[Question #6340] STI or irritation? Antibiotics?

15 months ago
Dear Experts,
Last week I had a sexual encounter with a woman. I received uncovered (no condom) fellatio, and we had protected (with condom) intercourse. 2 days later, we had protected sex again, and later that day I started to feel an irritation around the tip of my urethra. It feels a bit like a sunburn right around the opening, and there is a small bit of redness just underneath the urethra opening. Sometimes it feels internal, sometimes external. This irritation has continued for 3 days at this point (5 days after first encounter). It is consistently present but changes in severity from about a 1-5 on a scale of 10. It does not burn when I urinate, and I have no discharge of any type. Oddly the only time the irritation seems to subside is when I am urinating. I have no testicle pain or anything else that seems abnormal, just this mild burning irritation at the tip of my penis.

It lasted long enough that I saw my GP last night. He said it would be an abnormal presentation of an STI, but that if it were it would likely be Chlamydia. He had me give a urine sample but said that due to the holiday it could be 10 days before my lab results come back, and he prescribed me a course of Azythromicin which he said I could take if I felt like I need it. He also said it could be a latex reaction, random irritation, cut, etc. I have a history of mild urinary issues like transient BPH, and I had an injury in my groin a while ago that caused  a similar sensation of burning at the tip of my penis, which my uro explained was due to density of nerve endings in the area.

Anyway, long story short my question- is it likely enough this is an STI that I should start taking the antibiotics prior to the labs coming back? 10 days is long time to wait if I have an infection that needs treating. on the other hand I don't know if it's bad to take the antibiotics if they're not necessary. But I'd like to continue with my life sooner than later if there is an issue. Happy holidays
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
Welcome to the forum and thanks for your question as well as your detailed description of events and symptoms.   I am in the same boat as your GP.  The posture you describe was relatively low risk- most people do not have STIs,  your genital contact was condom protected, oral sex is relatively inefficient means of STI transmission.  Further your symptoms are not classic for STI.  Several additional comments:

1.  Any specimen sent to a lab today should be processed and have results vail able within a few hours.  Delays in lab reporting are often a convenience to allow for transmission and recording of results.  If your doctor's office is open on Friday you should be able to get results by then.
2.  I agree that your symptoms are suggestive of local irritation.  If this is the case and there is no further irritation contact, nonspecific irritation should improve substantially over the next day or two while, on the other hand, STI signs should worsen.

My suggestion would be to see if you might get your test results sooner.  My guess is that they may be.  I agree and support  your desire not to take unnecessary antibiotics and would hold off.  If the symptoms persist, given the similarity to your prior prostate problems, I would checkon this with a urinalysis if that has not already been done.

Hope this helps. Please feel free to follow-up if any of this is unclear or I missed something.  EWH
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15 months ago
Hi Dr Hook,
Thanks for your reply. Unfortunately my doctor did mention he'd be closed through the weekend, which I think is partially why he left it up to me to decide what to do. 

I suppose I will wait and see if it improves or worsens as you suggest. I forgot to mention that there is also a bit of an itchy feeling that comes and goes sometimes in the same area. i don't know if that changes things. My understanding of STI's like Chlamydia or Gonnorhea is that they don't just feel itchy or burny in general, but rather while urinating, and that they cause discharge. So I don't know if if my symptoms are STI like at all, even if they were to worsen. I guess if there is any further clarification possible on that question it might help. Otherwise I'll just see what happens.

Thanks


Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
You are correct on both counts.   Typically STIs causing penile infection lead to burning on urination, not discomfort at the tip of the urethral meatus. Further, the sort of itching you describe is normal, particularly for persons who are on the lookout for symptoms. 

 If you are OK with it, my suggestion would be to observe things for a day or two. If your symptoms do not progress I would not take the Azithromycin.

 I think you are on the right track. I hope that my comments have been helpful. EWH 
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15 months ago
Thank you. I will wait it out for another day or so. So far it improves a little bit and then reverts back to being burny, etc, etc. 

I suppose it could also be NGU? I'm a little confused by the difference between that and Chlamydia.

Anyway, I'm just speculating. Hopefully I'll be able to get test results by tomorrow.  I appreciate your responses. If you want I can let you know what the results are when they come in.
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
Thanks for the additional information.  I suspect,that you'll find that the symptoms are most pronounced when you you don't have distractions and with distractions are less apparent.  It sounds like things are getting better.  I appreciate your patience.

The symptoms of NGU are similar to the symptoms of Chlamydia (which is one of the causes of NGU).  Mostly burning on urination and perhaps a slight discharge.

Normally I would close the thread but will keep it open now so you can post your results.  We appreciate your willingness to share them ans expand our knowledge.   Take care.  EWH


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15 months ago
Dear Dr Hook,

Thank you. My doctor actually emailed me over the weekend to tell me my urine test results came back and were "normal and good". This also included things like PSA and some other tests beyond STI's, so I am a bit stumped as I am still feeling the symptoms I described, although to a lesser degree than I was previously. But that's something I can look into with my urologist if it continues. I think, since my understanding is that no urine exam would return a false negative result while the body was already producing symptoms, I can feel confident in the results (despite the short window between exposure and testing).

Thanks for your advice with this matter. On my own I think I would have just taken the antibiotics (unnecessarily).

ps- You are correct that while distracted, the symptoms were less severe (although still present). This was especially the case as time went on.


Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
Thanks for the follow-up and for sharing your test results.  It is now clear that your irritation, no matter what the cause, was not an STI.  I suspect it will continue to resolve.  

This will complete this thread which will now be closed   Take care.  EWH
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