I am writing in relation to a new issue.

On 1/18 I had protected oral and intercourse with a CSW at an" incall" escort service. However, during intercourse, the condom slipped off. I noticed this right away, and I would say the unprotected intercourse went on for no longer than 1 minute. I immediately washed my penis with soap and water and urinated, before putting on a new condom and continuing. There were not further issues.

On 1/21 I had my annual physical which included  STI testing and my results were clear.

On 2/2 I had intercourse with an escort who i have seen several times. She mentioned that she was getting tested that week, which on one hand means nothing but does at least indicate that she gets tested periodically. She performed very short (2 min or less) fellatio on me before I put on a condom and we had protected intercourse. 

On 2/4, just over a week after the first encounter and two days after the last, I started experiencing irritation in my urethra and in the head of my penis (which still continuing today). The next day 2/5 I started noticing what seemed like very faint urine spotting on my underwear about 1/3 the size of a pencil eraser. I expressed my urethra and got just a faint wetness at the opening. On the morning of 2/6 I expressed my penis first thing in the AM (at this I was getting concerned) and there was a very small amount of whitish discharge. I decided to get tested and gave urine that afternoon. My doctor said the test results would take 7-10 days, (which seems crazy) and put me on 100mg doxycycline 2x daily for 1 week. He said he couldn't tell if I had an STI or not, but that my symptoms indicated some level of urethritis so he would treat me. I am 2 days into the antibiotics and don't feel any different. Still seeing "micro wetness" on expression at tip of urethra.  I have had no pain on urination. Similar to my last question, I seem to feel better while urinating, not worse. 

So I am awaiting test results but wasn't my exposure very low for STI infection? 

Obviously if I test positive then I guess not, but if i don't is it possible I have some other recurrent type of NGU? The spotting and one instance of discharge are new, but the irritation is not.

Finally, I am concerned about my regular partner. How quickly after exposure (assuming that's what this is) does one become infectious?

On this occasion, it seems likely you acquired urethritis, and your doctor is treating you for NGU. I don't know what to make of "he couldn't tell if I had an STI or not". If he definitely diagnosed urethritis (that is if he saw abnormal discharge and documented inflammation in it, i.e. white blood cells), then it's an STD. If he saw no abnormality and was going on the basis of your symptoms, I would suspect you have nothing wrong (again?), except perhaps increased sensitivity to minor symptoms or normal symptoms and physiology. That your symptoms have not improved two days into doxycycline treatment suggests that no infection is present. However, you should finish the doxycycline and check back with the doctor when your test results (probably gonorrhea and chlamydia) are available. I predict they will be negative.

I would recommend no unprotected sex with your regular partner until you have finished doxycycline and know your test results.

HHH, MD

I am sorry if I seem like I'm being irresponsible or leaning too hard on this forum. The truth is that I do tend to rely on it as a second opinion, or a consult to decide if I should bother with testing I wouldn't do anyway. By my count I have asked an average of 3 questions per year. Maybe that is excessive but I wouldn't think so. 

At any rate, I think I asked some things poorly.

My doctor did not examine me. I described my symptoms to him. He said watery spotting could be urine or "discharge". Based on the fact that I'd had one incident of milky discharge and constant irritation, he wanted to treat me. As I've described previously, he is a "antibiotic first, ask questions later" guy.

A lot of my ambiguity relates to oral sex, which I understand from this forum to be very low risk, even unprotected. I have also read answers where you indicate that a condom malfunction that is short lived is also very low risk.  That said, I seem to have some acquired some type of urethritis. 

I'm trying to figure out the most likely source if I did get infected. My concern about my partner has to do with the fact that we had intercourse a week after the condom malfunction, prior to the second one.. not future encounters. 

I am not trying to waste your time or be self-indulgent in my questions. You are, I think, more qualified than the average PCP to answer these questions. I also realize you are not an all seeing oracle, but I was hoping you could give some guidance. I will not ask more questions in the future.

It is always a mistake to treat for possible urethritis without first documenting that urethritis in fact is presaent. Based on your symptoms and their lack of response to doxycycline, it's likely nothing is wrong except your heightened awareness of trivial symptoms or normal sensations and physiology. Consider finding a doctor who takes STIs more seriously.

Since you probably don't have NGU or gonorrhea, I can't judge whether you have anything attributable to either vaginal or oral sex. NGU from oral sex may not be an infection at all, but adjustment of the urethra to normal oral bacteria. There has never been a known case of NGU from oral sex causing any health problem in affected men's vaginal sex partners.

Gonorrhea is transmissible partners within a day or two. Unknown for chlamydia, but perhaps that quickly and certainly within 3-4 days. The standard recommendation is that any and all exposed partners need treatment, even if only hours after the exposure leading to infection.

It's usually futile to attempt to determine the source of infection when exposure are within a few days of one another. I have no judgment as to which exposure is responsible for your symptoms -- but as suggested above, I doubt you have anythin anyway.

Indeed I and the other moderators are more knowledgeable about STDs than many or most practitioners. But still we do not provide direct care, and lack the advantage of direct examination. Given your lifestyle and the frequency with which these things keep coming up, I would reemphasize my comment above about finding a doctor who is more knowledgeable and more attentive to proper STD mangement. Or consider whether you want to continue your current sexual lifestyle. Seems to me it may be causing more anxiety than reward.

My doctor just confirmed I do not have Chlamydia or Gonnorhea, but says he still thinks I have some type of urethritis, likely non-sexual (?) and wants me to complete the antibiotics. I am on day 3 of the antibiotics now and the discharge is still continuing.  I understand that it is natural when something is on a person's mind to be hyper-aware of symptoms, or even invent them out of normal physiological events, but discharge and wet spotting in my underwear throughout the day is a very new thing for me, and the meatus irritation is an increasingly common event. I guess it is normal for some men to "leak" cloudy ejaculate every morning and to have cloudy or clear fluid appear when they express their urethra? I have experienced this post sex or post arousal, but never before on an ordinary afternoon when I'm just thinking about work. So I don't know what to make of it.

I take your point about my sexual activity, from a clinical advice standpoint if nothing else. But the fact is that I think unless I become entirely abstinent these issues would concern me, because they are not normal for me (although they are becoming more so) and whether I'm dating a woman exclusively or seeing multiple women, "professional" or otherwise, I don't want to be cavalier about their health or my own. In fact, I had thought that sex with high end escorts was actually safer statistically than "hooking up" with random people who don't test as often.

Anyway, my one final follow-up would be, if allowed - is "non-sexual" urethritis considered contagious? Should I abstain from sex when I am experiencing this type of thing?

Thanks

Nothing is known about "nonsexual urethritis" or whether it's even a real entitiy. There has been no systematic research. But because by definition there is no infection to transmit to a partner, I don't see how such a condition could be contagious.

That concludes this thread. Repeated questions on the same topic are not permitted, and you've had several -- all ,more or less like this one. We really can't help you further. Thanks for your understanding.