[Question #4595] Concerned About STDs from Unprotected Oral Sex

26 months ago
Hello Doctor,

I'm a married man, 2 weeks ago I received unprotected oral sex from a prostitute. Afterward, I got worried about STDs. 10 days later I notice small stings in the tip of my penis raising my concerns. On day 12, I woke up and noticed a small bead of white liquid on the tip of my penis. I immediately went to a health clinic and got a swab, blood, and urine test. The results won't be available for 10 days, but the swab test was ready. The Dr said that she didn't see much mucus at all around the tip of my penis. She said that there was no sign of Gonorrhea and that the only thing she saw was "a couple white blood cells". She then said that she wouldn't normally treat someone in this case, but left it up to me. For peace of mind, I asked to be treated and she gave me the single dose (4 tablets) of Azithromycin.

The next day, I was still worried. I purchased a quick test for Chlamydia and Gonorrhea that came back as "NOT DETECTED". Since then, I still notice a very small amount of clear discharge in the morning, and urinating sometimes feels slightly uncomfortable. Making me very concerned.

Is it possible that I had something like Chlamydia, but it cleared up because of the dose of Azithromycin?
Could it be something else like Syphilis, Trichomoniasis, or a UTI?
Could this be psychosomatic? I can see that happening in the small stings, but not the white blood cells and the bead of white liquid. The white liquid was only seen once, in the morning.

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome to the forum. Thanks for your question.

Several aspects of this are reassuring. Oral sex is low risk for all STDs and nearly zero risk for some. 10 days is too late for gonorrhea symptom onset. And although that timing is concistent with nongonococcal urethritis (NGU), both chlamydial and nonchlamydial, I doubt you have any urethral infection or STD from the oral sex wvent. Attentive, worried (read "anxious") persons who examine themselves closely often notice minor symptoms or signs that otherwise would be ignored or forgotten, which almost certainly explains the "stings" and probably the single episode of white liquid. Most likely it was normal urethral mucus, or perhaps left over semen or preejaculate fluid, e.g. if you had had a nocturnal erection during the night (since you only noticed it once in the morning). That the examiner could not see an overt discharge is reassuring, and almost any urethral swab shows at least "a couple of white blood cells". And you also have your own negative test results, and I'm confident the ones collected by the clinic also will be negative.

Syphilis doesn't behave at all like this, and trichomonas cannot be acquired by oral sex (it's never found in the oral cavity, only genital tract). Chlamydia also is one of the STDs rarely if ever transmitted by oral sex. I doubt the azithromycin is making any difference.

I think yoour "psychosomatic" comment probably is right. I'll also point out that whenever someone suspects his or her own symptoms have a psychological or emotional origin, usually she is correct. You do not have elevated urethral WBC, "a few" not being abnormal. And no recurrence of the morning discharge also is reassuring.

Finally, in the off chance you do have NGU, following oral sex NGU is believed to often (usually?) be due to adjustment of the urethra to unaccustomed but entirely normal mouth bacteria. There are no reports that it ever causes serious outcomes or complications of any kind; and no evidence that suggests any potential for harm to sex partners. In other words, And azithromycin usually is effective (although it takes 7-10 days for symptoms to clear entirely.) So if you did (or do) have NGU, which I strongly doubt, no harm will come. You should resume sex with your regular partner, without worry -- although I would understand if you want to wait until you receive the negative test results from the clinic.

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

HHH, MD
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26 months ago
Thank you so much. Your response is very reassuring. I am noticing a small amount of clear discharge. That has me worried a bit but it sounds like I should just accept it. Is there anything I should be looking out for at this point?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
If you're clearly seeing abnormal urethral discharge, return to your doctor for reevaluation. Abnommal dischage usually is not clear, i.e. at least some cloudiness; obvious without having to squeeze the tip; usually more obvious in the morning or at time when you haven't urinated for a few hours; sometimes staining of underware. If entirely clear and also scant amount (you have to look closely to see it, perhaps nothing new) then I would suggest you sit tight for another few days before having it seen.

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26 months ago
Thank you again. The discharge is clear, and it seems like a small amount. It does happen after a couple hours of not urinating, and rarely do I see it without pinching the tip of my penis. I think I will wait a couple days to see if goes away, and if it is still here, I'll go see a doctor.

Based on your previous message, it sounds like the worse case scenario is that it could be NGU, but the azithromycin should help. I was given the dose 6 days ago, so I'm still within that 7-10 day period you mentioned.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
My guess is you don't have NGU, just some excess production of normal mucus. If azithromycin were going to resolve it, that probably would have happened by now. Good plan to be reevaluated if after another week or so you're convinced this sort of mucus/discharge is new and not normal for you; or if before then it turns cloudy or yellowish, or significantly increased in amount.

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