[Question #4880] Symptoms after oral concerned

25 months ago
Hello Dr.

I am male received unprotected oral on 12 Dec and developed symptoms by 15 dec which includes discharge, itching and tingling sensation. Didnt had any vaginal sex unprotected.

After a week i went for urine pcr for chlamydia and gron and tested negative. Repeated the test again after a week and tested negative.  Urine test resulted in sterile pyuria.

Went to local std clinic on 11 Jan and the Dr did physical examination, did penis swab tests and blood. All results are negative. My symptoms started to dissappear from 12 Jan and now discharge and burning sensation is completely gone. However i do feel like tingling sensation at the base on penis head occasionally.

I am concerned whether im developing any symptoms for herpes or any other stds. Considering three tests performed so far chlamaydia and gron and all resulted negative,  should i be concerned? 

I dont have any changes around genitals and urine is normal with no pain. 



25 months ago
Also curious if penis irritation followed by temporary discharge is possible without any underlying std if received oral. Only change i have done was to increase water intake and noticed relief.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome. Apologies for the somewhat longer than usual time for this reply.

You clearly acquired nongonococcal urethritis (NGU) from the oral sex exposure -- slightly atypical that symptoms started within 3 days. The negative tests for gonorrhea and chlamydia were conclusive, which is typical. The causes of NGU from oral exposure are not well understood, but often probably it results from enitrely normal mouth bacteria, not traditional STDs. 

NGU from oral sex probably is harmless -- no complications hve ever been reported, and there is no known danger for sex partners. Still, normally it is treated with doxycycline for a week or single-dose azithromycin. Were you treated? If not yet done, that would still make sense, even though your symptoms apparently are clearing up. Herpes is exceedingly unlikely; almost always initial herpes involving the urethra is highly painful, would not improve this fast, and would not cause mere "tingling" as you describe.

Normal practice for someone with NGU or any other STD would be to have blood tests for syphilis and HIV after a few weeks. However, the chance of either of these is virtually zero and I wouldn't worry about it.

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

HHH, MD
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24 months ago
Update:
I have been to another clinic and they have done all the tests again including herpes 2 and concluded i have got NGU. They have prescribed azithormycin single dose and cipro  twice a day for 7 days.

I am on day 3 still feel mild burning sensation. 
24 months ago
They have also tested for syphlis and trich. Doctor told me i have for urethra inflammation and also noted bacteria when examined under microscope for sample obtained from penis.
24 months ago
I travel often for work related and got tested in US, Australia and UK. All of them told tests are negative except the doctor in US who concluded as NGU. He inserted needle like equipment in penis to obtain sample from urethra which was not done in other countries.  In US they have also tested for hsv2 which was refused in Australia and UK. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Thanks for the additional information.

The ciprofloxacin was unnecessary. It's not recommended by any STD experts or authoritative guidelines; the azithromycin alone would have been sufficient. There are no STDs at all that respond well to cipro. 

It's good you had the various tests, and you can rely on the results. However, some of them were unnecessary. Trichomonas is not carried in the oral cavity, and cannot be acquired by oral sex. HSV2 also is rarely if ever acquired by oral sex. The refusal of herpes testing in Australia and the UK was appropriate; I would not have done it had you been in my clinic.

Anyway, assuming your symptoms clear up entirely, all will be well.  
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24 months ago
Thanks for the clarification- last question. If the symptoms still exit with sterile pyuria in urine post completion of antibiotics, should i still be concerned for stds? I have taken azithormycin 4*250 single dose three days back and still got very minor occasional sensation. My urine test on day 3 still showed sterile pyuria. 
24 months ago
Further to add, approx 12 hrs after taking azithromycin i have noted discharge again after around 2 weeks. This was the only time i noted since symptoms cleared up few weeks back.
24 months ago
Are there still chances of cause by virus or herpes? Doctor concluded my examining sample under microscope. Does that mean it was bacteria? 
24 months ago
As i started to develop symptoms again after 2 weeks clear. This started after taking azithromycin and while on day 3 of Cipro 500. As you mentioned, cipro is likely un effective, in your opinion would your prefer doxcy in case azithromycim failed?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
With this relatively complex and somewhat atypical situation, an online forum is not suitable to sort things out any more than we have already done. You'll need to rely on direct, in-person medical care if any symptoms are continuing, preferably from an STD-experienced doctor or clinic. If symptoms are gone, you can be confident the problem has resolved completely. However, I am very confident that neither herpes nor any other virus is involved.

That concludes this thread. I hope the discussion has been helpful.
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