[Question #4050] Possible NGU, negative std tests.

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84 months ago
Dear Dr.
In a drunken emotional state I (M,35) received unprotected oral from M CSW 5months ago. I stopped it after 5mins and without ejaculating. Penis tip was red and irritated for 12 hours. CSW was inhaling poppers heavily at time so possible link/irritation.
Next day had unprotected sex with wife, withdrawing before ejac.
Day 3/4 wife mentioned she may have a mikd UTI. Day 5/6 I felt more frequent.need to urinate, urethera seemed swollen. Then developed pink eye, red dots on tongue. GP
examined mouth (visible spots) and temp (fine), said a viral infection of some sort but would resolve itself. 
Visited GUM clinic on Day 12, negative results for Chlamydia,Gonn, Trich.
Avoided any sexual contact with wife for 7 weeks. 
Througout this time, Meatitis visible on tip of penis, urethera swollen and only half way opens. No discharge at any point.At times, dull pain/sensitivity in testicles, left side. Symptoms remained so visited another GP who didnt examine but suggested urologist. Visited Urologist who assured me nothing was wrong, did not see any possible link between penis symptoms and conjunctivitis, throat etc & unaware of Melbourne study.He didnt examine my penis in any way but recommended re-testing and prescribed 7 days of Doxy 2x100mg if results positive. Attended GUM clinic, negative for Chlam/,Gonn/Trich and nurse assured me all was ok. No exam. I completed the course of doxy as precaution and resumed sex with my wife (unprotected, withdrawal). 2 weeks later my symptoms returnsed and have gradually become worse. No a further 6 weeks later, my tongue has red dots, eyes quite gunky, meatus very swollen almost closed. Sore after ejaculation. Never any discharge but more pronounced pre-ejac fluid, only when aroused. 
IWhat is your prognosis based on this, and what course of action is required? My wifes father has just been diagnosed terminally ill and i cannot add to her stress if at all possible, but equally cant risk her health
 I am desperate and near breakdown. 
Thanks
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Edward W. Hook M.D.
84 months ago
 

Welcome to our Forum.  I'll try to help.  Let me first point out that at this point there is no evidence that you have and STI that needs or would benefit from treatment.  Most commercial sex workers do not have STIs and oral sex only relatively rarely leads to infection.  When it does, the most common problems are either gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex, both or which you have been repeatedly tested for and found to not have.  When it occurs, his sort of oral sex-related non-chlamydial NGU is not clearly an STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the United Kingdom, many specialists do not treat NGU associated with oral sex.  When treated, oral sex-related NGU typically resolves quickly.  In your case, you were treated and the problems seem to have recurred providing further evidence that this is not NGU. 

When it occurs acutely, viral infections, particularly those caused by a virus called adenovirus can cause conjunctivitis and urethral discomfort but this problem is not treatable, needing to run its course, which it typically does in a week or so without consequence, and does not cause complications.  Adenovirus urethritis does not recur in the fashion you describe. 

A swollen urethral meatus in this setting, with negative tests is most often associated with the inadvertent trauma of repeated self-examination.  Similarly, increased pre-ejaculatory fluid is not a sign of any STI. I am confident that this is not a typical STI and see no reason for further treatment of STI testing.  My advice is to not worry and let this run its course.  I think you may be noticing things you would not have noticed had you not visited the CSW and started looking for symptoms.  OTOH, if you feel you must investigate, I would see another urologist to look for some sort of coincidental problem that you began to notice about the time you visited the CSW.  I would not worry about STI and would not worry about impacting your wife's health as a result of your extramarital encounter. 

I hope that this perspective is helpful to you.EWH



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84 months ago
Thank you for your reply Dr. I have held off on responding to give me time to re-evaluate the situation to avoid using my questions too quickly as I honestly believe this forum is my only hope for help.
Here are the facts, now 5 months post event:
Meatus remains slightly swollen and penis head red and not normal visually. I don't pinch or touch it, so can't be causing it. Still no discharge.
I experience daily epididymitis like symptoms in left testicle. Tube feels swollen and tender at these times, causing discomfort.
Red dots remain on tongue tip. Throat a little irritated/mild discomfort swollowing.

No fever/temp/no headaches etc. Energy fine.
Only tests ive had were urine sample for chlam/ghon/trich, twice and clear. Nobody has even looked at my penis.

In recent week or two, my fingers have felt stiff. I was passing it off but my wife just mentioned in passing having arthritic feeling in her hands (she is 30). This has caused me no end of worry and fear. My life will not be worth living if I have caused her serious illness.

Please advise if this could be Mycoplasma genatalium, how to test for it and what treatment you'd recommend.
Could this be caught in this fashion (brief oral from male)? This was my only ever incident in 11 years of faithful marriage and came at a time i was at my most low mentally.

Could this have been picked up from a female either, or could it only have been male contact?

From studying your forum history here and previous sites, yourself and Dr. H both have said HIV is not something to worry about from one oral incident (i was insertive partner, 2mins, no ejac). Please confirm this remains the case? Could i really have ruined our lives in one 2min incident?
I truly am desperate for help as this seems to not be widely understood. 
Yours,
Brad.
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Edward W. Hook M.D.
84 months ago
I'm sorry your difficulties are continuing.  None of the additional information you have provided suggests any STI however.  Five months of a swollen urethral meatus is not a sign of an STI, nor is intermittent (even daily) epididymal tenderness and swelling.   That you and your wife both have joint stiffness is not suggestive of any STI either.  I think you should be looking elsewhere for the cause of your symptoms.

Testing for M. genitalium is widely available, particularly at UK GUM Clinics.  M. genitalium is often asymptomatic and I am not aware of any data to suggest that it is passed through receipt of oral sex. 

I can also confirm that there has NEVER been a case of HIV documented to have been acquired through receipt of oral sex. 

Sorry I cannot be more help. This really does not sound at all like an STI of any sort.  You might look up the chronic pelvic pain syndrome in men (CPPS) on Wikipedia which provides a very good description of this problem.  This may be that.  EWH
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