[Question #6099] Assessment and testing
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70 months ago
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I had condom failure with an escort, stupidly continued unprotected vaginal sex for roughly 5 minutes in my drunken stupor. She seemed genuinely concerned and said she had tested 2 weeks earlier and was fine. I want to believe her, but idk how honest she would be. She was 20 yo. My anxiety was out of control so 2 1/2 days later ( 56 hours to be exact), I went into an urgent care clinic and was tested via urine for g/c. Test was DNA by PCR. Negative results. While it calmed me temporarily, now I’m thinking I tested too early with useless results! I’ve had no real symptoms of anything other occasionally feeling an icy/hot feeling at the top of my penis and maybe leaking a few drops of urine after urinating. Nothing constant so as I’ve read in previous discussions I don’t know if it’s simply anxiety or more. So I guess I’d like to know where to go from here. Should I trust the tests or Retest again? I’m now 5 days post incident. Any other testing I should pursue? I’m married and absolutely terrified that this mistake is going to ruin my life! I have had zero sexual contact with my wife since.
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H. Hunter Handsfield, MD
70 months ago
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Welcome to the forum. Thanks for your confidence in our services. I happened to log on a few minutes after you posted it: most users should not expect nearly real-time replies.
You can relax. You really are not at nearly the risk you apparently think. First, even among the most sexually active women, including sex workers, at any point in time most do not have tranmissible STIs. Second, it sounds like your partner tries to be careful and safe -- otherwise why was she upset at the condom failure? Most sex workers really do care about their health and take precautions.
That said, it is reasonable for you to be tested, not so much because the chance of infection is high, but for the reassurance you will gain from the results. Your gonorrhea test was not too soon -- you can be sure you don't have it. However, you should be re-tested for chlamydia. (Probably chlamydia testing was done; with the standard DNA tests, chlamydia testing is done automatically along with gonorrea. However, chlamydia testing may not be valid until 4-5 days after exposure. And although the risks of either syphilis or HIV were extremely low, you still should be tested 6 weeks after the event. Both are rare in most sex workers in the US, and both are transmitted inefficiently: even if your partner had HIV, the average transmission chance from a single episode of unprotected vaginal sex is around 1 in 2,500. So stay relaxed until you are tested: almost certainly the results will be negative.
As for your current symptoms, they definitely are not due to any STIs. As you apparently suspect yourself, this sounds like anxiety magnifying trivial symptoms that you otherwise wouldn't notice, or even normal body sesnations. Whenever someone suspects his or her own symptoms have an emotional/psychological origin, usually s/he is exactly right.
Assuming you have (another) chlamydia test with negative results, it should be fine to resume sex with your wife 10-12 days after the event. That's long enough to notice any STD symptoms (penile dischrage, blisters, sores, painful urination). But I advise against waiting to have sex at home for the 6 weeks until conclusive HIV and syphilis testing. It is exceedingly unlikely you caught either of them, low enough that it is reasonable to take the miniscule risk of having to 'fess up if either test is positive. If I were in your situation, that's what I would do -- and you can trust me: like you, I would never take a chance of harming my wife.
I hope these comments are helpful and reassuring. Let me know if anything isn't clear.
HHH, MD
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70 months ago
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Hello Dr Handsfield, so a few updates on my situation. I’ve been having some burning in my penis while holding urine. Also seems like I need to go a lot. Also problems with dribbling after urination is much more pronounced. No discharge I’ve ever seen thus far.
I returned and retested for Gon/chl testing after 5 1/2 days with negative results. No other testing thus far. Honestly I’m convinced I have urethritis of some sort by self examination, I wasn’t directed examined by the doctor since I didn’t have a discharge to report. Honestly I really don’t know what to do or try next. Treatment for NGU? Any advice you can give would be greatly appreciated! Thank you!
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70 months ago
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I apologize, I meant to add that my urine was negative for leukocytes however my protein was 30 mg/dL. Does this mean anything STD wise?
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H. Hunter Handsfield, MD
70 months ago
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The main symptom of an STD involving the urethra is discharge; urgency, frequency, dribbling, etc suggest bladder symptoms, which are rarely if ever caused by STDs. It could be a non-STD urinary tract infection, but very unlikely. Your symptoms also are typical for genitally focused anxiety. Absence of leukocytes also is strong evidence against urethritis, and against UTI. So you may be "convinced" you have urethrits, but there is no evidence for it. All I can suggest is to continue to work with your doctor(s) if your symptoms continue and/or you remain concerned, but I am confident you have neither NGU nor any other STD. ff you were my patient, based on what I know, I would not treat you for NGU or anything else.---
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70 months ago
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Symptoms progressed overnight with burning urination and trouble emptying my bladder. I saw my PCP today who confirmed my symptoms and ran a urine test. Many WBC found and notable swelling in my urethra.
I wanted to be tested for trich but they don’t have NAAT testing, only microscope and culture. He prescribed me metronidazole 500mg three times daily for 10 days and Azithromycin 500mg initial then 250mg once daily for 4 days.
My questions are:
1. Is this treatment reliable?
2. Any ballpark estimate how long to wait before sex with my wife so I wouldn’t have to worry about infecting her?
Thank you in advance. The service you provide on here is fantastic! I greatly appreciate the advice!
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H. Hunter Handsfield, MD
70 months ago
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Thanks for hte follow-up and glad you are being reevaluated. It now is apparent you have urethritis from the exposure described, despite my initial skepticism. It illustrates the importance of not relying on this or any other online resource as a substitute for direct care.
Trichomonas is very unlikely; it rarely causes such prominent symptoms, or any symptoms at all in men. I would not have prescribed metronidazole in this situation, unless the symptoms persisted after azithromycin alone.
1) Treatment reliability: First, I hope you were retested for both gonorrhea and chlamydia -- especially for gonorrhea, which would require additional antibiotic therapy. Azithromycin often works, but not reliably at the dose you were given. And even for chlamydia or NGU, there are no data on the azithromycin regimen you have been prescribed: standard treatment is a single dose of 1 gram. The 5 day regimen probably will work, but can't be certain since it has never been studied. Consider sharing this paragraph with your doctor and asking about taking 1g all at once.
2) Standard advice is to wait to have sex at least 7 days, or until symptoms have entirely cleared up, which sometimes takes a bit longer.
Threads normally are closed after two follow-up comments and replies, but I'll leave this open for another round. I'd like to hear how your symptoms fare in the next few days and about repeat gonorrhea/chlamydia testing. (The test will remain valid for 2-3 days, even if you have started treatment.)
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H. Hunter Handsfield, MD
70 months ago
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Two additional thought for you to discuss with your doctor, in response to your description of urethral "swelling": that's an additional reason for repeat gonorrhea testing, despite the previous negative result; and perhaps even to have a dose of ceftriaxone for presumed gonorrhea before the test result is known. Such swelling is not common with chlamydia, trichomonas, or NGU. Second, that swelling also raises the possibility of herpes, especially if there is tenderness or pain in the swollen area. Usually genital herpes causes external blisters/sores, but sometimes only the urethra is involved. A urethral swab for HSV PCR testing might be warranted.---
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70 months ago
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I tested negative for gon/chl at 2 1/2 days and 5 1/2 days. By swelling I mean my urethra but nothing crazy bad. I ask my doctor about herpes but he didn’t seem to think it was a concern. I’ll call and ask about swab testing for HSV. I’m absolutely freaking out now! Wouldn’t passing urine be super painful if I had lesions inside?? What are the chances? Sorry I’ll gladly pay for another question I’m just super worried now
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H. Hunter Handsfield, MD
70 months ago
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OK, I didn't know or forgot about the 5 day GC/CT test. If the swelling is mild and not tender, And yes, herpes in the urethra usually is very painful: a couple of my past patients described it as the worst pain they ever experienced. Going along with that, usually there is marked tenderness at the site(s) of urethral lesions. It sounds like your doctor knows his business and I agree herpes is not likely -- I wasn't sure from your previous description about the severity of your urethral symptoms. Don't worry about it.
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That will end this thread. It really shouldn't be necessary to continue at this point. Take the treatment as prescribed. If your symptoms resolve that should end it. Feel free to start a new thread if necessary if the symptoms continue or other important questions arise. But for sure give it several days before coming back. I really don't think it will be necessary. I hope the discussion has been helpful.