[Question #4661] NGU Syphilis? unprotected oral massage

28 months ago
Hi,

Thanks in advance for your help.

34 WM in Northeast USA ,On 11/6 I received a massage at a Asian massage not the full service kind, this was the second massage, first was standard massage with light grazing, second one resulting in unwanted unprotect oral for 15 seconds. I stopped her immediately once I realized what was occurring, miscommunication as I thought she was just going to finish with hand, first time doing this.  1 day later I have a slight burning/pressure upon urination and this has been persistence to present (day 35 days). Very sensitive head of penis, urethra seems inflamed and has a slight swollen halo around urethra opening, no burring during urination or discharge. Called doc and got Chlamydia and gonorrhea test urine, tested negative at 1 week and at 14 days. Doc tested for Trich even though no sex, all negative, just wanted to exclude other poss, doc said no NGU base on results, will be doing 6-week HIV and Syphilis test in one week. Doc did urinalysis and was all negative so no treatment as he couldn’t identify, recommended urologist, Got diagnosed with inguinal hernia month prior and have surgery in 2 days to repair.  Last week went to urologist and he performed a cystoscopy, and all looked normal.  Prescribed cipro 500m for 14 days for Dysuria, 4 days in no improvement. Current stat, depressed, lost 10 lbs since, anxiety, neck lymph nodes feel inflamed, along with groin lymph nodes, currently at a loss. Would doxycycline help this instead of cipro? Scared of syphilis and NGU, HIV adenoviral urethritis as im married? Could it be genital focused>? Please help?

28 months ago
Just wanted to add i have frequent  urination,  dribbling for some time, the irritation in tip comes after urination and last for 10 min.  also and have had  lymph nodes pressure in throat since the exposure.
28 months ago
Hi,

I show this thread has been updated but I don’t see the response but I see other responses. Is that a system issue ?  Just wondering if it’s a browser  or account issue ? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome to the forum. Thanks for your question. Notices go to users whenever there is any activity on their question, which includes such things as entering the assigned moderator's name. We try to answer questions within 24 hours, but you will understand that the moderators aren't on call 24/7!

This was an exceedingly low risk sexual exposure. In addition, your symptoms are not typical for any STD. Far and away the main symptom of urethritis -- i.e. urethral infection with any STD -- is abnormal discharge from the penis. Discharge usually is accompanied by various levels of discomfort or overt pain during urination. However, painful urination or a sense of urethral irritation, by themselves, rarely are caused by STDs. In addition, symptoms originating with bladder spasm or increased bladder muscle tension -- which is the origin of uregent urination, diffuse discomfort in the genital area, and so on -- also are rarely caused by STDs. And in addition to the negative testing you have had, including cystoscopy, you can be 100% certain you have no STD and almost certainly never did. Persistence of your "burning/pressure" and/or dysuria despite the antibiotics you have received is additional evidence that no infection is responsible for your symptoms. Definitely you should not take doxycycline or any other antibiotic, certainly not unless prescribed by your urologist or other physician. It wouldn't help.

As for your other symptoms, no infection from the massage and oral sex event is a plausible cause of your weight loss, anxiett, the lymph node "feeling" you rport, etc. I doubt your throat "pressure" has anything to do with lymph nodes, especially if there are no obviously enlarged nodes. Could all this be genitally focused anxiety, as I think you ask? ("Genital is missing....") Yes, I think that's a good bet. It's also possible you have noninfectious prostatitis or chronic pelvic pain syndrome (CPPS), which is closely related to genitally focused anxiety. That would explain the urinary dribbling and pain at the tip of the urethra. These are issues to  discuss with your primary care provider and/or the urologist. (You could consider printing my comments as a framework for discussion. I'm betting they'll agree with me.)

In the meantime, I hope these comments are helpful and reassuring, as they are meant to be. Symptoms like yours never turn out to be anything dangerious or serious, either for affected men or their sex partners. You have nothing you can transmit to anyone. This is an issue of comfort, not of a serious medical problem. Sometimes just understanding that is the first step in improvement in sympttoms.

Let me know if anything isn't clear.

HHH, MD
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28 months ago
Thanks Doc for the reassurance ,  this has been a stressful month. We are trying to get pregnant and I feared I could pass something to my wife, i.e syphilis  or ngu as I’m not sure if the massage parlor worker has any mouth sore, the oral was brief  may have been more like 30- 1 min as I open my eyes and thought it was her hand, Doubt that changes your response , anyway. Could my doc have actually determined nsu/ngu from a urine analysis/ trich/ gonna/ chamidua test?   As for the hernia, could that poss contributed to any of my symptoms or inflamed groin lymph nodes, to clarify, my throat lymph nodes have been inflamed since a few days after the incident and have progressively gotten bigger. Both are swollen and I can feel like a kidney bean on both with a sore jaw, not noticeable by the eye , only by touch , could a std for viral infection from the oral made it way to my moth/ neck lymph nodes.?  At 4/5 weeks would theee be any other std that sytoms could appear that are delayed  like andonviral or would that have left my system, if so could that have been passed to my wife.? Her heath is the most important thing to me,  Also, after my cystcopy I trurley know what acutual burning feels like, when I pee it doesn’t burn like that , just feel pressure upon peeing and discomforted during,.  How long could this uncomfortable urination go one for, if it’s cops, does that eventually go away? Any thought on medication to help.  

Thanks and look forward to hearing from you, sorry for the long folllow up
28 months ago
Not cops.. meant cpps. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
NGU from oral sex is probably due mostly to normal oral bacteria, or the urethra's adjustement to such bacteria, and harmless to sex partners. In any case, absence of discharge is strong evidence, by itself, that you didn't have NGU. Self assessment of enlarged lymph nodes by non medically trained persons is notoriously unreliable, so I don't buy that you have such a problem. Get rechecked by your doctor if you still feel otherwise.

To the extent that your urinary discomfort and other symptoms probably are entirely psychological, they probably will continue until you become convinced -- emotionally as well as intellectuatlly -- that nothing is wrong. Perhaps the main issue here is guilt over a sexual decision you regret. But don't confuse that with infection risk:  they aren't the same. Deal with the former as you need to -- perhaps professional counseling (start with a frank conversation with your doctor(s)) -- but forget the latter. It's for sure not an issue.

So none of this changes my opinions or advice. You have no infection from the exposure described. Accept it and do your best to move on without worry about it!
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27 months ago
Hi Dr.   As mentioned perviously I took my STD test at 7 and 14 days and just had my HIV and Syphilis test left and I took it today, blood tests, i know you said my exposure was low risk, however i wanted to get all test completed and today was day 40 and I just had my blood taken for both HV and Syphilis, is 5 weeks and 5 days conclusive for both test?  how accurate would a blood be to test pick up Syphilis at this point?   most of the below are for education  as i know im low risk but want to be sure im educated.

I've had HPV and had a few small warts on my scrotum for a few years now and recently noticed a brownish flat wart  that looks similar to my other warts but this is darker and brown  near the fold of my buck cheek/inner upper thigh not to far (inch or two) from my anus /scrotum. AS you know i know received unprotected  oral from Asian female massage, no anal play or anything near anus, could a syphilis chancre occur in that place? the wart from my knowlage is not an open sore, nor do i believe it was ever, i only recently noticed it , not in a general viewing place,  my hand felt it and took a photo and saw it. are brown HPV warts worrysome? it could have been there for some time, poss before exposure, not sure.

I also  recently noticed in the past 2 days a slight small white discoloration on my penis head  (maybe a centermeter big)and im suspicious it may be a chancre forming, what are the chances of a chancre forming at 5 weeks and 5 days?  if it was the beginning stages, would the test i just took today pick up syphilis if it was a chancre?

as a final note, what are the chances of any other STD forming at 40 days after and going forward if i havent had any further symptoms?

Thanks again for the great work you do, hopefully these questions and answers helps others with clarify and reassurance.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Syphilis and HIV tests are conclusive at 6+ weeks, and 40 days is close enough, especially given the zero risk of the exposure.

It is unlikely the bumps on your scrotum are warts. Genital warts are not common on the scrotum, and never persist for years -- almost all warts clear up on their own within 1-2 years. Whatever the new spot, probably it's also not a wart. In any case, having warts does not increase risk of catching HIV or other STDs, even if the warts are directly exposed.

The discoloration of your penis has nothing to do with the recent sexual events. It seems clear you are compulsively examining yourself, and almost certainly you are noticing normal variations in genital skin that you otherwise wouldn't notice or would ignore. Trust me on this:  there is NO realistic possibility you caught any STD from the events described. You are not at risk for any STD except by intercourse, i.e. your penis inside another person's vagina, rectum, or mouth. You really need not worry about any other kind of sexual event.

That concludes the two follow-up comments and replies included with each thread, and so ends this discussion. I hope it has been helpful. Thanks for your kind words about our services and happy holidays!
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