[Question #4657] Dr. HHH - Unprotected oral, symptoms, help

Stephen
28 months ago
Worst mistake of my life. Two unprotected oral exposures (agency escort), on 11/17 and 11/30. First one brief and not deep, so wasn't worried. No memory of whether / when I had sex with wife after that. Second exposure I froze up and did not stop it until 20-30 sec, and it was deeper, so I was afraid. Found Dr. HHH's old posts on Medhelp, and an STI researcher who had never seen proven case of transmission this way. Was so relieved that I had unprotected sex (no ejaculation) with wife only 48 hours later (12/2), planned to never do this again.

2 days later (12/4) awoke with changed meatus appearance. Squeezed a whitish bead of fluid out not looking similar to ejaculate. Very scared. Examined / milked for next 4 days, only found small amounts of clearish or grey/ambiguous fluid. Once a tiny bit of yellow-ish elastic mucousy discharge. Meatus area looks puffy/sore but I also keep touching it. No burning or pain while urinating at all. On 12/7 checked / squeezed aggressively through the day and then started to hope maybe I was OK.

12/8 awoke with erection and felt sting. Squeezed and out came discharge of whitish fluid (under warm lighting, unsure of tint). Panicked, went to clinic for test and awaiting results. Since then (2.5 more days) still never any discomfort urinating, but still bits of ambiguous or clear-ish fluid, notably after sleeping, and sensitivity / puffy appearance / soreness at meatus. Then, just now right as I typed this, a bit of pussy looking fluid.  Very scared now.

Chances this is gonorrhea and my partner is infected?
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago

Welcome to the Forum.  Clients on our site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.

I presume that your unprotected oral exposures were receipt of oral sex, not performing it.  I suspect that the MedHelp response that you have found was referring to HIV.  Indeed, There are still no proven cases in which a person has acquired HIV from receipt of oral sex so HIV is not a concern.  As for your penile symptoms, they may reflect one of two STIs potentially acquired from time to time after receipt of oral sex..  While  most commercial sex workers do not have STIs and oral sex only relatively rarely leads to infection, on occasions infections occur.  When they do, the most common problems are either gonorrhea of non-gonococcal urethritis (NGU) caused by mouth organisms introduced in to the urethra during sex (chlamydia is so very rare following oral sex that it is not a practical concern).  This sort of non-chlamydial NGU following 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 (thus your wife would not be in danger).  In the United Kingdom, many specialists do not treat NGU associated with oral sex.  When treated, oral sex-related NGU typically resolves quickly.   A final possibility is that you were initially or even now detecting the smallish but variable amount of normal urethral secretions that are present (and more so on awakening) and/or that your repeated self-examinations and the trauma associated with them may be causing inflammation which you are now detecting.

You did the right thing to be tested.  It would have helped if the clinic you were seen at also did a gram stain of urethral secretions looking for white blood cells (a urine test, while less sensitive is also sometimes helpful for this).  Your test results should be available in a day or so to guide further decision making.  If you wish to accelerate things, seeking a test for urethral or urine WBCs may provide additional useful information; these tests should be available at a local health department clinic. .  In the meantime, I suggest you do your best to stop the repeated self-examination and squeezing.  

I hope this perspective and information is helpful.  EWH


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Stephen
28 months ago
Yes, receiving. It cannot be normal secretions, because since submitting the question yesterday there was some yellowish pus at night and in the morning, like squeezing a pimple.

No, the posts I was referring to were about the risk in general of STDs following oral exposure and the risk of resuming sex with the partner. I know that there are never any guarantees of random risks but I am also in shock that this has happened to me if it is indeed as unlikely as Dr. Handsfield has said in the past. Since the clinic said I could have to wait many days or even a week for this test (I will see if I can go somewhere else for faster results, I need this now) I started asking this question because I want to know

- If the symptoms indicate something one way or another, especially considering the timeline, the intermittent symptoms / discharge, and lack of urinary discomfort, at least up until now. I know there is no medical point in asking this now since I have to wait for results but it will just mentally help me process as I try to get through these days
- If gonorrhea is the only thing that I have to be worried about in the sense of infecting my partner, then what are the chances I gave it to her based on the previous description and how long do I have before something could go wrong... I am so afraid to have to disclose this and that it will destroy everything, but I read that women usually do not show symptoms so I want to know how long I would have

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
 For the clarification. I am confident that Dr. Handsfield would never say that infection such as gonorrhea and NGU are never acquired through receipt of oral sex. When all episodes of oral sex are considered urethritis is rare  and most such episodes do not lead to urethritis but it is by no means unheard of. 

 Tests for gonorrhea and chlamydia take only a few hours when specimens are processed in the laboratory. Sometimes clinics give longer waiting times for the convenience of their bookkeeping. I would call the clinic you were Seen at and check on the availability of your results. Further,  as I mentioned above, if they are not available, you should be able to be evaluated at a health department clinic or appropriate emergency department and be cared for expeditiously. 

 If you do happen to have gonorrhea, the likelihood of transmitting the infection to your sexual partner is about 20 to 40% per episode of intercourse. 

 I hope this additional information is helpful.   EWH
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Stephen
28 months ago
I did not claim Dr. Handsfield said it was impossible in prior posts, just that he said it was very unlikely--and it seems he was correct because I got my tests back and they are all negative. Swab: moderate wbc, no yeast cells, no gonorrhea detected. GC Aptima urine not detected, chlamydia aptima urine not detected.

I asked the doctor how I could have experienced this pus, and said that pus can occur just from inflammation. I asked if I could've caused it by touching or probing as much as I did and she said quite possibly. She offered to refer me to a urologist if I was still concerned but did not say anything about NGU or treating anything further.

I want to be immensely relieved, but in your opinion from what I have written previously, what is going on? Could I have caused all this, including those discharges, by reacting to the first stimulus (which still seemed abnormal to me) and probing too much? Or do you think I could actually have NGU, and in that case is it OK to just move on as if things are normal? How long (after leaving it completely alone) would I expect to see nothing more unusual happening?

Thank you very much




Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Thanks for the clarification about the risk.

The fact that you do have white blood cells nd no gonorrhea suggests that you have non-chlamydial NGU as I mentioned in our initial exchange.  The good news is that this does not represent a risk for your sexual partner but that does not mean that you should tolerate the discharge.  Treatment with a single 1.0 gram dose of azithromycin or doxycycline 100 mg twice daily will likely clear things up.    I see no reason to see a urologist unless treatment does not resolve it.  

In addition, while it has not been studied, I continue to worry that repeated self-examination may be amplifying the irritation.  Thus, in addition to seeking therapy for NGU, I suggest you do your best to minimize the self-examinations.

I hope this is helpful.  I think your tests have provided an answer as to both what you have (non-chlamydial NGU) and what you do not (gonorrhea, chlamydia).  As you know, with this third reply this thread will be closed shortly without further replies.  Take care.  EWH
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