[Question #6130] Persisting Symptoms
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70 months ago
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Hello Dr. Thank you for your service. I am asking for your expert diagnosis and advice. At the beginning of this year I began experiencing symptoms of Urethritis/Prostatitis/UTI (not sure which is more likely). It all started after I went and got a massage. Their was no sexual contact during the massage, however I did lay naked on the table and at the end was rubbed with oil and a hot towel, which did include my genitals. I can't remember if the masseuse's hands touched there but they may have, however there was no extensive handjob or anything like that. Two days later I started experiencing symptoms that included aching testicles, frequent urination, slight burning when urinating. I didn't have any discharge except one time when I was peeing, semen (I don't think this was discharge) came out in my urine. Currently, whenever I am aroused, I am having large amounts of pre-ejaculate fluid (clear) and after urination I have lots of urine dribbling. It also seems like I am ejaculating at a much quicker rate. Anyway, three weeks after these symptoms appeared, I got tested for Gonorrhea, Chlamydia, Trich, HIV, Syphilis and all were negative. I trusted the results and tried to forgot about it, however all the symptoms still persist (ten months later) except I longer experience burning and the aching testicles is on and off (and mild at that). I recently went to the urologist and had a urinalysis ( normal) and tested for mycoplasma/ureaplasma (negative). The urologist prescribed me doxycycline and said she would leave it up to me if I want to take it. She said that a non-sexual bacteria could have gotten in my urethra and is causing the problems or that this could be an anatomical issue. I would find it hard to believe that this is a coincidence right after my massage. So my question to you is what should I do? Should I take the antibiotics (I prefer to avoid these unless no other option)? Should I retest? What could I have been exposed to, was this an at risk event? Is
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Edward W. Hook M.D.
70 months ago
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Welcome to our Forum. Thanks for your question. From the sounds of things, you have done everything right. I'll make a number of comments below which I hope you find helpful.
1. The encounter you describe was a biologically no risk event. STIs which cause urinary symptoms only occur with penetrative sexual activity. The encounter you describe did not include penetration.
2. You have tested for all of the right pathogens and your tests are negative. Currently available tests are exquisitely sensitive. Negative tests prove that you were not infected.
3. Your urologist clearly is not concerned about infection. If she were, she would have encouraged you to take antibiotic therapy. That she left it to you is strong evidence that she was doubtful that this is an infectious process.
4. You may have prostatitis, which is typically NOT an STI. More likely however you have the CPPS (the chronic pelvic pain syndrome) which typically is NOT an STI and NOT responsive to antibiotics.
Bottom line, The encounter you describe raises no concern related to an STI. Your urologist sounds appropriately thoughtful and circumspect regarding the origin of these symptoms. That said, you have proved that this is not an STI.
I hope this analysis and response is helpful to you. EWH
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70 months ago
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Thank you Dr. for your reply. I have a couple of follow up questions and wanted to add some information to my case. I didn't test for HSV or HPV because I never had any rashes or blemishes, also I have never felt sick with a fever or flu or anything else during this time.
1. Is it possible that the dirty sheets/towels/ masseuse hands transferred a bacteria that is causing my problems? I find it odd that this started happening two days after the massage. This place didn't seem to be the most cleanly establishment and I get the feeling "other activities" may go on there, increasing my risk. I want to add that I am uncircumcised so I am guessing I am more at risk with bacteria. If this is a non-sexual bacteria, would something show up in my urinalysis?
2. Would you suggest I take doxy or would you advise against it? If I have prostatitis or CPPS, what should I ask my urologist for/how can it be tested? Also, what are the causes of this, could I have acquired it at the massage parlor? Will they go away?
3. My biggest remaining symptoms are large amounts of pre-ejaculate fluid and frequent urination, with very mild on/off testicle aching. I can't find much info online about the causes of excess pre-ejaculate fluid, is this something you hear of frequently? Since its a semen and urine problem, it makes me think its a urethra problem opposed to prostate or bladder which is why i'm confused.
4. Is it safe to have unprotected sex with my girlfriend again? We haven't had sex since my symptoms.
5. At first I thought this may be anxiety related, because initially after the event I was concerned, but once my STI tests came back negative, I pretty much forgot about it, yet my symptoms continue so I don't believe its anxiety related anymore. Perhaps it could be anatomical as my urologist suggested, maybe the massage did something to my pelvic muscles, I'm not sure. I really don't know where to go from here.
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Edward W. Hook M.D.
70 months ago
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I'm glad you did not test for HPV or HSV and would have recommended against it. With respect to your follow-up questions:
1. I cannot comment as to whether or not you might have acquired some sort of non-STI infection from dirty sheets (or froe a reaction to something on the sheets) - this is not my field. With no visible abnormalities and just a burning sensation, I would think it it would be unlikely.
2. The origins of CPPS are unclear but it does not seem to be something that is acquired as a transmissible infection. In my opinion the doxycycline is unlikely to help and it has it's own set of side effects, including risk for fungal skin infections, etc. I would not take it if I were you but this is a personal choice. I also interpret your own doctor's lack of enthusiasm for taking it (i.e. leaving the choice up to you) as a sign that she did not expect it to help either.
3. I have never heard of an infection that increases the amount of pre-ejaculatory fluid. With respect to the origin of your symptoms, the urethra is the tube that fluids from the bladder, prostate and testicles come from. I would consider this a urological problem, and, give your test results and description, almost certainly not an STI acquired from the encounter you describe.
4. I would have no qualms about having sex with your GF. You have ruled out that this is an STI so she would not be in danger.
5. My advice on where to go from here is to continue to work with your urologist. She has seen you, examined you once and sometimes when we have difficult to manage problems, seeing the change (or lack of change) over time is helpful for sorting things out.
I hope that this information is helpful. EWH
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70 months ago
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I greatly appreciate your advice and guidance. I will move on without a doubt that I don't have an STI. I think I will hold off on the antibiotics until I can pinpoint the cause. I have been suggested to looking into DNA sequencing that can help discover non-STI bacteria that could be causing my problems. And perhaps a prostate exam and ultrasound would be a good step as well. Thank you Dr. and wish me luck.
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Edward W. Hook M.D.
70 months ago
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Thanks for your thanks. I'm not sure what DNA tests will tell you but I agree with your plans to discuss the need for further evaluation (i.e. prostate studies) with your urologist. Like you, I would not take the antibiotics. Take care. EWH---