[Question #3966] STI Test

85 months ago

In a weak moment I had unprotected oral sex (fellatio) and protected insertive vaginal sex as a one night stand with a woman I met in Las Vegas, (not a professional).

Within a few hours I took one Clarithromycin and the following day took one sulfamethoxazole.

I then had unprotected sex with my wife 6 days later.

Seven days after my protected encounter (5 days after the second antibiotic) I had a chlamydia/gonorrhea NAAT test that was negative.

Then again at 11 total days (9 days from the second antibiotic) I again tested negative.

On the 11th day I also started to get symptoms of prostatitis (abdominal pain, frequent urination, very slight tingle, etc) and was diagnosed with prostatitis three days later. On the same day I was diagnosed with prostatitis I also got Blepharitis in both eyes.

1) Did my misuse of the two antibiotics cause a negative result 9 days after taking them?

2) Could this all just be a coincidence?

3) Should I not continue and relations with my wife until this is cleared up?

I self disclosed all these facts to the urgent care doctor who did not seem to think my symptoms were in line with an STD.

He also recommended that I see a urologist ASAP.

Respectfully

Kristover

I apologize if this came thru twice

H. Hunter Handsfield, MD

85 months ago

Welcome to the forum. Thanks for your confidence in our services.

Your story is a common one on this forum. As you suggest, taking antibiotics was a mistake, with the potential for obscuring proper diagnosis of some STDs. However, only single doses of clarithromycin and sulfamethoxazole-trimethoprim were unlikely to have any effect on later diagnosis: these doses might have temporarily suppressed a positive test for chlamydia or gonorrhea, but probably would not be effective in preventing or curing either infection. Also, it is a misconception that antibiotics only interfere with testing without curing the infection. They do not: they screw up testing because they cure the infection, not because they temporarily suppress it. For these reasons, you can be confident in the negative gonorrhea and chlamydia test results a few days later. And since you didn't have sex with your wife until about the same time, you can be certain you could not have infected her.

And in any case, you had safe sex (good move!). Most important, you used a condom for vaginal sex with your pick-up partner. Oral sex is very low risk for all STDs, with only a small chance of gonorrhea and exceedingly low risk for chlamydia -- and your tests show you don't have either one. Nongonococcal urethritis (NGU) is a risk from oral sex, but most such cases probably are harmless for both infected men and their partners (perhaps due to normal oral bacteria) and also likely would have been aborted by the antibiotics.

Prostatitis is not known to be sexually acquired (there have been theories about it, but no proof after 50 years of research). Equally important, prostatitis is not an easy diagnosis to make accurately. The symptoms are identical to those of genitally focused anxiety and the chronic pelvic pain syndrome (CPPS). So I doubt those symptoms were a coincidence; they likely are closely related to your emotional reaction to this obviously regretted sexual decision -- but almost certainly they are not from any infection from that event.

As for blepharitis (or conjunctivitis), it is conceivable you have both genital and ocular infection with adenovirus, a common cold virus that can infect the urethra and commonly causes conjunctivitis. It can be acquired by oral sex. OTOH, adenovirus urethritis usually starts sooner and causes more severe urethral symptoms than you seem to have had.

In other words, I agree with the urgent care physician you saw. (Indeed, I congratulate him or her for understanding this. We get lots of stories of non-specialist doctors who misinform patients along these lines.) But at the same time, I'm not sure you need to see a urologist. Of course if your symptoms are severe (lots of pain, reduced urine flow, etc) or otherwise in doubt, follow through with that appointment. But my guess is nothing will come of this.

And at this point, I see no reason not to continue unprotected sex with your wife. I'm confident you have no STD.

I think those comments address all three of your questions, but let me know if anything isn't clear.

HHH, MD

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85 months ago

Just to clarify, I definitely have had some issues that are not anxiety driven. Since Tuesday I’ve had moderate pain in the pelvis, and a slight tingling in the perineum, and now an occasional sharp pain in the lower right pelvic area.

Also, I’ve been told over the past couple years that I’ve occasionally had trace amounts of blood in my urine when having urinalysis, (these urinalysis are regularly scheduled for professional reasons).

1) Therefore, I suppose I should follow up with the prostatitis diagnosis?

Currently, (yesterday), I was prescribed sulfamethoxazole trimethoprim 800/160MG twice daily and Tamsulosin 0.4MG once per day.

I was concerned that the common symptoms of chlamydia are almost identical to what I see in the general descriptions online, (e.g. “Pain: in the eyes, lower abdomen, pelvis, testicle”)

As far as the eyes, I started getting dryness on the same day the other symptoms started, but the noticeable swelling didn’t start until yesterday. I have a, “stye” and swelling on the lower left eyelid and just swelling on the lower right eyelid. For that I was prescribed erythromycin ointment. The only thing I did different the day before spray sunscreen on my face and rub it in.

As you so wisely stated, that caused a great deal on anxiety, on top of the standard guilt felt by straying during a period of estrangement. Then immediately after deciding it best to work things out. If anything came of this it definitely would not help in that realm….

However, my main concern here was that the NAAT chlamydia/gonorrhea tests were accurately negative 9 days post my misuse of the two antibiotics that were consumed.

2) So in closing, it sounds as though your professional opinion is to close the door on any STIs of concern and move on?

Respectfully

H. Hunter Handsfield, MD

85 months ago

Some of your symptoms still could have a psychological origin (tension headaches are real pain, but psychological and emotional factors often cause the responsible muscle tension). That's not to say yours are; you're a better judge than I can be from this distance. In any case, with the urine blood it sounds like whatever is responsible precedes the sexual exposure you are concerned about. It sounds more like kidney stones than prostate problems. Anyway, I reverse my comment above about seeing the urologist: definitely you should do that.

You have misinterpreted chlamydia symptoms. The vast majority of infected men have only discharge from the penis and sometimes mild discomfort on urination, especially in the first few weeks of a new infection. Longstanding or complicated chlamydia may cause the other things mentioned, but not newly acquired infections. Also, it isn't possible to have chlamydia symptoms and have a negative chlamydia test. Finally, the odds of chlamydia after a single unprotected oral exposure probably are on the order of one chance in a million. It's really very rare.

So yes, do "close the door" on STDs and move on to explore other causes of your symptoms.

Good luck in your reconcilation with your wife. These events shouldn't get in the way of it.

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85 months ago

Thank you, doctor.

I will do as adviced.

Good work here.

H. Hunter Handsfield, MD

85 months ago

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe.---