[Question #6235] STD? Anxiety? Both?

69 months ago

I have two incidents that I regret and are causing me great stress and anxiety about STD acquisition. #1: I Visited a Gay Spa on 9/17/19. All contacts were hand to genital contact with the exception of one very brief (5-10) secs where another person took my penis and rubbed it against his back side (between legs, & buttocks area). There could have been some contact between my penis and his anus during this brief contact, but I can't be sure. No penetration though. The evening ended by receiving a handjob from someone else. #2: On 9/24/19, I met up with a male from internet. We performed 3-4 mins of frottage (penis to penis base rubbing) and he kissed my penis a couple times. Again this indecent finished by receiving a handjob only. Approximately one day after the second incident / one week after the first incident, I began to feel some discomfort in my penis. Starting that day the anxiety ramped up and continues today. The pain/discomfort in the tip of my penis can be intense at times and seems to come and go. Seems to be better when I can get my mind off it, but none the less feels VERY real when it is happening. It seems to be worse just before I need to urinate. NO pain during urination. NO discharge. NO visible sores, rash, etc. Experience some "urine dribble" and renewed discomfort right after urinating. As you can imagine I've been checking and examining dozens of times a day and every-time I use the bathroom. When feeling this pain/discomfort, I do tend to urinate more frequently. Urine Test for Chlam/Gonn on 10/16 (midstream) APTIMA Combo2 Assay. Both Neg. Anxiety and pain/discomfort continue today. What do you feel the risk of STD from the events described? Do I need additional testing (1st catch)? Thoughts on my "symptoms"? I've seen you say previously that frottage is low/no risk. Having a hard time understanding my symptoms. Feeling anxious about sex with my wife possibility of passing STD.

H. Hunter Handsfield, MD

69 months ago

Welcome to the forum. Thanks for your confidence in our services.

These both were virtually zero risk exposures for all STDs. The standard term for such events is frottage (body rubbing), and included genital and genital-anal apposition without penetration. There is potential risk (but very low) for those STDs transmitted skin to skin (primarily herpes, HPV, and syphilis) and no risk at all for those transmitted through infected body fluids or blood (HIV, gonorrhea, chlamydia, nongonococcal urethritis [NGU] and a few others). Hand-genital contact is risk free as well, even if genital fluids or saliva are used for lubrication. (Genital fluids in theory could transmit one of the skin-to-skin infections, but in my 40 years in the STD business, I have never been aware of a case in which this appeared to have happened.) There is no need for testing for any STD after such events. Since you were not at risk for gonorrhea or chlamydia, of course it is no surprise that the urine test was negative.

Similarly, you could not have caught HIV. However, having started down the path of HIV testing, you should consider another test, since the one you did was too soon for conclusive results. You should have another AgAb HIV test, such as Combo2, 6 weeks after the second event. This advice does not mean I believe you were at risk, and if you have another HIV test, there is no chance it will be positive (assuming no other risky exposures you haven't mentioned).

As for your symptoms, the title of your question says it all. They are typical for genitally focused anxiety, not for any STD. Furhter, no STD can start to cause symptoms only a day after exposure; 2-3 days is the minimum for any and all infections. Finally, when someone suspects his or her own symptoms have an emotional or psychological origin, usually s/he is correct.

My advice is to continue sex with your wife without worry. That's what I would do if somehow I were in your situation.

I hope these comments are helpful. Let me know if anything isnt' clear.

HHH, MD

---
---

69 months ago

Hi Doctor Handsfield. Thank you for your replay and all that you and the team do. I remember you guys from the previous Medhelp forum and I think its outstanding the support you provide. In situations like these, we are often left with no where to turn to talk through situations such as these. The services you provide are invaluable! Just a few followups on my situation and then I feel I can confidently move on. 1) For the skin to skin transmitted STD's you mention, I assume at this point (almost 7 weeks post the 1st incident 6 weeks post the 2nd) that if there are no visual symptoms, I can be confident of no infection and no need to test? 2) Have you ever seen these transmitted by Frottage? 3) Any issues with the Midstream collection on the Gon/Chlam test? I realize now this should have been 1st catch, but the lab employee provided no instruction. 4) You mention HIV testing in your reply as if I had that done already. I did not. I only had CHLAMYDIA TRACHOMATIS RNA, TMA, UROGENITAL & NEISSERIA GONORRHOEAE RNA, TMA, UROGENITA tests done. In the comment field on the report it included "This test was performed using the APTIMA COMBO2 Assay (Gen-Probe Inc.)." There were no other risky exposures that I did not mention. Just the two Frottage and Handjob Incidents. Assuming based on your response no HIV testing is warranted? 5) Just trying to come to grips with the symptoms I am having being "genitally focused". It's hard to believe as it feels so very real (even as I sit here now typing). To clarify, the symptoms started a week after the 1st incident. Anything more out there explaining how genitally focused anxiety, etc. could produce such "real" feeling symptoms? Still wondering if I should see a doctor for these symptoms even if not STD related. Perhaps they will all subside when I can come to grips and accept all of this. Hopeful.... Again, thank you for the service you provide!

H. Hunter Handsfield, MD

69 months ago

Thanks for the thanks. It's always nice to re-meet a MedHelp alum!

1) Absence of symptoms by 6 weeks is strong evidence against syphilis and herpes, but not necessarily of HPV, for which most infections cause no symptoms; and if warts appear, it can be up to a year later. But you've undoubtedly had HPV already, perhaps several times, if your sex life has been fairly typical -- and these events to not materially raise that chance.

2) Nope, never to my knowledge.

3) Midstream is fine. Official advice is first void, because that's how the initial research was done. Day to day use in STD clinics for 15+ years indicates it makes no difference.

4) Sorry, I read too quickly! ("Combo2" is commonly used in the vernacular for antigen-antibody [4th generation] HIV testing.) I definitely do not recommend HIV testing -- I mentioned it only on the assumtion you had already started down that path. Apologies for the confuseion!

5) No STD causes the sorts of symptoms you describe. Such symptoms originate not in the urethra, as for STDs, but in the bladder, perineum (the pelvic floor, i.e. between scrotum and anus), or sometimes prostate gland, and STDs do not infect these areas. If you remain unconvinced and the symptoms continue, see a physician. If you do, I am confident no STD will be found. And indeed it is true that such symptoms usually subside once believed and understood (at a gut/emotional as well as intellectual level) that nothing important is going on and no harm will come.

---

H. Hunter Handsfield, MD

69 months ago

Also note I'm not saying the symptoms aren't real. They are. But the mechanism is essentially the same as a tension headache, which as the name implies has an emotional/psychological origin but causes real pain. In one case, tension in scalp and neck muscles; in the other, pelvic muscles. Indeed, symptoms like yours have sometimes been called a pelvic tension headache. ---

69 months ago

Thanks again Dr. Handsfield. I'm doing my best to deal with this. Last night was a little better but not great. I suppose its taken 6 weeks to create this mess if it is all anxiety driven, so it isn't going to resolve itself overnight. Doing my best to believe that my symptoms are not STD related, but certainly easier said than done. Perhaps it would help to understand the differences between what I am feeling and what I might actually be feeling if this were STD related? It's just so concerning to feel a stinging/stabbing pain in the penis area. The only explanation my brain can come up with is Urethral inflammation. How would my symptoms be different if this was in fact an STD? This might be helpful for others in my situation to understand as well. Thanks again. I know this is my limit on questions/responses. I'll do my best to accept this information that you have provided and move on. I can only hope things get better with time.

H. Hunter Handsfield, MD

69 months ago

I didn't understand your penile pain is this severe. Is your penis tender, i.e. painful when you gently squeeze it? If so, is that tenderness localized -- i.e. upper shaft, lower shaft, head? Any redness or swelling of the meatus (opening)? And definitely no discharge? In any case, it sounds like you should see a physician for in-person evaluation. All that said, it remains exceedingly unlikely you acquired any STD from the exposures you have described.

Normally threads are closed after two follow-up comments and replies, but I'll keep this open to hear your responses to these questions?

---

69 months ago

Hi Doctor,

My penis is not tender per say. Is not painful when I gently squeeze it or even when squeezed harder as I just checked. If anything the sensations/symptoms I am experiencing go away when I squeeze or hold it, change positions, etc. Also as I mentioned at times when I am fully distracted the feelings don't seem to be noticeable. It's worth mentioning that I spent a week in CA for work a two weeks ago (right after my neg Gon/Chlam test results), and these "symptoms" were almost 100% non existent. I returned home very comfortable, had sex with my wife that evening and noticed some irritation the next day. Then it's been full blown panic and "symptoms" mode again ever since. I don't see any swelling of the meatus that looks abnormal to me, although it is a little darker than the rest of the head, and is sensitive to rubbing on clothing, etc. Definitely no discharge that I've seen and I've over inspected it many times. I've seen some clear discharge only when aroused or masturbating before ejaculating, but I would attribute that as pre-ejaculate. I did go a week or so without masturbating, just to "leave it alone" and try to limit the irritation. When I did finally masturbate yesterday the semen was a bit thicker and chunky at the end than I'm used to. All normal color, no odor. Could be just because that was an abnormal amount of time for me not to ejaculate? Overall sexual function seems alright, no painful erections or painful ejaculation. It's just this stinging feeling in the tip that can come and go and that seems to be a little worse before urination, No burning during, but sometimes some tip irritation after.

Can you describe how these feelings might be different than what I am describing if it was an STD?

Thanks Again for your help!

H. Hunter Handsfield, MD

69 months ago

Thanks for clarifying. Now I'm even more convinced there is nothing physically wrong -- primarily because the symptoms are not continuous. No STD, other infection, or inflammation can do that. See your doctor if the symptoms continue or you otherwise remain concerned. But if you do so, I am confident nothing will be found.

That concludes this thread. I hope the discussion has been helpful.

---