[Question #4856] Oral Exposure - SO Intermittent Issues

25 months ago
Hi Dr's,

In November I had three instances of sexual contact with high end CSW's. During these excursions I practiced safe sex - protected vaginal/anal intercourse, as well as unprotected oral sex. 

After these events I always keep on the lookout for burning/discharge to identify I've been unlucky enough to be infected with gonorrhea or NGU. After no symptoms emerged, I returned to regular unprotected intercourse with my committed partner.

Of course, after resuming with my regular partner, a few weeks after she started to complain of urinary burning and urinary urgency. She assumed a UTI was developing, increased her liquid intake, and these symptoms went away.

A few weeks passed without incident. A week ago, these symptoms returned, then went away a day later. Then again today, they have returned. These stints include urinary burning and urinary urgency (strong urge to go again immediately). No other symptoms seem to be present. These symptoms seem to be brought on by and immediately following extensive amounts of rough sex. 

Of course this has made me paranoid about an STI, so I have been dealing with lots of genital anxiety including urinary urgency and focused pains coming from my urethra. That said, I have no pain upon urinating, no discharge, and generally no other symptoms except my paranoia.

What are your thoughts?
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
 Welcome to the forum. Thanks for your question. Your situation is not unusual.  

 Let me first congratulate you on your commitment to safe, condom protected sex. It will almost completely eliminate your risk for STI's.   My suspicion is that your regular partner's UTIs are unrelated to the events you describe. It may be worth pointing out that UTIs in women are more common following sexual intercourse and that your partner's first episode may not have completeLy  resolved when her symptoms diminished.   A brief course of antibiotics is far more likely to take care of a UTI in women than increasing fluid intake. 

 As you have already pointed out with your correct and consistent condom use your risk of having acquired an STI from the three encounters you mentioned is low.  Many factors contribute to this low risk: Even most commercial sex workers do not have STIs; even with unprotected intercourse most exposures do not lead to infection; when infections occur in men they are more often symptomatic than not and you are asymptomatic; and finally, your use of condoms makes infection very very unlikely. Putting all of these factors together it is most unlikely that you have an STI. Of course, the only way to know is with testing.

 Thus, to summarize, your partner's UTI is more likely coincidental than a consequence of your dalliance. I would not worry. If you want to be entirely sure that you did not acquire an STI however, I would recommend testing. I hope  this information is helpful to you. EWH 
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25 months ago
Thanks Dr Hook. I guess my concern is unprotected oral, but most of the research I have done (and answers here) seem to indicate the probabilities of acquiring STI from oral seems pretty low.

Do STI's ever manifest in the manner I've described, intermittently and mostly focused on UTI like symptoms? My general sense is they do not, but your experience and perspective would be helpful.

Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
 Correct. The risk of acquiring any STI from oral sex is low.   Thus, it is quite unlikely that you acquired any STI from the exposures you have described. 

 And women's one of the symptoms of STIs can mimic UTIs.   That does not change the fact that it is unlikely that you acquired an STI or transferred that STI to your sexual partner. EWH 
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25 months ago
Thanks Dr.

As part of my regular physical, I asked to be tested and everything came back negative (as expected). My doctor was hesitant to give me a gonn/chlam NAAT after a urinalysis came back with Leukocyte Esterase, Blood, Nitrates, etc as negative. However, it sparked my curiousity.

I did a little research, and it looks like in many peer reviewed research papers, a clean urinalysis (specifically, negative Leukocytes) has a pretty good negative predictive value, sometimes as high as 95% in some papers. From your experience in the field, does that hold true? Figure I'll use my 3rd and final question to learn something.
Edward W. Hook M.D.
Edward W. Hook M.D.
25 months ago
You are correct that a negative your analysis has pretty good, but not perfect negative predictive value.   Nonetheless specific testing for the pathogen's you are looking for is more precise than the urinalysis. We do see occasional patients with gonorrhea and chlamydia who have no WBCs in their urine. 

As you suggest, this reply will complete this thread which will be closed shortly. Take care. Please don't worry. EWH
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