[Question #3998] 3 Months of Misdiagnosis & Confusion. (Oral Sex)

32 months ago
Straight male, sexually inactive/STD free for years before this encounter & inactive since encounter.  *PE = Post Exposure

I received oral sex from hetero woman. No vaginal contact.
-48 hrs PE Painful & frequent urination along w/ little white discharge. White line at top of penis. Discharge never returned after. 
-4 days PE Dr. gave Doxycycline injection and 1g Zithromax.  Discharge never returned, burning stayed. 
-7 days PE. ER tested urine for Chalmidya/Gonorrhea. Gave shot of Cetrifaxione as precaution, 250mg IM. Testicular ultrasound clear. Results negative both Chlamidya / Gonorrhea, urine levels “perfect.”
-5 days after, burning milder.
-20 days PE, Urgent care tested HSV 1/2 through blood, no sores. Had cold sores as teen. Given Fluconazole “in case” of yeast. HSV1 POS, HSV2 NEG. Gave 10 days of Valacyclovir, 1g 2x per day. No OB & no relief. 
-26 days PE I got early detection RNA-PCR HIV test. NEG. 
- 48 days PE, PCP gave me Cipro 500mg 2x a day for Prostatitis, w/o testing. 5 days, no relief.
-55 days PE, Urologist tested STD’s, blood/urine. Testicular/bladder ultrasound clear. Visual exam, normal. Told me diet, exercise, stop Cipro. I got the call from his office, all urine/blood work came back good and negative. 
-70 days PE (now), I went to a different Urologist. Urine/bladder clear. Tested my prostate. He said it felt “boggy” & could be prostatitis. Prescribed me 100mg Doxycycline 2x a day - 14 days. 

I can't seem to find relief. My research suggests this isn't Trich or NGU. Also, skin on penis is red and shiny, itchy. Please help. All this guessing by docs has taken a toll on me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Welcome to the Forum.  I'll try to help by providing my perspective and analysis.  First, let me point out that the encounter you describe was very low risk for acquiring an STI.  Most people do not have STIs, even when they do, pharyngeal infections are uncommon and only a minority of exposures to persons with pharyngeal STIs lead to infection. Of the infections which may follow receipt of oral sex, gonorrhea and non-gonococcal urethritis are far and away the most common infections.  There are no proven cases in which HIV has been acquired through receipt of oral sex and other STIs are rare as well.  Symptoms-wise, it is hard to know what of make of your symptoms- urinary frequency s not an STI symptom and when STIs cause discharge, the discharge typically persists and is not transient as yours was.  Further, you have received a number of medications which are active against gonorrhea(azithromycin, ceftriaxone, Cipro) and NGU/chlamydia (azithromycin/doxycycline0.  Finally, you have a number of test results which show that you do not have gonorrhea, chlamydia, a new HSV infection or HIV.  You should believe these results. 

If anything your symptoms to me are more suggestive of either the Chronic Pelvic Pain syndrome (Wikipedia provides and excellent description) or prostatitis as suggested by your most recent urologist.  Certainly there is no evidence that you have an STI of any sort from the encounter you have described.  My advice is to find a doctor (perhaps a urologist) who you are comfortable with and work with him/her.  Unfortunately, in some instances there is some trial and error involved and each time you start with a new doctor, they start over again as well. 

I hope this helps.  If there are further questions, you have up to two follow-up questions for purposes of clarification and further discussion. EWH

32 months ago
I appreciate the response Dr. Hook.

Here are some of my concerns:
-Every time I was tested, I was in the midst of some  antibiotic treatment. The first test was done 4 days following 1g of Zithromax and Doxy injection. The 2nd test was done after a few days of Cipro 500mg 2x a day. I have read that this can cause false negatives, but really I feel like NGU, Chlamidya/Gon would have been wiped out by now with all this treatment.
- I have had some strange things going on, which I am trying to be sure are unrelated. The skin on my face around my mouth has felt dry and tight. Also, I woke up with a weird belly button infection recently. I cleaned and treated with peroxide, which has mostly subsided. I also have felt very fatigued and I imagine it's a side effect of all this medication I have been on in a short amount of time.
-My semen and urine have a very strange fishy odor. I have read this is a sign of infection. 
-The woman I received the oral sex from (non sex worker, we were dating for 2 weeks without sexual contact before this) has informed me that she had just gotten over a cold sore before our encounter that she covered with makeup. However, I never experienced sores or an outbreak almost 3 months later either orally or genitally. 
- We only had one towel at my place where she showered separately first, and then I showered after and used the same wet and damp towel she had just used to dry my body head to toe. Not sure if this is risky or relevant. 
-After being treated for almost everything, and the burning urination being so mild now and the discharge completely gone, is there a possibility of this being Trichomoniasis? It seems to be the only slightly possible STI that I have not been treated for yet. My urologist said the current course of Doxy would clear that as well, but I am reading conflicting information on this. He also said usually no more discharge means no more infection, unless it's the prostate. I am wondering if taking a Trich treatment would hurt at this point. 

I just want to have this thing cleared up as it's been going on for so long and I'm sure all of this medication could not be great for my body.

Thank you.

Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
I'll try  to address some of your concerns but before I get to them, let me preview the bottom line of my response- nothing you said in your follow-up changes my sense that even if you had an STI, there is no reason to still be concerned.

Testing while on antibiotics can confuse things but if you were failing therapy, the tests you have had would have been positive.  Antibiotics can certainly do things to people through their side effects and they could be the source of some of your symptoms but that does not change that there is no evidence that you have an STI.

I have not explanation for the changes in your facial skin other than a possible antibiotic effect or some other, process unrelated to the encounter you described.  Same for your navel irritation.

Your partner's recent cold sore similarly does not change my opinion.  The is not related to a herpes infection. Similarly there is no risk for infection from sharing a towel.  

If you are continuing to be concerned after completion of your current course of antibiotics, I suggest you test again, off antibiotics to confirm what I have said- this is not anSTI. Sorry I don't have more to say.  EWH
32 months ago
Thank you once again for the detailed responses doctor.

I know this is my last response allowed so I'll give some updates for your opinion.

I found out I indeed WAS tested for Trich which came back NEG along with all other tests. I also went once more to get a swab test, since I had already done the urine and blood. Swab tested for CHL//GON and came back NEG.

For peace of mind because google has scared me, would 2g Valacyclovir per day change the outcome of an early detection RNA-PCR HIV test at 26 days post exposure? It was NEG and want to trust the results since insertive oral is such a low to no risk exposure. 

Discharge still never returned and the burning at the tip of the penis is almost completely gone. My prostate has felt fine. However, I am still feeling fatigued and a bit off balance. My stomach went absolutely WILD and out of nowhere and I went to the ER. My CBC returned with RBC on the low-normal range and WBC in the higher normal range. Also, nuetrophils were high which signify inflammation. The scan on my stomach revealed a little mouscus spot which they chalked up as "mild terminal ileitis" and sent me home with *SURPRISE* more antibiotics - Flagyl and Cipro. I took the Flagyl without help and skipped the Cipro. Went to GI specialist a few days after ER and took me off Flagyl. Sent me for more bloodwork and stool sample. Awaiting results. Can ANY of this be related to an STI from insertive oral?

Lastly, and honestly my most main concern because it's the only serious issue left down below - the skin on my penis is super dry and red and uncomfortable. Feels tight and sometimes itchy. The bottom of my shaft feels rough, dry and bumpy. Is it possible that all the antibiotics gave me a yeast infection? I feel like the doctors would have been able to tell since so many have seen my penis at this point but I'm not sure how they test for that.

Thank you again doctor!
Edward W. Hook M.D.
Edward W. Hook M.D.
32 months ago
Thanks for the detailed update.  Your repeat tests and additional information only serve to add evidence that your symptoms are not an STI and are likely not due to any disease acquired from your receipt of oral sex.  It does sound like some of your symptoms are resolving. 

Valacyclovir would have not effect on your HIV test results, including an HIV RNA PCR. 

The medications you received for your GI upset at the ones typically given for bacterial GI infections and while they might have some impact on STIs.  That does not change my assessment however that there is no credible evidence that you acquired an STI from insertive oral sex.

Finally and regarding your penile discomfort and dry skin, what you describe may well be a fungal infection and a trial of treatment may be appropriate.  this is not an unreasonable possibility and could well be related to the antibiotics you have taken.  Alternatively you may want to see a dermatologist.   I should point out however that repeated self examination, scratch and itching also are quite likely to cause itching in and of themselves.  With or without treatment for a fungal infection, one of the best things you can do for the irritation and redness your are experiencing is keep your hands away from the involved area.

As you already know, this is my 3rd response to your questions. I hope my comments have been helpful.   This thread will be closed later today.  Take care.  EWH