[Question #4515] At a loss

81 months ago

This event happened a year ago and is still bothersome. I am male, received oral sex unprotected from female. Happened to be while i was taking doxycycline for acne. Had sex with regular female partner 4 days later. She developed burning and i itching inside penis a few days later.

7 days and 14 days post event, 10 days aftwr dinishing doxy i had urine naat gon and clymid test. Negative. Partners symptoms went away.

Mine got better but returned. No discharge, just itching. When i pull apart and look no real redness. When i take a picture with zoom i can see tiny white particles when itching but hard to see without looking close. During past year repeated sex with partner. Sometimes she gets uti symtoms, sometimes not after sex. They always go away. I have had repeated naat g/c negative test, negative hsv 1 and 2, negative mycrplasm, neg tric urine. Multiple times. Both on line and at GP office.

Most recent was 5 days post sex with partner. 2 urinalysis...all normal range. One wbc 0-5 and the other wbc not present. Koth test showed mucus threats. Negative g/c and trich again. Partner has uti symptoms. I have same itiching only.

Regular partner claims no other partners and past gyno appointments post symptom resolution showed nothing. I only have had oral a year ago

So...

1. do you think i have an sti?

2. Next steps?

3. It seems like my risk is low, test are reliable but symtoms continous

Only other health problems are diabetes controlled and blood pressure issues, normally controlled.

H. Hunter Handsfield, MD

81 months ago

Welcome to the forum. Thanks for your question.

You know the old saying about good news and bad news. I have good news for sure: almost certainly neither you nor your partner has an STI. And not really bad news, i.e. there's nothing here that suggests any other serious health problem. However, I can't come up with a definite answer about the cause of your symptoms.

Oral sex can be viewed as safe sex, with a low risk for all STIs (a lot lower than for vaginal or anal sex) and virtually zero risk for some. Further, most infections that can be acquired by oral sex would have been prevented by taking doxycycline at the time. Third, your negative gonorrhea and chlamydia tests are conclusive, and I also assume that somewhere along the line, your partner was tested and negative for both of these. It's also good to hear she has been tested and negative for trichomonas -- although trich is never carried in the oral cavity and not a risk from an oral sex exposure. (And her symptoms don't fit well with trichomonas anyway.)

As for your urethral "itching" and the "white spots", i'm pretty sure you're just looking to closely. Certainly there is nothing that will show up on inspection, even with magnification, that could cause urethral irritation symptoms, that you would not notice from more overt symptoms, such as abnormal urethral discharge. I'm not familiar with the term "Koth test" (and can't even find it on Google), but mucus threads are normal in the urine. As a diabetic, you probably know you are prone to yeast infections in the genital tract and elsewhere, unless your blood glucose control is excellent, including low A1C hemoglobin, and yeast infection conceivably is a cause of urethral itching -- and maybe even white spots in the meatus (penile opening).

Women get UTIs all the time from sex, not as STIs, but because sex massages UTI bacteria -- which are often present nomrally in and around the vaginal opening -- into the urethra. Sometimes just minor infections, not showing up under the usual diagnostic crieteria for UTI; other times urethral irritation from sex itself. Mucus threads are normal on urinalysis.

So I'm quite confident that nothing is wrong, and for sure no infectiou acquired during the oral sex event a year ago. Much (most?) of what you are experencing is suspicious for trivial symptoms that don't mean anything, or even normal body sensations, magnified by your anxieties about STI or over a sexual decision you may regret.

Those comments address all three of your questions, but to be explicit so there is no misunderstanding:

1) I am confident you have no STI.

2,3) Ongoing symptoms ans next steps: Nothing, really. Discuss with your doctor if the symptoms continue to concern you. But stop any attempts at self examination and diagnosis and just live with your minor symptoms. Same deal for your partner. (If indeed some of this has an emotional basis, the "cure" will come once you become convinced -- emotionally as well as intellectually -- that nothing serious is wrong.)

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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81 months ago

Thank you. Very helpful. The koth test is a typo for both tests...not koth, my bad. I meant to say regular urinalysis did not show anything bad. One said wbc was 0-5 the other not present, hence the word both...or koth, lol. I dont think she was tested for trich. I was x3, most recently 5 days after sex . I did not realize i could get yeast inside the urethra. You are correct, i have gone from no anxiety to being axious about this.

So...my last questions...

1. Yeast is possible inside the urthra?

2. I assume having less than 10 wbc count is normal since labcorp thinks it is.

3. I assume none of my new comments changes your opinion.

Otherwise, very clear. Thank you

H. Hunter Handsfield, MD

81 months ago

I should have thought it might be a typo -- Sorry! Thanks for the thanks.

1) Yeast urethritis is possible, yes. However, its frequency has never been studied and it's a bit controversial. I understand it's diagnosed fairly frequently in UK GUM (genitourinary medicine, i.e. STD) clinics; but I'm not sure I've ever seen a confirmed case personally.

2) There are no rigid standards for WBC in male urine, partly because it depends a lot on how the urine is collected (midstream vs initial stream), how dilute or concentrated the urine is (fewer cells after high fluid intake and increased urine flow), and whether examining urine directly or only after centrifugation. In general, 0-5 for sure is normal, but 5-10 cells is getting borderline.

3) Correct: no change in my assessment or advice.

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81 months ago

Thank you very much for your response and this service. My last question. A recap....I have had these symptoms off and on for about a year, mainly itch feeling inside but more nagging than painful and no discharge ever. I have had (a) two urinanlysis that showed nothing but threads one time, less than 5 WBC and threads the second. (b) two NAAT tests for clymidia, gonnarhea and trich....all negative, (c) most recently I decided to go back to the doctor to see about a referral to a urologist and they did a quick test in the lab that showed no bacteria or WBC but sent it off for a culture. The culture read...."3 or more organisims present each greater than 10,000 cu/ml may represent normal flora contaminant and no further testing required" I have had this test before about 10 months ago with the same result.

So, I do believe I do not have any of the three STIs listed above and I have had two previous tests for. But I am not so sure I don't have bacteria. When I google, I know I should not, my results from the latest culture, the literature states that more than 2 organisism could be significant and indicate an infection but it hasn't been studied.

So my questions.....1) do you still believe I am correct that I have no STI and 2) my doc says the test show nothing. Given the 3 or more organisims the test did show would you be concerned and recommend further testing?

Any comments, thoughts appreciated.t

Thank you

H. Hunter Handsfield, MD

81 months ago

First, I remain confident you have no STD. However, it seems possible you have chronic prostatitis, perhaps due to one or more of the bacteria found on culture (maybe all three).

But because prostatitis isn't an STD, and that's the only domain for this forum, I have no further advice. If you have not seen a urologist, that would make sense. Or if you have, perhaps get a second opinion. Most likley nothing will come of it, but better safe than sorry.)

That concludes this thread. I hope the discussion has been helpful. Best wishes.

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