[Question #4848] Viral Transmission

27 months ago
Hello Experts,

As I continue to deal with pain throughout my body I continue to research and see what could have caused my ordeal.

Dec 27th. Engaged in unprotected oral with a non commercial sw. (Made contact with roof/throat of mouth Of sw)
Next day, I began to experience balanitis. Pain, tenderness, inflammation at the head & tip of penis.
1/1- I visit urgent care. I have a urinalysis done as well as 3 panel Test for: gonorrhea, chylamydia,  Trichimonasis.  Physician at urgent care states she “believes it’s an Sti causing pain”
1/3-I visit a different urgent care experiencing testicle pain/aches, which could be Epididymitis. I’m proscribed doxycycline which doesn’t remedy issue.

I currently have reoccurring testicle pain, I occasionally feel a sting at the head of penis as well as mild burn/sting towards the end of my urine. I’m experiencing severe abdominal/stomach pain which I’ve saw could be a cause of Epididymitis. 
All of this began only after the encounter on 12/27... I understand anxiety can be a contribution but I’ve found myself in anxiety filled situations many times and have never dealt with this type of pain/body reactions. The pain I’ve dealt with is very much real no matter how much I try to ignore.

I haven’t had any sores, lesions, or blisters. Nor have I had fever, sore throat. It’s hard to say if I’ve had chills because it’s winter here and occasionally I’ve found myself cold/chilly. Only a rash that appeared as peeling/flaking skin. And skin irritation below the ring of the head of penis that M.D. visually confirmed. 

I Understand an std may not manafest this way to cause symptoms but is there any Viruses or viral causes that could have led to my infection?? I’ve taken an HIV RNA Test(1/11/19) that’s conclusive 9-11 Days after exposure. Can I be 100% it isn’t HIv at this point? The doxycycline hasn’t remedied the Problem. An ultrasound has already ruled out physical trauma. 
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
On this occasion I will be addressing your follow-up questions  In preparing to answer these questions, I read your recent interaction with Dr. Handsfield and agree with all that he said,  Further testing for STIs is a waste of time and will only hinder efforts to understand what is going on.  Further, I would add that urgent care settings are precisely the WRONG place to go for problems such as this.  Urgent care clinics are designed to provide quick evaluation and to treat common problems. when problems persist or tests are negative it is time to see a thoughtful provider who will provide thoughtful care and follow-up.  

I am not denying your pan, just saying that it is not an STI and not related to the low risk encounter in late December that you described.  

You can be entirely confident that you did not acquire HIV form the encounter and should look for other causes. the best way to do this with a primary care provider who will provide continuing evaluation based on test results and repeated examinations.  EWH
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27 months ago
Thank you for your response Dr. Hook. I no longer go to the urgent care for this issue. Just for clarification purposes when you say it’s not an STI does that also includes viruses that could be transmitted through sexual encounter? I know sometimes they are grouped in two different categories. Also, do you have any opinion on any other types of testing I could recommend to a primary physician to utilize in this instance since you’re ruling out STI infection from that oral sex encounter? Do you think there could be bacteria, fungi, or etc that could have caused this, That wasn’t eradicated from the doxycycline? I suggest these are caused from that encounter because I’ve never dealt with this before, these issues have only arised after the sex encounter. I didn’t do or expose myself to any other situation that I would think would cause these issues.

Thanks 
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Your description does not suggest an infection, viral or otherwise acquired through sex.  Your symptoms may or may not be related (it is natural to wonder if this might be the case but not infrequently, when we noticed one problem there is a tendency to link it to other, unrelated problems).  In fact, the problem may not be infectious at all, hence the non-response to doxycycline.  My guess is that the association with the sexual encounter you describe is coincidental.  My advice:
1.  As you have focused on the testicular problems, a good urologist would be a good place to start.  
2.  If other problems (flaking skin, GI upset) continue to occur, after seeing the urologist and gaining his/her assessment, I would then see your internist or generalist and describe the situation, asking both what might be causing these and if they might be linked.  This interaction will be helped if you can provide a written timeline or current symptoms, their severity and what seems to make them better or worse.

Hope this helps.  EWH
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27 months ago
Hello Dr. Hook. The pain in my stomach/abdominal has went away. I still have tenderness and pain in my penis head. And pain in testicles. I’ve been said to have slight Prostatitis by urologist. I still haven’t had any blisters, sores, or sores inside penis as it doesn’t hurt to urinate.  This balanitis And epididymitis has lasted for about a month now. I’ve been given cipro but this hasn’t helped. Urologist says i don’t have signs/discharge of std so he prescribed me 2 more week of doxy to take next week after I finish my cipro. 

Is there anything else we’re missing? Anything that could cause this issue? Will my balanitis ever go away? Is HPV a possible diagnosis? My Meatus sticks sometimes throughout the day. Isn’t that a sign of some sort of std infection? 


Please let me know. I haven’t been able to have an erection, unless really trying to master bate. I’ve noticed smaller output of semen after masterbation. 
27 months ago
I’ve now gone a month without having a diagnosis of what I’m dealing with. I just would like to have an idea. Thanks. God Bless.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
 Thank you for your follow up. I'm glad to hear that your stomach discomfort has improved.   It is not clear to me that you have balanitis. Balanitis is characterized by a rash or other visible changes on the head of the penis. Are there still visible signs of penile inflammation? You have not mentioned such problems since your initial post.  The origin of your testicular discomfort as well as the tenderness in the head of your penis is certainly not an STI and your urologist is the  right specialist to address this sort of problem. 

 As you know our forum limits replies to three replies for each set of questions. This is my third reply and you have had replies to an earlier thread from Dr. Handsfield. This forum is dedicated to helping address concerns and problems related to sexually transmitted infections. There is no evidence that an STI is present in your case.    Thus, as this thread ends my continuing advise on this thread, echoing the earlier advice of Dr. Handsfield is that there should be no need for you to return to this forum. My advice is to work with your urologist on your continuing problems. I hope the advice that we have given to you will prove helpful. Take care. EWH 
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