Hope you are well. Please could you offer some advice. I have had protected intercourse with a couple of female escorts in London last Tuesday (about a week ago). I had unprotected oral sex both her on me and me on her. About 3 days later, I begun to experience pain / burning whilst urinating. This has become more painful over the last couple of days. I do not believe there has been an increase in frequency in urinating and I do not seem to have any herpes lesions which would be my main concern as I believe chlamydia and gonorrhea are treatable. I also have no noticeable discharge from my penis. I have also noticed a sore throat and sensitive glands in my neck (but not groin) and a blocked ear sensation. Any advice would be much appreciated. I am travelling at the moment and will go to a clinic when in LA in the next couple of days. If there is a clinic close to Santa Monica you recommend for travellers with no US insurance but travel insurance, that would be greatly appreciated 

As we discussed in your distant past questions, most female escorts (expensive sex workers by appointment) are believe to not be at very high risk of STD. And you used condoms (once again, congratulations on your careful approach to such events). But oral sex also carries risk -- not as high as unprotected vaginal or anal sex, but not a rare cause of urethritis, i.e. gonorrhea or nongonococcal urethritis (NGU). (Very low chance of chlamydia, which uncommonly infects the mouth, hence very low risk by oral sex). Painful urination suggests urethritis. Discharge usually is also present, but may take another day or two to become apparent. (Urinary frequency is rarely caused by urethritis -- absence of it doesn't mean anything one way or the other.) The short duration from the oral exposure(s), only 3 days, favors gonorrhea; NGU (or rarely chlamydia) usually causes no symptoms until 7-10 days. If indeed you have gonorrhea, I would expect overt discharge to appear very soon.

Herpes? Possible, but as you surmise, usually there would be obvious external blsters or open sores, not only urethral symptoms. And of all men with NGU, herpes is the cause in only 1-2%, so on statistical grounds it is unlikely.

Finally, another possibllty is that your sore thoat and urethral symptoms are linked. Certain common respiratory viruses, especially adenovirus, are occasional causes of NGU following oral sex, and the short incubation period is consistent. And so are your throat symptoms, especially if your escort contact included kissing in addition to the oral sex. Adenoviral NGU, like herpes, accounts for 1-2% of NGU -- so your symptoms fit, but still hard to predict. Fortunately, adenoviral urethritis -- like colds and sore throats -- clears up on its own over a couple of weeks, with no known chronic infections or complications.

You're obviously doing the right thing by planning on medical evaluation. Sorry, but I have no experience or knowledge with specific providers in Santa Monica. However, the LA County Health Department STD program is highly respected, and I imagine they have a clinic that will be conveniently located. They also might be able to recommend one or more private practices with STD experience and expertise, should you choose that route. I can't predict insurance coverage, but public health clinics typically are free to very inexpensive; I doubt finances will be an important limitation.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I notice my glands on my upper neck seem to be risen and I have bumps on my tongue and inside my cheeks as well as sore gums. I also have a very sore throat resulting in swallowing being uncomfortable. Does this still sound like adenovirus? I still have no discharge from the penis and no obvious sores there although still pain / burning when urinating