[Question #5412] Help-Anxiety and Fear of STD

21 months ago
Hi and thanks in advance for the help. I had unprotected oral sex with woman I did not know in December, 2017. Married and immediately had tremendous guilt and regret. About three days later I felt dull pain in one testicle. That was followed by frequent urge to urinate and weak stream. Other General discomfort in pelvic region. No discharge and no pain urinating for the most part. Stupidly panicked and took Amoxicillin I had. No impact on symptoms. Went for testing and did 10 panel test and all game back negative. Went to doc and urinalysis clear, but doc prescribed levaquin for potential prostate infection and was on for like 25 days. took for like 10 days with no change and returned to doc who then also put on flowmax and that helped urgency and stream issue a lot. Some pelvic discomfort but generally good. Tested again like two months after exposure to confirm as I was worried antibiotics could have impacted. All clear. Also included Trich that time. Was pretty good until summer when frequency issue and other discomfort returned. Symptoms persisted pretty good for a month and then dissipated again. Outside of frequent urination and weak stream, a level of discomfort in penis and scrotum, discomfort behind scrotum in that area, etc. Generally consistent with what I read about pelvic pain syndrome.  Symptoms have returned again in last 2-3 weeks. Still on flomax but not as helpful. Worked great at first. Generally no discharge. On two occasions in last month I have noticed clear fluid, first time I thought it could have been urine. Could be pre-cum and totally clear.  I don’t think I have otherwise had anything that could be described as discharge.  My partner beginning maybe 6 months after exposure had a few odd things. Discharge once and or twice that I am aware of (don’t believe on going) and spotting a little bit before period starts. I got tested again 10 paneHave had major anxiety and guilt from this. Have never had vaginal sex with anyone other than my wife.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to the Forum.  I'll try to help.  I'm afraid I must tell you however that your symptoms are not due to and STI.  The evidence supporting this statement are many and include:
1. Receipt of oral sex is a relatively low risk event to acquisition of STIs.  Most women do not have STIs and when they do, pharyngeal infections are not efficiently transmitted.
 2.  Urinary frequency is not a sign of STIs.
3. You have been tested on multiple occasions with negative results.  Current tests for the most common STIs are among the most sensitive tests in all of medicine.
4.  You have taken several courses of antibiotics which would cure most STIs including syphilis, chlamydia, NGU, and most gonorrhea.
5.  Your problems appear to have come and gone, this is not typical of STIs.

As you have already acknowledged, you are quite anxious and feeling guilty about your misstep.  Urinary frequency occurs commonly with anxiety.  You entire problem may well be a reflection of your guilt and anxiety.  My sincere advice is that this is one of those situations when you would probably benefit most by talking things through with a confidential, professional counselor.  

Alternatively, as you have already alluded to there may also be some other urological problem contributing to symptoms (in my opinion, if this is contributing, it is likely heightened and intensified by your guilt and resulting anxiety). That Flomax has helped some suggests this but in my opinion, the first thing to address here is your guilt over your misstep.  I see no reason for further STI testing and no role for further antibiotic therapy for a possible STI.

I hope my comments are helpful. EWH
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21 months ago
Thank you Dr. Hook! Your response helps a lot. I think sometimes it is hard to believe that anxiety can have such a significant physical manifestation, but rationally I know that it can. I wasn’t tested for Mycoplasma Genitalium. I assume your answer remains the same? You guys really perform a helpful and needed service and it is much appreciated.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for your thanks.  You are correct, the fact that you were not tested for M. genitalium in no way changes my assessment or advice.  EWH
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21 months ago
Thanks and my last quick follow up. You said that urinary frequency is not a symptom of an STI. That includes a feeling like I have to urinate even after I have just gone? Again, this comes and goes. Yesterday I felt pretty normal, today it is constant. Thanks again for your help. I will sleep much better tonight.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Correct, the sensation of incomplete emptying is not an STI symptom.  It is a symptoms of prostate problems. If this is a part of your symptoms, evaluation by a urologist may be helpful.  EWH---