[Question #4041] Oral

31 months ago
Docs, I've seen a local urologist after developing prostatitis-type symptoms weeks after an oral exposure from a csw. There isn't much for him to do as prostatitis is not understood real well. However, I have some things I was hoping to get answered regarding ongoing symptoms:

1) Are "trace intact" RBC's in dipstick urine testing significant, without WBC's or nitrates? If so, what could cause that from an infection standpoint? The urologist wasn't concerned about it, and did not feel it was necessary to do other testing such as semen analysis, or EPS fluids. Would NGU cause this?

2) My exposure was oral, 18 weeks ago which I know is a risk for Gon, NGU, and HSV1; negative results for gon and chlamydia as well. Is there anything from this exposure that could be causing these symptoms this late after the fact: 
penis pain, sometimes stinging like. No discharge at all. 
Discomfort post-ejaculation. No pain during ejaculation, just feels a little irritated afterwards for about 10 minutes, and perhaps the urethra looks a little more red. 
Dysuria: Very minor, very intermittent for a very short time after urination. I have never experienced pain during urination at all. Would infectious dysuria be very hard to miss, and be very painful? 

3) Can penis pain be referral pain from nerves affected by CPPS, or should I be chasing a bacterial origin? 

I don't want to ask about the same exposure again, however I've sought local professional opinion and all I can get is a dipstick test and advice that I'll have to learn to live with the pelvic pain, golf ball feeling, penis pain, etc that very coincidentally followed this oral exposure. I still have concern that perhaps NGU could have caused this to begin with, or another pathogen that the urologist won't test for. My partner has shown no symptoms after sex with her thankfully. 



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome back, but sorry you found it necessary. Unfortunately, we really can't help any further. In your last thread, and to some extent in the preceding ones, I gave several reasons why your symptoms almost certainly are not due to any infection from the oral sex event. Please re-read those other discussions. It is correct that "prostatitis is not understood real well"; and in any case, I doubt you have prostatitis. As you seemed to know in your previous thread, CPPS is a more likely cause of symptoms like yours than is prostatitis. And you certainly give no evidence that prostate gland inflammation has actually been documented.

1) I agree with your urologist that trace RBC is a normal finding and not to be worried about. There are no infections likely to cause it.

2) See my comments above and in your previous thread. I remain confident you have no infection from the oral sex event 18 weeks ago. If the symptoms are from that event, it is through the psychological mechanism of anxiety, probably increasing pelvic muscle tension (believed to be the main explanation for CPPS symptoms).

3) Yes, penile pain in CPPS is due to referred pain, also probably related to pelvic muscle tension.

You definitely do not have NGU and probably never did. My advice is exactly what you have already heard from your doctors:  "I'll have to learn to live with the pelvic pain, golf ball feeling, penis pain, etc". Men with symptoms like yours are a dime a dozen in STD clinics and urologists' practices. Our collective experience is that in most men, the symptoms fade with time. The most significant factor in improvement often is when the patient becomes personally (both intellectually and emotionally) confident that it's nothing dangerous. And I'm very glad to hear that you're having sex with your partner. Sometimes having regular sex with a committed partner is part of the solution, perhaps something you have heard from your urologist. The important thing is that you work to understand and believe that this is only an issue of comfort, not evidence of anything that will ever harm you or your current or future sex partner(s).

I hope these comments finally help you move along. Let me know if anything isn't clear.

HHH, MD
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