[Question #6404] Recieved Oral Sex

14 months ago
Hi Doctor,

Almost 2 years to the day ago I received unprotected oral sex from a CSW.

Approximately 10 days after the event I felt things were not right I had a swollen meatus and my urine flow was slower. I had a rash around my flank for approx 2 days and under my eyes for about a day. My glans changed in appearance from very smooth and shiny (I am uncircumcised) to a much dryer appearance (this has remained to this day).

I was tested for all the usual STI's (twice) and they all came back negative.

I still suffer from NGU that I am sure came from this event. My penis appearance has changed and my ejaculations feel less forceful as if is being restricted inside my urethra my testicles are far more sensitve than they used to be, but other than that everything is normal. No spotso and no growths.

I recently read in a well know uk newspaper (internet column) that nesseria meningitidis can cause these symptoms.

I am now in a steady relationship and am wishing to have unprotected sex and I am still very apprehensive about doing so. While I dont have a diagnosis.

I do not feel its CPPS as I have not really been particularly stressed I am a kind of laid back person admittedly for the first few months I stressed over it but on the whole in the past two years i have mostly gotten on with life.

Your advice will be grateful recieved

Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome to our Forum.  I'll be glad to comment. Clearly that you still feel that there are problems which you characterize as NGU 2 years after the event suggests that this should be evaluated.  Have you been evaluated by any of the superb genitourinary medicine experts in the UK?.  The symptoms the you mention, both soon after the exposure (rash, change in appearance in your glans) and more recently a sensation of less forceful ejaculation are not typical symptoms of NGU or any other STI.  You are correct the the meningococcus can occasionally cause urethritis in men but when it does symptoms are typically an obvious urethral discharge and white blood cells evident in urethral smears.  Did the testing you had include a Gram stain or test for white blood cells in your urethra, one of the hallmarks of NGU?  Have you taken any treatment and did it make any difference?

I will likely have additional comments after you reply to my questions but at the moment, with all due respect, this does not sound like NGU. 

Looking forward to the additional information you will provide. EWH

14 months ago
Yes I was seen by a top specialist gum clinic within the NHS system and was referred to one of the leading CPPS specialist in the country after 6 visits though I was discharged.

I was referred there due to my continuing symptoms but no positive tests from any of the STI tests I was given. The doctors and nurses were excellent but I did feel that I was only referred there as nothing else could be found.

I did have a gram stain taken on two occasions and both times it was negative.

As treatment I was given flomax and anti depressants. I am currently not on either of these medications, I stopped the flomax after 3 months and the anti depressants after about a year (the numbing effect it had on my penis helped the symptoms feel reduced)I have not taken any antibiotics due to my test all being negative.

Do you have any ideas on what could be causing this.

The first 3 months were the hardest
the symptoms were
massively increased sensitivity in the tip of my penis would feel uncomfortable rubbing on underwear.

I would ejaculate in under 30 seconds when masturbating, felt like increased sensitve in the shaft (the anti depressants calmed this somewhat)

Random shooting pain in penis that would increase in frequency correlated to the frequency I masturbated. So if i stop masturbating the shooting pains reduced. (These are very rare now maybe 2 a month)

All these symptoms are now so so much less, but they still exist.

Also in the beginning I was convinced it was going to be herpes, I had pain in lower back which I read was a precursor to herpes but it never materialized into any spots.

Thank you for your fast response

Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thanks so much for the additional information.  In the absence of white blood cells on two occasions, it is very difficult to call this NGU.  This is not to discount  your symptoms but I find it hard to generate evidence that this as an STI.  The other question I would add for completeness sake however is to make sure that your testing including testing for Mycoplasma genitalium which can occasionally be a cause of persistent urethral symptoms. 

My other comment has more to do with personal experience than science-based data from research studies.  When I have seen patients who have had persistent urethral symptoms, as difficult as they are the good news is that there is no evidence that those symptoms represent a threat to the health of sexual partners, nor do they progress to complications . Instead if anything they tend to decline in severity over time, as has been your experience. 

I have to say that as well that there are certainly instances when the presence of symptoms such as yours tend to lead affected persons to concentrate and become increasingly aware of sensations which are normally discounted or overlooked.  I cannot help but wonder if this observation is helpful as well.

I hope that this information is helpful to you.  EWH 

14 months ago
Hi Doctor again thanks for your fast response

I did do a Mycoplasma genitalium test but it was soon after potential exposure so I have ordered a home test online due to your recommendation.

It included 9 other tests and was only £40 hopefully that along with your expert advice will give me the confidence to get back in the saddle (unprotected)

Kind regards

Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thanks.  I think having a mycoplasma genitalium test you have confidence in is a good idea.  Presuming that is negative, I can see no reason whatsoever for you to not "get back in the saddle".

As per Forum Guidelines, this thread will now be closed without further replies.  I hope that my comments have been helpful  EWH.