Hello Dr

English is not my native language. I’m 42 men, monogamous for 20y.

 1year ago- unprotected oral sex from SW

2days later- unprotected sex with my wife.

4days later a few painless herpes like lesions on my upper abdomen and lower chest. They healed rapidly. I was extremely stressed and concerned about acute HIV. Repeated HIV- negative.

Some days later I felt testicular discomfort and mild clear morning discharge. Tests were not performed and during next 6 weeks I received Ceftriaxone 1gr /Azithromycin 1gr, Doxycycline 10d, Moxifloxacine 7d. No effect. Tests were performed: FVU PCR for GC, CT, TV, MG, MH, UU, UP- neg. Urinary sediment- WBC- neg, culture- neg. Blood tests panel- neg. Swab  not performed.

During next 10 months I felt normal, but was concerned about possible transmission to my wife.

5m ago- my wife felt discomfort. Candida was diagnosed and treated with rapid improvement.

4m ago- she noticed small (4-5 mm) node in labia minor. Location was inappropriate for Bartholin gland. It was like sebaceous cyst. The node was manually drained with small amount of sebaceous content and healed rapidly. I was asymptomatic, but much stressed. We both received Ceftriaxone 1g/ azitromycin1g.

 3m ago she felt recurrence of candida and I was stressed.  I was sure that my symptoms will recur and it happened after 2 days.

2m ago I’m still symptomatic and stressed. I read obsessively STD literature.  Tests were repeated (2m after last ABx).

FVU collected 7-8h after last urination. Urine contained morning discharge. Volume was small to prevent dilution. PCR and Blood (Treponema Ab, HIV, HSV1/2, HBV, HCV)- all negative. WBC- neg, culture- neg. Swab not performed.

 1m ago the symptoms worsened. I was concerned about false negative results; especially CT and AB resistant pathogens.  We both received double dose Ceftriaxone1g/azitromycin2g and continued doxycycline until now (14days). There is no effect. I still have morning clear discharge and intermittent testicular discomfort. The last 2 days discharge was also at midday.   

-My wife had no tests (she doesn’t know about my adventure). We had unprotected sex for 1y and I was tested negative. We received the same treatment excluding first course. What is possibility that I infected her?

-Does treatment that we received cover all possible infections?

-Do you think that symptoms may be result of stress and sex abstinence for a long time?

Thank you

Welcome to the Forum.  I will try to help.  It is, of course, difficult to tell whether or not you got an STI or not from your casual sexual encounter a year ago.  Statistically it is unlikely that you did get an STI- most people do not have STIs and even among people with STIs, oral infections are uncommon.    If you did get an STI, from what you tell me, it was most likely non-chlamydial NGU, a problem believed to relate to transfer of your partner's mouth bacteria to your penis.  If this did happen (it may not have), this is typically not a problem which is transmissible to future sexual partners and, if it does occur, does not represent a danger to your or your partner's health.  My suspicion however is that because of your guilt, you have looked harder for signs of infection than you would normally and noted normal findings which, since you had not seen them in the past, you thought were abnormal.  Testicular discomfort of the sort you describe is not a typical indicator of STI and most men have a small amount of clear urethral discharge which is normal but goes unnoticed unless a person is looking closely. From what you have told me, there is certainly no indication that you are infected. 

I suspect the lesions on your abdomen and upper chest were folliculitis, not herpes, particularly since you have had negative herpes tests since then.

It is more likely that you were not infected.  Further, your repeated negative tests for many STIs indicate reliably that you are not infected at this time.  Even if you had been infected, the multiple treatments you have taken would have cured common STIs.

At this time, I strongly advise you to do your best to stop worrying and to stop your excessive self-examinations. if you had been infected, the symptoms of infection would have been easier to see.  I hope this assessment is helpful to you.  EWH

Your concerns are not warranted.  You are worrying unnecessarily:

1. What, theoretically, may lead to symptoms exacerbation during so massive antibiotic treatment? Is candida possible?

This is a silly question- theoretically this could be due to some of treatment failure or the effect of an invasion of alien STIs from outer space.  What is more likely however is that your guilt and anxiety are making you focus on POSSIBLE symptoms and leading you to notice normal variations and the sorts of everyday illnesses and symptoms that most people have from time to time and attribute them to an STI.  From a scientific and medical perspective this is about as likely as having an infection from outer space.

2. What is real sensitivity of FVU PCR?

These are among the most sensitive tests for STI diagnosis we have EVER had.  your tests were negative not once but twice.  The likelihood that you have one of the infections you were tested for is less than a small fraction of 1%, because of negative tests, as well as the low risk nature of your exposure and the antibiotics you have taken.

3. Is WBC in FVU sediment equivalent to WBC in swab for diagnosis of urethritis? May not making swab miss urethritis and pathogens or FVU is good enough?

No, a FVU is not quite as sensitive as test for WBCs as a swab.  You however have been tested not only for WBCs but for the pathogens.  You should believe your test results