[Question #4433] Clarification

29 months ago

45 year old Male

 

May 23nd – encounter with  Indonesian  CSW in Asia .  Unprotected sex under 2 minutes until condom was applied.  Engaged in giving and receiving oral.

July 10th – what looks like  pimple appears on meatitis of penis. 

July 31st – around August 3rd noticed two more bumps  tip of penis.  Later diagnosed with MC.

- slight inflammation on meatitus.  No discharge.  No discomfort urinating.  Again no pain  feeling of knowing it is inflamed.  No discharge.

August 1st – Tested for HIV, Syphilis, Gonorrhea, Chlamydia, Herpes –  tests negative. 

August 14th –  doxycycline 100mg twice daily for an unrelated issue (dermatitis) – probably 4 weeks of doxy.

August 18th –  rash  (like folliculitis) started to develop on my buttock.  – masturbation was not painful but it felt as though it was not quite finished.

August 19th – 27th – (13 weeks after exposure)  chills , hoarse throat, runny nose.  General malaise.  Slight prostatitis?  Conjunctivitis in right eye.  Cleared pretty quickly.  No more than  week.

-do not believe there was any discharge from penis. 

August 23rd – visit GP.  Sees nothing concerning.  Feels rash on buttock is folliculitis. Bloodwork and does IGG for Herpes 1&2 (13 weeks after exposure – tested negative HSV 2 positive HSV 1 – acquired as  child.  Tested negative for Gonorrhea and Chlamydia.

 bloodwork the following was found:

    • Leuk – trace
    • Ketones – trace
  • Notes show possible dehydration – however slight inflammation of my urethra I wonder if it was due to infection.  Doctor felt that if infected there would have been more than a trace.

September 19th –  diagnosed with MC.  5 MC in pubic hair area – 3-4 MC on scrotum .  Couple sessions of cryotherapy.  MC has not reappeared for 3 weeks believe I have cleared virus.

September 26th – urine sample taken to check for bacteria – no bacteria present. GP see’s no inflammation of penis tip.

I seem to have no symptoms now –  no symptoms for a while – just anxiety. 

Question:

Too much research has led me down many paths:

1/ Reactive Arthritis – primarily due to conjunctivitis – but only in one eye?  Have no swelling of joints or other major arthritic pain than what might be considered normal.  Have tested negative for Chlamydia twice.

2/ Andenovirus – given general cold symptoms and unilateral conjunctivitis?  But seems a long time after exposure to occur?

3/  Could my outbreak week of August 19th be due to STI?

Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome to our Forum.  I will try to help.  Thanks for your detailed history of exposure and test results.  From the sound of things, you did acquire molluscum contagiosum following your encounter in May and continue to be concerned that there may be other STIs lurking.  Further, the topics you mention do suggest that you are spending a lot of time on the internet, a practice which, when it comes to topic of STIs is all too often misleading and anxiety provoking.  I'll comment briefly on each of the topics you raise but may have missed the specific question you are raising.  If that is the case, please use your up to 2 follow-ups to clarify the question.

Before I get to your questions however, let me point out that, other than the MC you have verified on several occasions, you have repeatedly proven that you do not have ongoing STIs.  that is not too surprising- even most CSWs do not have STIs and most single exposures do not lead to transmission when they do.  Further, the doxycycline you have taken since they would cure a large number of STIs including chlamydia, non-gonococcal urethritis, and syphilis.  These facts, plus the fact that your are asymptomatic at this time suggest that you are STI free at this time.  

1/ Reactive Arthritis – primarily due to conjunctivitis – but only in one eye?  Have no swelling of joints or other major arthritic pain than what might be considered normal.  Have tested negative for Chlamydia twice.

Without arthritis (not just occasional joint pain), unexplained skin rash or other problems, isolated conjunctivitis in typically not related to reactive arthritis but is a separate, self-limited process often cause by viruses which resolves without complications or subsequent problems.  Adenovirus (mentioned below can be a cause of conjunctivitis.  


2/ Andenovirus – given general cold symptoms and unilateral conjunctivitis?  But seems a long time after exposure to occur?

You may or may not have had adeno.  If you did, you may not have acquired it through your contact in May.  In fact, most sporadic adenovirus infections are acquired through respiratory routes and casual, non-sexual transmission.


3/  Could my outbreak week of August 19th be due to STI?

Unlikely.


I hope these comments are helpful. EWH


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29 months ago
Thank you for your prompt reply.  I agree that anxiety has certainly gotten the better of me.  As you have mentioned many times on this forum genital anxiety can take its toll mentally.  Honestly I am ready to move on!  Given I have tested negative for common std's - the one that l can't shake is m genitalium  - 
1/  Could I have m genitalium?
2/  Given no bacteria was found in my last urine test - would that suggest if I did have an STD that I have cleared it?
3/  Depending on your thoughts - would it be safe to resume sexual activity or should I refrain? 
Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
1.  Whether M. genitalium is an STI pathogen remains a topic of ongoing research.  it clearly causes treatment resistant urethritis in a minority of men who have the organism but you do no have urethritis symptoms or abnormalities on your urinalysis to suggest this.  The likelihood that you have it, or acquired it from the encounter you describe is low.  If you wish to put the issue to rest however, most commercial laboratories do have urine tests for Mg available however.  Were I you, I would not both to look but it is up to you.
2.  Correct
3.  I see no reason for you to abstain from unprotected sexual contact at this time based on the test results and descriptions you have provided.

Hope this helps.  EWH
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29 months ago
Dr. Hook...again many thanks...last questions:

1/  I appreciate your thoughts on M genitalium - in the rare case that I do have  this  and do not get tested - what are the risks for for my partner?

2/  If I do have M Genitalium  would there be bacteria in my urine even if I am asymptomatic?
Thanks again - I am looking forward to putting this anxiety behind me!

Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Your asking good questions. Sadly, the answers are not as satisfying.  The morbidity associated with Mg infections in women has not been well described.  The infections are now appreciated to be VERY common among sexually active persons and most infections resolve on their own.  OTOH, there are a few small case reports and case series which suggest (but do not prove) that Mg in women may occasionally be related to STI syndromes such as pelvic inflammatory disease.  Thus I can't provide you with a solid, well quantified answer - the research is just not there.  Were I in your situation, I would not worry about it.

If you did choose to test for Mg, urine tests are the preferred test in men.  the tests appear to be good.  Most Mg in men is asymptomatic.

sorry I can't provide more clarity.  As I said above, were I you, I would not test and would move on without continuing concern

I hope my responses have been helpful.  As you know, our Forum provides up to three response to each client's questions.  As thisis my 3rd response, this thread will be closed shortly without further response.  Take care. EWH
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29 months ago
Dr.  Hook, I am sorry one last question.  If I need to buy more questions I understand - please just let me know and I will repost.  I just went to my doctor to have the test done for M.  Genitalium following our exchange - I asked to review my past lab results and I was incorrect.  
The urine test show:

Leuk: Trace
Nitrates: they were above normal range as well.

This test was done 10/6 

The test done 08/23 - trace Leuk, trace Ketones

Again, no discharge, no inflammation of the urethra currently and whether or not I have a sensation at the tip of my penis and the area between my legs under my scrotum is difficult to say because I'm not sure how much of this is anxiety driven.

Does this seem normal and does it change your opinion on the possibility of M. Genitalium? 

Is there anything else that could cause this - given I am almost six months past exposure?    

 The doctor had never heard of it and needed to find the correct test.  I will be doing a urine sample tomorrow morning and dropping it off to get the test run.  

Thank you.



Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Small amounts of leukocytes are not a sign of STI and are regularly present.  In your case the presence of ketones also suggests that you may have been dehydrated and perhaps hungry but does not suggest STI at all.  

No change in my advice regarding Mg.

Finally, remember, the optimal specimen for any STI is urine collected as you begin to urinate, not from mid-stream.  Also best if it is collected after an interval of at least an hour since you last voided.  

Closing thread now.  EWH
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