[Question #5003] Genitally Focused Anxiety

26 months ago
Hello doctors,

Im having anxiety/guilt over a sexual exposure I had on Dec 21 2018. I'm a 28yo white man who had unprotected oral and protected vaginal sex with a 41yo white girl. After vaginal, I pulled out and noticed the condom slipped off completely leaving my penis exposed for roughly 2 minutes.

2 weeks after exposure, I got tested for gono and chlamydia which came out negative.

On Jan 9, 2019 I started feeling a sensation in my urethra (could be pain, burn or tingle). I'm aware of this sensation all the time and can't get my mind off it. I'm also so focused on it that it feels like it burns during urination and ejaculation. I also feel some pain in my testicles but nothing excruciating. I also have clear penile discharge when having a bowel movement (which I hear is normal).
5 weeks after exposure I went to the doc and had him examine my penis, do a urinalysis and a prostate exam. All turned out normal, but he said it could be prostatitis. About a week ago, I told him I was still feeling something down there and he prescribed Bactrim for 3 weeks. It's been almost a week and no change to my symptoms has occurred. I should also that I'm taking Prozac 40mg to try and get my head off of my junk, but this time it's not working.

Questions:

1. Would it be worth it to have tests done for U. Urealyticum, Mycoplasma Genitalium, Trich and Yeast?

2. Will I need to wait until the Bactrim is finished to test for those infections?

3. I've seen you guys say it many times, but can you give me sources that state prostatitis is rarely caused by an std (everywhere on the internet says they can besides you guys)?

4. Should I try seeing a urologist and see what they find?

5. If this were oral bacteria, U. Urealyticum or Mycoplasma Genitalium, would they have shown up on the urinalysis or at least shown WBC's?

6. If this is some sort of infection, what's the likelihood that it'll clear on it's own?

I look forward to your reply. Thanks for all you do!
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to our Forum.  I'll be glad to comment.  Your situation is a familiar one.  We know that when persons ar concerned about the possibility of acquiring an STI and focus their attention to look for infection, what they do is to become aware of normal sensations which they overlook otherwise.  Your negative tests prove the you did not get gonorrhea or Chlamydia.  Your challenge is to accept these results and stop worrying.  Really!!

In answer to your specific questions:
1.  I would absolutely recommend AGAINST testing for ureaplasma (normal flora) and yeast which would not cause the sort of symptoms you describe and which can also be present normally.  The yield of testing for M. Genitalium and trichamonas will be low and I see little benefit to testing.
2. If you choose to test, I would wait at least 4-5 days after completion of bactrim.  As I already said, I doubt that testing will be useful.
3.  The Internet is wrong.  I would suggest looking at a textbook.  This is common knowledge.  You experience with the Internet is exactly why we do not recommend it.
4.  As I indicated above, I think you ar going overboard.
5.  If you hand NGU from oral bacteria,  increased numbers of WBCs would most likely have been seen.
6.  The fact that your tests are negative and the antibiotics you are taking are strong indications that this is NOT an STI.

I hope this helps.  I think you are worried entirely to much.  EWH
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26 months ago
Dr. Hook,

Many thanks for your reply. This is the third time I got it anxiety over casual sex with someone I barely know. I know that whether I have an infection or not, I need to stop letting it eat me up inside. I think your response has given me some clarity on what i need to do moving forward.

Couple follow-up questions:

1. I'm starting to see someone which may turn into a long term relationship. Since I'm over worrying, do you think it best to practice protective sex until my mind is clear?

2. Do you know of any cases of urethritis where all symptoms were present besides discharge (burning urination, burning ejaculate)? Mind you the only time I have discharge is after a bowel movement and it's completely clear.

3. Could this be mild prostatitis brought on by some sort of non-std related bacteria?

Thanks again for your wisdom! 
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Straight to your Followup questions:
1.  Given your level of concerns, condoms to start with are probably to start with condoms.  If things are going well, a great next step, out of respect for each other (no blame, you want to be respectfully safe) would be to go together to get tested.
2.  Those are the main symptoms.   The clear discharge you mention may be prostatic fluid which is expressed when you move your bowels.
3.  Unlikely

Hope these followup comments help.  EWH
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26 months ago
Dr. Hook,

Your comments are very helpful. You as well as everyone I talk to ensure me that I have nothing. A couple more follow-up questions:

1. When you say to get tested, which ones do you think we should get tested for (Gono, Chlam, Syph, HIV, Hep, UU, MG,Trich, Herpes, all of the above)?

2. Could I be excreting prostatic fluid during a bowel movement because of a prostatic issue or is this normal?

Thanks again for all you do. If you want, I can post my test results if/when I get tested.
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Final Responses

1.  Were you to get tested to make sure all was well as you entered your relationship, I would test for chlamydia, gonorrhea and  trichomonas -these are the most important tests.  I might have blood tests for syphilis and HIV.  Your risk for hepatitis is very low and I do not feel strongly about testing for viral hepatitis of any sort.  I would not, and recommend against testing for ureaplasma, M. genitalium, or blood tests for herpes.    
2.  This is normal.

This completes this thread. There will be no more responses.  I trust that you will not need to return.  Take care. EWH
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