[Question #496] Prostatitis caused by STD/STI?

42 months ago
Sir/Ma'am,
I received unprotected fellatio from sex worker 2 months ago and immediately received problems two days later. My prostate,and abdominal were sore so I took a full STD panel test including trich and was all was negative. I was still having problems with prostatitis so I went to Nurse PA and received 7 days zithromycin, and menzadole. He checked my prostate and I was told it was boggy. He also put me on 45 days of Cipro, which during the half way mark I received oral sex from the same worker and immediately felt even worse symptoms than before. When I got off Cipro I had extreme burning in the prostate, burning and tender urethra, dribbling urine, sore rectum, and tender scrotum. No pus. Is it possible I received another infection? Trich is very hard to test for and its hard to cure. Is it mycoplasma or chymydia?I know because i had it before from oral sex and it was resistant. I'm back on Cipro for 1 month and I want to know the option. I can't have sex because Im scared I might pass something.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question.

I'm quite sure you don't have any STD and never did. Here are some general reasons, followed by comments about some of your specific symptoms and other issues. This is going to sound pretty blunt -- but I think you want straight talk, not beating around the bush.

Oral sex rarely transmits STDs. There are no STDs or oral bacteria known to cause prostate infections. Two days is too soon for symptoms from just about any STD except occasionally for gonorrrhea, which for sure you don't have and almost certainly never did. Neither trichomonas nor mycoplasma infects or is carried in the mouth or throat, hence no possibility of contracting them by oral sex, and chlamydia rarely so. If you had chlamydia, it would have responded to treatment; there has never been a known chlamydia strain resistant to azithromycin. Diagnosing prostatitis is difficult even for the most expert in the field, and rectal exam to determine prostate abnormalities (such as a "boggy" consistency) is very inaccurate.*

Your symptoms are most consitent with genitally focused anxiety and/or the chronic pelvic pain syndrome (these two conditions may be the same). In any case, even if you had true prostatitis, I would chalk it up as a coincidence, and not from the oral sex exposure. Finallly, the lack of response to antibiotics, both azithromycin and ciprofloxacin, is not evidence of an infection resistant to those antibiotics. Rather, it suggests no infection was the cause of your symptoms. While most physicians give cipro or other antibiotics a try in this situation, usually the result is as you experienced:  it doesn't help. Unfortunately, I doubt the repeat treatment you have started will be any more effective.

So, where to go from here? First, discuss all this with your urologist or whoever is managing your care. I'll bet you'll find a lot of agreement. Second, resume sex with your regular partner, if you have one. Even if you (or your urologist) doubt my assessment, I can state with 100% assurance that sexual activity will not harm you, and that you have nothing that could possibly harm any current or future sex partner. Third, this is an issue of pain and discomfort, but not harm; you have nothing that will ever cause damage or ill health other than the discomfort. No cancer, no infertility, nothing that will be a problem. No complications have ever been documented as a result of chronic prostatitis or CPPS. Finally, once these things all sink in -- i.e. a true understanding and belief that nothing serious is wrong and that all will be well -- my bet is that your symptoms will melt away.

As I said, pretty blunt. But I hope you understand and that it helps. Let me know if anything is unclear or if I can otherwise help any further.

Best regards--  HHH, MD

*I'll bet if you could lined up 10 of the most experienced urologists and/or STD experts, present them with 10 patients and tell them 3 were thought to have prostatitis, and not tell them which ones, most of them would miss two of the three with "boggy" prostates and diagnose it in two more without actual abnormalities. I consider myself highly expert, and I certainly can't tell a normal from "boggy" prostates most of the time. 
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
I meant to say more about my opening statement that "Oral sex rarely transmits STDs." Oral sex isn't completely risk free, of course. But it's zero risk for some STDs and low risk for the rest. For example, much less likely to transmit infection than unprotected vaginal or anal sex. And for sure oral sex has not been known to cause prostatitis.

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42 months ago
Thanks Dr Handsfield!
I'm just nervous because three years I received unprotected oral sex from someone and had different symptoms like white pus coming from my penis. I was told I had Trich from my doctor at a deployed location and I received 7 days of metronidazole 1 gram to 2 a day I think to knock the bug out. I remember being sick from the medication and my prostate slowly healing in 2 weeks. Rewind over 3 yrs later I receive oral sex again from a sex worker and the same symptoms happen. I committed adultery on my beautiful wife and I don't know how to get past this pain but confess and pray. Dr. should I stop taking the Cipro and what should help me with a inflamed or infection of the prostate. STDs are so misunderstood it's scary. Also if trich was only cased by vaginal intercourse than why did my girlfriend at the time had vaginal problems similar to BV? Man I done messing around because it's wrong and just karma stuff.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
NOTE THIS IS A CORRECTED REPLY. If you already read it, take another look; I corrected a couple of misstatements and reposted it almost an hour later.

Thanks for the additional information. For the reasons above,the episode 3 years ago probably wasn't trichomonas, unless it was acquired from your girlfriend at the time. Also, trich rarely causes any symptoms in men. However, it might be speculated that treatment with metronidazole -- which would have no effect on gonorrhea or nongonococcal urethritis (NGU) -- might have allowed progression of infection (or non-infectious inflammation) to involve the prostate. You apparently had a girlfriend at the time who had bacterial vaginosis and/or other "vaginal problems", so your urethritis might have been from her, not from the oral sex event at that time. Or maybe even trichomonas, which can be difficult to distinguish from BV.

If you don't mind a bit of amateur psychoanalysis, your choice of terms to describe the recent oral sex event contains more clues about your present symptoms. "Committed adultery" and "my beautifful wife" are emotionally loaded terms (as opposed to "I had sex outside my marriage", for example); and "confess and pray" imply an upbringing or life philosophy that seems to imply great guilt and shame over a sexual decision you regret, which wouldn't much bother some people. All reinforcing my guesstimate above about a largely psychological origin of your symptoms. And by the way, that doesn't imply I believe your pain is "in your head". It is real pain with a known physiologic mechanism: just as stress-related headaches are real pain from increased tension in scalp and neck muscles, so genitally focused anxiety pain is due to pelvic muscle tension or spasm. In other words, real pain but still with a psychological origin.

As implied above, it is conceivable your urethritis 3 years ago was from your girlfriend, not the oral sex event. BV is easily misdiagnosed as trichomonas and vice versa; trich can be carried in the vagina for years. In any caseif you and your girfriend were sexually active together at the time you had the oral sex exposure back then, she needed treatment, and you both should have received more than just metronidazole. So it is conceivable you had something smoldering for years that is now contributing to your symptoms. (Having said above that prostatitis isn't sexually transmitted, and there is no proved connection with sexually acquired NGU, it hasn't been carefully researched and some experts think NGU and prostate symptoms may be related to one another.)

I'm not your doctor and can't give specific treatment advice. However, I think you should discuss all this with your doctor (you could print this discussion) and ask him -- then make a joint decision -- whether to continue or stop your current ciprofloxacin treatment.
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