[Question #6393] Protected Vaginal - Unprotected Oral

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68 months ago
Up to the 6th of december all my STD tests were negative (hiv, syphilis, chl, gono) with no sex exposure 6 weeks before taking the tests so no doubt about this. 

6th of December, protected sex (no doubt) with a CSW (she had condom) and received unprotected oral sex (i can't recall how long it lasted, but wasn't long).

On the 9th I had unprotected vaginal sex with my partner - no reason to suspect she had encounters outside the relationship.

On the 10th I received long unprotected oral sex from a CSW (she showered me first, made sure i was clean and after the oral sex was done she used anti bacterial liquid in her mouth and also offered me some).

On the 12th(yesterday) while driving my motorbike in the afternoon I started feeling a discomfort in my left abdomen, which somehow was tingling on my left testicle. It kinda stopped once I got home and perhaps also got distracted and wasn't very noticeable, but it was there. On the next day in the morning I didn't feel it that much and after one day without any poo I finally managed to do it (so I assumed it was only a gut problem). Once I left home and got on my bike, the discomfort started again. It went throughout the day, but never sever. Until now i didn't have ANY discharge or discomfort urinating.  The pain seems to be more noticeable when I'm sat, as when I walk I can feel something (more on my left testicle) but nothing severe. I touched my testicle and wouldn't feel any pain.Moreover, when I'm sat the pain is quite intermittent between what seems to be my lower front abdomen and sometimes the back, but I can't be sure. It is difficult to understand if the pain is actually on my testicle or if it is a radition of the "pain"

Questions: 1- Should I be concerned of a possible infection?
2- Should I seek testing? Is it needed given the exposures and symptoms?
3- I read this could be epididymitis? Does it make sense to be concerned?

Thank  you

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Edward W. Hook M.D.
68 months ago

Welcome to the Forum and thanks for your question.  I'll be glad to comment.

Before I address your specific questions, let me make some more general comments.  The encounter you describe was relatively low risk.  As we have pointed out here on multiple occasions, most commercial sex workers do not have STIs and many CSWs do a better job or STI prevention and are less likely to be infected than casual, non CSW partners one might meet in a bar.  In addition, I was interested to hear that your partner used mouthwash following performing oral sex.  This measure has been suggested (not proven) to reduce risk for STIs during oral sex and is currently being actively studied.  If anything, that practice would reduce the risk that she was infected to even less than average. 

As for your symptoms, the are not suggestive of STI. When STIs cause symptoms they typically persist and do not go away when one is distracted.  When persons develop epididymitis, they typically have noticeable symptoms and lower abdominal pain is not part of typical epididymitis.  Your symptoms could be mechanical (i.e. muscle strain) in nature or reflect another process such as a kidney stone or even bowel problems.  While I cannot assure you that this is not an STI without testing, I find it quite unlikely and believe there are other possibilities which are more likely.  My advice is to seek the advice of your own physician who can examine you and order appropriate tests..

In answer to your specific questions:

1.  Your risk for infection is low but not zero.  When you see evaluation, I would suggest testing your urine for gonorrhea and chlamydia, as well as performing a urinalysis (which may be helpful for diagnosing things like kidney stones).

2.  If your symptoms persist or worsen, I would seek medical evaluation as a general recommendation.  I am not so worried about STI.

3.  Your symptoms are not particularly suggestive of epididymitis. 

I hope these comments are helpful.  EWH

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68 months ago
Hi Dr,  thank you for your reply.  I saw it once you replied but decided to wait 24 to see if there would be something new/relevant to add. 

After reading your reply I went out to have a few drinks with some friends and I must say that I didn't think/noticed the pain/discomfort. This morning I woke up and went for a run and nothing hurt, but after when I got home and relaxed it came back. Has been persistent during the rest of the day. The feeling in my lower abdomen has stopped (maybe sometimes i feel smth) and all I feel now is a groin/inner thigh tingling sensation that radiates all over my leg. I assume that maybe sometimes might seem that is my left testicle as it is close to my groin, but NO pain when I touch my testicle nor it seems swollen. No problem urinating either - all normal. 

This pain seems to change stop/start whenever I change position, or if I'm moving (walking/running) is pretty much not noticeable. 

I'm traveling at this moment with my girlfriend and it will be unfortunately impossible for me to test for the next 3 weeks. I've got some additional questions. 

1- Would you say that if these symptoms were related to a STI, something else would have also developed by now? As obvious testicle pain, burning urinating, etc? 
2- A friend of mine had gono not long ago and it actually evolved to arthritis however, he mentioned penile pain too (which happened before that), could this be something similar as there's arth gono or it doesn't make sense? Would it always be accompanied by other symptoms and discharge for example would be first?
3- Given the fact that my exposures were 2 times unprotected oral and if after 10days of the last one I don't develop an obvious discharge or smth similar, I can relax and just resume my life with my GF normally? 

Thank you.

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68 months ago
"This morning I woke up and went for a run and nothing hurt, but after when I got home and relaxed it came back. "

Let me please add that when I say this, it is not like the pain is not there but more like maybe is less stronger and so for that I don't feel it as much?

"This pain seems to change stop/start whenever I change position, or if I'm moving (walking/running) is pretty much not noticeable. "
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68 months ago
Sorry, please let me add an additional question. 

4- I know that you did say that this doesn't sound like epididymitis however, from what I've read it seems like a strong cause of groin pain. I felt this discomfort/pain 72h ago, in the case it was in fact epididymitis, would it have worsen? Have more symptoms combined? Or could it stay like this for 72h even if it was epididymitis?

Thank you
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Edward W. Hook M.D.
68 months ago

Thanks for the additional information and your patience in waiting to see if your symptoms would change.  The more information you provide, the more confident I am that the discomfort(s) that you are experiencing are not due to STI.  I would not worry.  In answer to your specific questions:

1.  Yes, the lack of progression (as well as the nature of the pain you describe) it inconsistent with an STI.

2.  The mechanisms by which gonorrhea leads to arthritis and to epididymitis are different.  If you had epididymitis your discomfort would be progressive and you would almost certainly have discomfort on urination or a penile discharge.

3.  Yes, my advice would be to relax and move forward without concern.

4.  If this was epididymitis, it would have progressed and would not have been intermittent.  What you describe really does not sound at all like epididymitis.

Hope this helps.  EWH

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68 months ago
Hi again doctor, 
Thank you so much for your replies. Here are some updates.

The discomfort is still there (groin,testicle,lower abdomen - I can't really tell the exact area). There are some positions that relief it or makes it less sensitive. Yesterday, I had lunch (not A LOT) around 3pm and didn't feel like having dinner, or go to the toilet at all. Felt quite bloated and so did think it could be a result of  constipation and bought some laxatives but hasn't really helped with the discomfort. It is completely bearable but annoying and uncomfortable enough to make me feel concerned. 


Please, allow me to ask some additional and final questions, as I understand this will conclude this thread.

1- The discomfort hasn't become more severe nor other symptoms have showed up, and as we discussed before, based on this I think I can  completely discard STI?

2- As I mentioned in other replies, it will be impossible for me to test for STIS, however (according to question 1), I shouldn't really be concerned with that and can/should resume sexual life with my gf?

3- I will take your advice however, and book an appointment with a general doctor and try to understand what could be wrong, but I shouldn't feel the need to mention my fear/concern of STI to him?

I think this is it, I really appreciate your help and would like to wish you and all the team a happy Christmas and a happy new year. 
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Edward W. Hook M.D.
68 months ago

Thanks again for the update.  That your symptoms have persisted suggest that you would benefit from evaluation.  In my opinion however, evaluation for STI is not needed for all of the reasons noted above which I will not repeat.  In answer to your final questions (as per Forum guidelines, this thread will be closed after this response and without further replies).

1.  Yes, I would discard the possibility that these symptoms are due to an STI.

2.  Correct.  I see no reason to abstain from unprotected sex with your regular partner.

3.  Yes, it is fair to mention this to your doctor, after all the possibility is prominently on your mind.  I would urge you however not to accept treatment unless your doctor also chooses to test. 

Thanks for your thanks.  I hope this problem resolves quickly for you.  Take care.  EWH

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