[Question #5105] Epididymitis/Urethritis Post-Oral Exposure x 3 Months

26 months ago

About three months ago, I received unprotected oral sex from a woman of questionable STI status. I immediately (within hours) began experiencing psychosomatic symptoms, e.g. an unrelieved stinging sensation at the urinary meatus. Because my perception of its magnitude changed depending on how focused on other tasks I was, I attributed it to classic genitally-focused anxiety and a lack of a definitive, negative N. Gonorrhoeae NAT/PCR. Life went on.

Last month, I took a 5-day regiment of azithromycin for sinusitis and, around day 4, had a episode of acute right testicular pain, washing away any self-assurance I may have had. I'm not sure if the anxiety or the nausea was worse. Anyway, the pain subsided but didn't disappear over the next few days and, fearing some kind of transient torsion event since there was no trauma, I went to a urologist.

I reported my last new partner as being two months prior, no discharge, and no change/pain on urination. After an ultrasound of my scrotum, bladder, and prostate, he palpated my epididymis and I left with fourteen days of doxycyline and cipro for epididymitis, in spite of the lack of tenderness/swelling for "due caution." The in-house UA showed neither leukocyte esterase nor nitrites. I'm not sure if he sent my urine off for STI checking. My yearly nephrologist visit the next week ruled out referred pain.

The stinging meatus sensation is as prominent as ever now, especially when I have to urinate. I realize its probably not the gram-negative superbug that my brain occasionally thinks it is, but the continued unreproducible-on-palpation testicular discomfort is worrisome.

So:

Is it possible the azithromycin knocked down a potential urethral infection to a point where I'd have a clean UA?

Is gonnoccocal epididymitis, sans discharge, even a possibility two months in?

Any thoughts on where to go from here? NSAIDs are a non-starter thanks to CKD, but the endless focus on my mid-section is wearing me a little thin.

Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to our Forum.  I'll do my best to help.  I appreciate your detailed and thoughtful description and self-analysis.  Your assessment that when persons have sexual encounters that, after the fact, they regret and start to look for signs or symptoms of STIs, it is typical to become aware of sensations that otherwise go unnoticed.  The most common such sensations are local "itch" or, somewhat less commonly, "stinging".  Testicular discomfort is also relatively common.  NAATs are among the most sensitive tests for STIs ever developed and your negative tests effectively prove that you were not infected.  

I think you need to look otherwise for a cause of your testicular pain and would not want to attribute it to an STI acquired during your misstep without some other evidence of infection- a positive test, abnormalities on urinalysis, or otherwise.  STI is most unlikely.

In answer to your specific questions:
Is it possible the azithromycin knocked down a potential urethral infection to a point where I'd have a clean UA?
A small proportion - 5-10% of chlamydial infections are both asymptomatic and are not associated with the presence of WHC but this is rare and acquisition of chlamydial infection from oral sex is very, very rare.  Further, if your pain was due to infection, then signs of inflammation (WBCs) should absolutely be present.  Thus your clean UA is indicative of the absence of inflammation/infection.

Is gonnoccocal epididymitis, sans discharge, even a possibility two months in?
Not realistically

Any thoughts on where to go from here? NSAIDs are a non-starter thanks to CKD, but the endless focus on my mid-section is wearing me a little thin.
Hopefully, my reassurance that this is not an STI will help.  In addition, I'd urge you to stay off the internet and to stop self-examination.

I hope this is helpful.  Nothing you describe suggests and STI to me.  EWH

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26 months ago
I guess I didn't articulate that as well as I'd hoped. I have NOT been tested for gonorrhea or chlamydia by NAAT or PCR. With that in mind, does your reply still stand? If so, I'll try to put the anxiety/obsessive Google'ing behind me.
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Thanks for the clarification.  I still consider an STI as most unlikely as the cause of your symptoms.  That said, if you think a negative test would help your concerns and allow you to shift your focus, then testing may be worthwhile.  I am confident that if you tests, the test will be negative.  EWH---