swab test.  While the urine tests are very slightly less sensitive that the urine tests, two negative tests virtually assure you that you were not infected.  No need for further testing of any sort.  I think it is better to just work through the rash.  EWH
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34 months ago
Dr. Hook thank you for your assistance. I do have one final comment.  Although urination does not seem to burn (no apparent dysuria), if I ejaculate there does seem to be a slight burning sensation.  Now, due to my rash I have been abstaining from sex with my spouse and I try not to masturbate.  Due to the rash (going on 6 weeks now) it's something I am trying to avoid currently.  But on the handful of times I have masturbated, when I do ejaculate there seems to be a slight burning sensation.  What could that be tied to?  Thank you again for all of your knowledge and guidance.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

You have now exceeded the number or replies specified for our site.  The "slight burning" on ejaculation with masturbation does not suggest and STI.  It does however suggest hyper vigilance on your part.

This will end this thread.  EWH

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