I’m not a regular visitor of CSWs and this was my first time in years. 

3. Does the timeline fit that the cipro did something or is it likely more irritation exaggerated by anxiety?

I agree with your self diagnosis, and the STD providers. This probably was some sort of physical irritation, perhaps from condom lubricant, especially if it contained a spermicide) -- especially since you've experienced similar sensations previously, perhaps related to sexual lubricants. In any case, you had an essentially zero risk sexual exposure; and uncomfortable urination alone, without discharge, rarely is due to STD. Had you been my patient, I would not have treated you for gonorrhea and chlamydia -- I'm not criticizing the STD nurse you saw, but the chance you were infected was too low to do so, in my opinion. In any case, I'm confident your gonorrhea and chlamydia test results will be negative, and in the meantime I would definitely recommend no further antibiotic treatment and that you resume (or continue) sex with your wife. To your specifci questions:

1) I agree there was virtually zero chance of any urethral infection, for the reasons you state.

2,3) There have been no studies on irritation symptoms related to sex, poorly lubricated or otherwise. But since there's no other obvious explanation, it seems a good bet. Or, as you suggest in question 3, perhaps just anxiety and nervousness about STDs, or about a sexual decision you regret, magnifying trivial symptoms or even normal body sensations that you otherwise would ignore or not even notice. (Whenever someone suspects his or her own symptoms to have a psychological or emotional origin, usually s/he is correct.) You shouldn't have taken cipro. It would have aborted some but not all cases of gonorrhea. It has no effect on chlamydia. But it could have interfered with testing for both infections. In any case, I'm confident taking the drug had no effect on your symptoms, unless possibly because of placebo effect.

At this point, all is well. I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD

At this point, I’m just sitting and waiting for the test results, however now with more confidence they will be negative. 

The only inconsistency in this timeline is why did the irritation start a week after the initial encounter. I know it was exasperated by my guilt and anxiety, but there was definitely something there. 

The words you chose also filled me with reassurance. I see that you’re a caring physician and the fact that you’d recommend resuming unprotected sex with my wife must mean that you are so very confident in your diagnosis, as consequences of an incorrect diagnosis would be catastrophic for me. 

Regardless, I have no follow up questions at this time as you’ve stated all bulletproof answers. I’ll use my last post to inform you of the test results. 

I agree that a week is probably too long for physical irritation to explain these symptoms. So that takes us back to the anxiety explanation as the best bet. In any case, I remain confident it's not an STD from the exposure described above.

As you predicted, the tests were negative. 

I have just a few remaining questions that are specific to my case. 

1. You say urinary issues without discharge is rarely due to an STD. How often is this true?

2. You say cipro could have invalidated my tests, how likely is that?

3. You said (in other threads) that STD transmission is inefficient and even unprotected sex with an infected person does not mean transmission.  Can you elaborate?

Basically I understand my risk is near 0% starting with a virtually 0% risk encounter. However, to fight guilt induced anxiety, I need to understand the subsequent risk of whether it was possible i transmitted something to my wife before I was treated and cipro caused a false negative and now a ticking bacteria time bomb is waiting for me the next time I have unprotected sex with her. 

Writing it down, it sounds ridiculous. However as you mentioned, the mind treats high risk & high consequence often the same 

2) Testing reliability for gonorrhea and chlamydia really doesn't matter much, because there is almost no chance you were infected from condom protected vaginal and oral sex. But if you were, there is a good chance gonorrhea would have been cured in the 3 days between starting ciprofloxacin and being tested, in which case the test could be either positive or negative. Cipro does not cure chlamydia, but in the high dose you took it likely would suppress the infection temporarily, perhaps resulting in a negative test result. But the important fact is that almost certainly you weren't infected anyway.

3) STD transmission efficiency varies widely between different STDs. Gonorrhea and chlamydia probably are transmitted roughly 20% to 50% of the time from a single episode of unprotected vaginal sex, if one partner is infected. For herpes and HIV, it's more like one transmission for every 1,000-2,000 exposures. HPV uncertain, but probably a pretty high percentage.

Bottom line:  Don't overthink it! It is very unlikely you have any STD from the exposure described, and so no significant risk of infecting your wife.

That completes the two follow-up comments and replies included with each thread, and so ends this thread. I hope the discussion has been helpful.