[Question #4955] Oral Sex, Burning in Urethra, and mild ED

24 months ago
Dear Doctors - I had three encounters with three different female sex workers in January. In all three instances, I received unprotected oral sex and also performed unprotected cunnilingus. In one instance, I also briefly licked a female sex worker's anus. In the last few days, I've noticed two things: that, for the first time in my life, I do not get an erection or maintain one very easily, and, more importantly (perhaps), burning in my urethra, often right after (but not during) urination. The burning seems to extend through the inside of the penis, right to the tip (where the burning sensation is often most noticeable).

I currently live and work in a country that would revoke my residence permit if I were to be diagnosed with an STD. I will not be able to get tested until I am back home in the U.S.A. in early June. I have a few questions:

1. What are the chances of contracting chlamidya, syphilis, or ghonorreah through oral sex and cunnilingus? Are any statistics available?
2. What are the odds of contracting HIV in these circumstances? Do you recommend HIV testing, or are the odds too low to justify a test? Do the two symptoms I've described seem consistent with HIV? (Given the seriousness of HIV, I am most concerned about it.....)
3. How harmful would it be if I wait until early June (four months) to get tested (assuming I do have something)? I've read that treatment should start a.s.a.p. if someone has something, but I don't know if four months is too long or not.
4. Do you know if there a way to get the appropriate antibiotics (for chlamidya, syphilis, or ghonoreah) shipped from an online site, or do they all require a prescription from a doctor? I am thinking I could take a course of meds, even without testing positive.

Thanks, - A
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Welcome to the Forum.  I'll be glad to comment.  Among varieties of penetrative sexual activity, oral sex is a relatively low risk event although, perhaps with the exception of HIV, infections can be occasionally transmitted if one of your partners was infected.  Your bringing symptoms suggest that you may have a urethral infection (urethritis).  Erectile dysfunction is not clearly an STI symptoms and may be more reflective of your concerns over your exposures and subsequent symptoms.   Following the receipt of oral sex, the most common infection is non-gonococcal urethritis (NGU) which may be causes by chlamydia but more commonly results from introduction of oral bacteria into the urethra.  Gonorrhea can be acquired from receipt of oral sex as well.  The risk for STI acquisition from cunnilingus is lower than from giving or receiving fellatio.  Infections like syphilis or herpes would present with lesions which would be visible.  There are no cases is which HIV has been proven to be acquired from either receipt of fellatio or performing cunnilingus.  Thus, in answer to your specific questions:

  
1. What are the chances of contracting chlamidya, syphilis, or ghonorreah through oral sex and cunnilingus? Are any statistics available? 
See above.  There are no accurate statistics on the per encounter risk of infection, if a partner is infected (most people are not infected) although it is clear that, if a partner is infected most (less than 25%) of encounters lead to infection.

2. What are the odds of contracting HIV in these circumstances? Do you recommend HIV testing, or are the odds too low to justify a test? Do the two symptoms I've described seem consistent with HIV? (Given the seriousness of HIV, I am most concerned about it.....)
See above.  These sorts of exposures are not known risks for HIV.  There are no proven cases in which HIV has been acquired by either receipt of fellatio or through cunnilingus.  Your symptoms are not consistent with HIV either.

3. How harmful would it be if I wait until early June (four months) to get tested (assuming I do have something)? I've read that treatment should start a.s.a.p. if someone has something, but I don't know if four months is too long or not. 
Delaying evaluation means that you could transmit your infection to others and puts you at risk for more serious complication such as epididymitis, if you are infected.  Evaluation sooner is far and away preferable.

4. Do you know if there a way to get the appropriate antibiotics (for chlamidya, syphilis, or ghonoreah) shipped from an online site, or do they all require a prescription from a doctor? I am thinking I could take a course of meds, even without testing positive. 
The availability of antibiotics without a prescription varies from country to country.  I would also add that taking antibiotics without knowing what is being treated does not mean that you will be taking the right antibiotic (different antibiotics are recommended for different infections) and may put you at risk for side effects.  My suspicion is that there are ways to discretely get tested, no matter where you are.  I suggest you quietly explore this possibility, I am confident you are not the first person to find themselves in this situation.

I hope these comments are helpful.  EWH
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24 months ago
Thanks, Dr. Hook. I'll try and see about anonymous tests here. Everywhere I've called seems to require submitting the residence permit. If I'm able to do it, I'll pay out of pocket. Is it safe to say I need not worry about getting the HIV test? And it sounds like syphilis is also unlikely given my symptoms. So, if you were in my shoes, would you suffice with just the ghonorreah and and chlamydia tests and then -- if things are negative, or if a round of treatment is completed -- go back to normal sexual activity without fear of infecting others?
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
You are correct, I would not worry about HIV or syphilis.  Testing for gonorrhea, chlamydia and NGU (i.e. urethral inflammation - increased numbers of white blood cells in your urethral secretions or, if that is not possible, your urine) would be my highest priorities and will help to guide decisions about the need for therapy.  EWH---
24 months ago
Dear Dr. Hook - I know this is my last reply. I found a doctor here to treat me anonymously and without insurance. He said he couldn't test me because the law would obligate him to report me if the test came back positive. However, he said it certainly sounds like ghonorreah//chlamydia and suggested treatment just in case. He prescribed two antibiotics he said should take care of both illnesses. Unfortunately, I don't remember the names of the meds. Both were orally administered (no injection was given). I took one for five days (one pill per day), and the other was for three days (two pills per day). I finished up the treatment yesterday. Nothing has changed, except that i have one NEW symptom -- I feel a numbing/tingling in my scrotum and urethra (all the way back to the rectum area). The burning sensation in the urethra is also still there. I should note that the numbing sensation is not painful at all, and the burning in the urethra is quite mild (and furthermore only occasional). I think I am safe to go back to him and ask him to prescribe additional meds. I'm concerned, though, that I'm resistant to the antibiotics. What do you recommend? Is there a specific course of meds that work best? I am in a third world country without great care. The other option is waiting until early June when I back in the U.S. I can absolutely tolerate the sensations I am feeling, but I don't want to risk any long-term problems. Your thoughts would be appreciated. Thanks so much. - A
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
It is difficult for me to even guess what antibiotics this person gave you but I can tell you that the recommended therapy for gonorrhea, chlamydia and NGU are all typically either single dose or occasionally sever days of therapy.  Perhaps, depending on the medication you took, you were overtreated with medications which would have cured these problems but without knowing their names, I simply cannot comment.  Presuming however that the medications you took were active against most STIs, your non-response may indicate that your symptoms were not STIs and not related to the low risk exposure you described in your initial post and that your problem may be non-STI in nature.  Your current dilemma is just the reason that we try not to treat persons without knowing what it is that is being treated.  

I simply do not have enough information to even venture a guess as to what is causing your symptoms and, in addition to the fact that we do not make specific diagnoses on this site, it would be unethical to guess at treatment at this time.  At this time, my advice is to see a health care provider.  Your exposure was low risk to start with, your symptoms were not typical of the most common STIs and the progression of the sensory changes you are experiencing is more consistent with a non-STI problem than an STI.

Sorry I can't be more help.  

As you point out, this thread will be administratively closed later today.  EWH
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