[Question #5637] Sore testicle

21 months ago
I am a 42yr old male.  I am healthy, have had a vasectomy and am circumcised.  
I have a couple concerns. While on a trip I met a couple on a dating site for a hookup.  They are in their late twenties early thirties.  They (both male and female) performed unprotected oral on me.  I also had condom protected vaginal sex.  I had troubles putting the condom on but it did not break.  I finished in the condom.  To my knowledge my penis didn’t come into contact with his yet she did perform oral on both of us.  There was no anal sex.  I had asked them if they were “clean” and they said they are tested regularly.  Because they are strangers I can’t guarantee that.  Assuming oral sex is safer sex I felt relatively ok about the interaction.  All seemed well seven days later and I had unprotected intercourse with my partner.  After nine days  I started getting a dull ache from my left testicle.   I did go for a very aggressive long run that day and it was hotter then normal.  I don’t normally run that much.  The ache (sensitive to touch but not unbearable) has continued for a couple days.  It seems to go away for the most part when I sit or lay down.   I would rank the pain at about a 3-4 out of 10.  I do not have any discharge whatsoever or any burning during urination.   I may be urinating more often but I can’t say for sure.  There is no urgency however.  It also feels like I am constipated even though I am regular.  Hernia has been ruled out. I went to urgent care and he gave me Cipro.
My main concern is that I may have Gonorrhea and have given it to my partner.    Is this likely?
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to the Forum and thanks for your question.  I'll be glad to comment.  Your major risk for infection from the encounter you describe is having received unprotected fellatio from two new partners.  Most people, even those with multiple partners, do not have STIs and oral sex only relatively rarely leads to infection.  When it does, the most common problems are either gonorrhea or non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex.  Both infections are typically symptomatic, causing a penile discharge or burning on urination.  Urinary frequency is NOT a sign of STI.  This sort of non-chlamydial NGU is not clearly and STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the United Kingdom, many specialists do not treat NGU associated with oral sex.  When treated, oral sex-related NGU typically resolves quickly  the ciprofloxacin you took would cure many cases of gonorrhea and non-chlamydial NGU. 

It would have been good if the health care provider you saw obtained a urinalysis and tested for gonorrhea but in its absence, it remains quite unlikely that your current symptoms are an STI.  When STIs progress to involve the testicles, there is typically a penile discharge present as well and the discomfort progresses, neither of which appear to be present in your situation.  Your discomfort is more consistent with local trauma.

I hope this comment is helpful. If there are further questions, please use your up to two follow-up questions for clarification.  EWH
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21 months ago
Thank you for your comments.   Given your response it sounds like the chances of the pain being an sti are low.   As a follow up, is the testicle pain without discharge or burning something that would almost never happen. A rough number estimate would be appreciated.  I had read that Gonorrhea has a very high chance of exhibiting symptoms and typically those symptoms are burning and discharge. 
If in the off chance I had contracted Gonorrhea what is the chances I passed it on to my partner
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
You are correct in your summary.  This is most unlikely o be gonorrhea or any other STI.  I cannot give you a precise estimate of the proportion of sexually transmitted epididymitis (testicular infection) which would not have discharge or burning on urination but it is certainly far less than 10% and when you combine this with the fact that at your symptoms are not getting worse, the chance that this is an STI become negligible.  

If it were gonorrhea, the risk of transmission through sex and before you took antibiotics is about 30-40% per act of unprotected intercourse.  EWH
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21 months ago
Thank you for your response. Based on your assessment I’m guessing it is ok to continue intercourse with my partner. 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
I agree.  EWH---
20 months ago
Just a follow up. After the antibiotics the swelling went down a lot. It has gone back down to normal size. There is a very small amount of discomfort remaining around the testicle area but I only seem to notice when I bathe or grab myself. I would rate it at a 1-2 out of 10 on a pain scale. I went to get a ultrasound done on my sore testicle. The doctor said I had a little extra blood around the testicle. And I  have what looks like orcitis but he didn’t seem confident.   He asked if I had been tested for Chlamydia I said no. I told him that I had only had unprotected oral sex. He told me that I could get chlamydia from oral sex. I mentioned to him about the facts you gave me but he shrugged them off. I am curious what your thoughts are on this opinion. And if you still think it sounds like an injury. 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Chlamydia from oral sex is very, very uncommon.  I still feel this is most likely to be due to trauma and is not chlamydia or other STI.  Of course you could easily resolve it with a chlamydia test if you wish which I am confident will be negative.  EWH---