[Question #4837] Balantis/Epididymo-Orchritis

27 months ago
Hello, Around 12/27/18. I had an encounter with what I believe may be a sex worker. I received oral sex without the use of a condom. The next day I started experiencing Balantis/Urethritis. About 5-6 Days Later I began to experience Orchritis. My testicles started aching painful while still experiencing penile pain. Since then I’ve been tested for Gonorrhoa, chlamydia, Trichomonas, syhilipis, hiv and hsv2. All with negative results and also a urinalysis and ultra sound that was normal. I had slight irritation on my penis shaft per the M.D. at my local urgent care. Also, another M.D. at another local urgent care examined my penile and made the comment as to whether I had an std because the mouth of my penis was Resistant to open and had a clear discharge. I haven’t had any rash/sore/lesion. Occasionally, I feel a sting around my penile head/rim. The skin on my butt/legs sometimes feels like an irritation type of sensation, when I’m sitting/laying. Now I experience groin/abdomen pain when I wake up and back pain throughout the day. My bowel movements have been diarrhea like so far no solid feces, just Pieces. I’ve also noticed when my hands are emerged in water for awhile, my fingers become wrinkled. I’ve taken doxycycline twice a day for 10 Days With no complete alleviation Of symptoms. What can I be dealing with? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome to the forum and thanks for your confidence in our services.

First, I have to doubt you have (or have had) urethritis or orchitis (or epididymitis -- but the two conditions really can't be easily distinguished, but STDs cause epididymitis, not orchitis). If you do, they are not from the exposure described:  no STD can start to cause symptoms the next day; 2-3 days is the minimum for gonorrhea, typically 7-10 days for chlamydia or other non-gonorrhea causes. Balanitis is possible from physical irritation, however.

I'm also not clear on what you mean by "experiencing" these conditions. Symptoms alone do not justify a diagnosis of any of these conditions. Also potentially important here is that testicular pain, urinary discomfort, urgent urination, etc are the most common physical manifestations of genitally focused anxiety. If you did not have discharge from the penis with increased white blood cells in the urethra, you did not have urethritis; and if you did not have visible enlargement and marked tenderness of a single testicle, almost certainly you didn't have epidiymitis/orchitis. (When caused by STD, almost always only a single testicle is involved.)

In addition, your negative STD tests are reassuring. Assuming they were done before you wer treated with antibiotics, they are solid proof you did not have either gonorrhea or chlamydia, which are the only STDs known to cause these conditions. Your negative trichomonas test also was reliable -- but in any case, you can't get trich from oral sex, and chlamydia only rarely. But 5 days is much too soon for HSV, syphilis and HIV blood tests to show anything, so you might consider repeating the syphilis and HIV tests (but not herpes) 6 weeks after the event. OTOH, there is no chance any of your symptoms are due to syphilis,HIV, or herpes.

Failure of doxyccyline to clear your symptoms is additional evidence against any STD or bacterial infection. Finally, your non-genital symptoms (skin changes and bowel function issues) are not possibly caused by any STD or anything you could have acquired from the oral sex event. Such symptoms strongly suggest that your anxieties about these issues, and perhaps over a sexual decision you regret, are making you notice minor symptoms or normal body sensations that otherwise you would ignore or not even notice.

So as best I can tell, the only documented medical condition here is the penile "irritation", which could occur from any number of causes -- perhaps starting from the oral sex event, but more likely unrelated to that. 

MOST IMPORTANT:  At this point it is clear that you have no STD of any kind, even if you possibly did to start. You should go forward with no further attempts at STD diagnosis, and if you have a regular partner, you can safely continue or resume unprotected sex without any risk of STD transmission.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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27 months ago
Thank you for your response. 

I would like to give a timeline of events to Better Understand.

12/27- The sex act of unprotected oral sex occurred.
12/28- Tenderness and painful sensations on the penile head began. With mild pain/burning during urination. 
1/1/19- First urgent care visit. Noticed small rash like spot on penile Head(looked like flaking/peeling of the skin) I used hydrocortisone before the urgent care visit so the rash was essentially concealed after. Tested for Gonorrhea, Chlamydia, Trichomonas. (Came back negative results)

1/3-Visited another urgent care (after receiving results from previous std test on 1/1/19 as all negative) experiencing testicular pain. Was given doxycycline.(Felt Alittle Better 1st one or two days after, it didn’t get better or worse)

(After a couple days, pain in testicle subsided to where I felt pain mostly while sitting or laying down)

1/9- I tested again for gonorrhea, chlamydia, trichomonas. Tested the first time for syphilis and hsv2 (all negative) Was Told To take Aleve to relieve inflammation/pain in testicle. 

1/11- Tested For HIV RNA Test.(Tests for genetic material of virus as opposed to antibodies)
Conclusive 9-11 Days after exposure: pure stdcheck(dot)com (Negative result)
1/14-Started experiencing groin/abdomen pain/diarrhea upon waking up
1/15- Experienced testicle pain again. 

I know I Made contact with the throat/roof of the persons mouth several times.
At the moment I still feel very mild penile Head discomfort. 
Is there any other viral/fungus/parasitic causes that could have led to my issue, is there any reason for this back/abdomen pain and diarrhea so suddenly? Sometimes I feel the discomfort in my abdomen during the day.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Thanks for the additional information, which I read carefully. However, these details do not change my evaluation and advice. I remain confident you have no STD or other infection from the oral sex event. We don't speculate much about non-STD causes of symptoms, but in any case I've already given you my best guess about the cause of your back and abdominal pain -- i.e. likely the physical manifestations of anxiety etc. However, there is no way I can be at all certain about this, and you should be seeing a doctor about your symptoms. Then follow his or her advice -- and move on without worry if no physical cause if found. They are not due to any infection from the exposure you are concerned about.---
27 months ago
Thank you. My last follow up question is: Will I have to worry about any Penile/Testicle pain reoccuring? Now, It has soothed, but will I find myself dealing with the pain coming back? And are we 100% certain it isn’t HSV2 as I haven’t dealt with any sores, lesions, or blisters. As you know I can’t trust the Test to be accurate as I haven’t had the time to develop antibodies in that time frame of taking the blood test. I’ve researched it could cause infection of the penis and testicles similar to my episode. As you mentioned I have felt a tremedious amount of guilt and mental stress since this episode. You have helped ease my mindset regarding this incident.

Thank you again. And God Bless. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
It's nice to hear my replies so far have helped ease your mind. Music to my ears:  that's why we're here!

It's difficult to predict the likely duration of the discomfort, not knowing the cause. However, when physical discomfort is due to anxiety or other psychological issues, usually the problem fades quickly once the affected person comes to understand and believe (emotionally as well as intellectually) that the symptoms do not indicate anything serious.

Herpes simply does not cause symptoms like this -- never. You may have read lists of herpes symptoms that include such things, but such lists usually don't provide context. Such symptoms might occur along with typical genital blisters/sores, lymph node inflammation, and so on -- but by themselves for sure are not herpes. And by the way, there is no chance of HSV2 from oral sex, only HSV1. (That's because HSV1 causes almost all oral herpes, HSV2 very rarely. So almost certainly you could not have been exposed to HSV2. Accordingly, it would be a waste of money to test for HSV2 after this sort of exposure or on account of the symptoms you have described. Don't do it!

That concludes the two follow-up comments and replies included with each question, and so ends this thread. I'm glad the discussion has been helpful, and hope these final comments also contribute to that reassurance. Best wishes and stay safe!
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