[Question #5269] Penis Discharge in the am

22 months ago
Hi Dr.,

I recently went to a upscale poker game that had cocktail waitresses that were very attractive and served drinks and would give massages at the table. After a few drinks i did some cocaine and one of the cocktail waitresses did some with me. She offered to let me do some off her and i did it off her breast. She had a pierced nipple and i licked and maybe sucked the nipple a little.  After hours of playing and drinking heavily and doing more blow i blacked out and have no recollection of events from 4 am till when i woke up at 1. I left there at 7 am in an Uber and was completely blacked out.  I don’t think anything sexual happened but not 100% sure. On Thursday morning 4 days later i woke up with a hard on and when i went to pee i squeezed from the base of my penis and i had some white looking discharge and was not sure if it was cum or pre cum but the pre cum is usually clear. I went to urgent care out of paranoia and the PA tested me for eveything. Calamidia, gonorrhea, hiv, syphillis, hep b, hep c. She also treated me as if i did have gonorrhea or chlamidia and gave me a shot in the ass and 2 pills and said if the test came back positive I’d be treated. Tests came back yesterday all negative. I was relieved, today i wake up and before i pee i squeeze on my penis and i see some white discharge!! Could it be possible the test was too early? They gave me a urine and swab but she only swabbed the inside of the tip. Also, is there any risk from a pierced nipple? What are your thoughts?? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back to the forum and thanks for your continued confidence in our services.

Looking at both this question and your threads 3 years ago (all with Dr. Hook), I have the feeling that you are generally more concerned about STDs and risks than most people, or than really warranted. I'm not being critical; that's just the way some people are. But this sounds like an extremely low risk situation. I have to suspect the PA would not have treated you on her own, but did so at your request or because you were highly concerne -- especially since you had no visible discharge when she examined you and apparently no increased white blood cells in your urethra. (A swab just inside the meatus is adequate.) Based on what you know of the exposure (or non-exposure) poker night events, if you had been in my cliniic, we would not have treated you (even upon request). 

Anyway, since there probably was no sex -- and oral contact with nipples is totally risk free, especially for STDs that could cause urethral discharge -- it seems you weren't at risk. And if there was, the tests for gonorrhea and HIV were conclusive; those tests will detect any infection acquired 4 days earlier. The blood test results all were too early to detect a new infection:  they are valid as baseline results to know you weren't infected before the event. For all, you would need retesting 6 weeks or more after exposure. However, for sure this was absolutely zero risk for all those -- and very low even if you had unprotected vaginal sex during the blackout. (But that's pretty much an urban myth. I doubt anyone ever is conscious enough to have sex yet inebreiated enough by alcohol or drugs to not recall it.) But you certainly could have follow-up tests for syphilis and HIV if the negative results would be more reassuring than my opinion based on science and statistical probabilities.) But not for hepatitis B or C:  zero risk.

What about your transient discharge? Any STD related discharge -- chlamydia, gonorrhea, nongonococcal urethritis (NGU) would not occur only once or intermittently, but would be continuous; usually accompanied by painful urination; and not when you otherwise would expect to see pre-ejaculate fluid. Although the latter usually isn't white, it can be, if prostate fluds or semen are mixed in. Finally, in the ecceedingly unlikely chance you actually had one of these, the treatments you had are highly reliablle. So even if you had something, it's gone now.

In summary, considering all factors -- low risk (or no) exposure, your symptoms, the PA evaluatiion, the negative tests, and the treatment you received -- there is no chance you have any STD from that evening. You really needn't worry further -- and as suggested above, there's no need for further tesitng, unless you feel you really need the additional negative blood tests in a few weeks in order to get past your worries about it.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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21 months ago
Thank you for taking the time to answer my question and yes I agree in your assessment that for some reason I am more concerned than most people about this. I feel good now other than a sore throat I had last week I have not had any other symptoms and I now think 99.99% nothing happened so no need to imagine worst case scenarios. I did freak out when i saw what i imagined to be discharge but in hindsight it had to be some sort of pre ejaculate. Take care Dr. and thank you for providing this resource. If anything else comes up I can open another ticket, you can close this one out. Thanks again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Thanks for the kind words. I'm glad to have helped.---