[Question #6688] STD risk

14 months ago
Since my last Chlamydia/gonorrhea test 8 months ago I've had the following sexual encounters outside my marriage:

1.  3 months ago protected oral and vaginal sex with a prostitute in Western Europe. I'm not sure how hygienically the condom was removed and I didn't wash my penis immediately. The condom didn't break and was used all the time.

2. 3-4 months ago two times protected blowjob with a prostitute

3. 1.5 months ago two times a handjob at a massage parlour, the other time the masseuse was touching her vagina with her fingers while doing the handjob.

I never had any symptoms before about one week after the last handjob. After urinating, I suddenly felt a very strong, burning pain in my urethra. I immediately became very anxious and developed strong bladder and urethral burning and frequent urination. I took azithromycin 1g to be sure and t syptoms went away in two days. Few days later I resumed sex with my wife. About a two weeks later she told me she has had feelings of sudden urge to urinate for the past few weeks. She doesn't have symptoms of UTI, only the sudden urge that comes rapidly. She's had the problem since. It's also been stressful time for her, so I thought I could be stress related. Immediately after hearing this, my symptoms of urethral burning, bladder discomfort and urge to urinate returned and are pretty intense now. I have no discharge and burning with urination sometimes but not always.

My question is, is there any real STD risk involved here, especially Chlamydia or gonorrhea?  Do I need testing?

One more question, I think I've read saliva is not a STD risk but after this episode I'm also stressing about an incident year ago when a prostitute from Mexico spit on the head of my penis during handjob. Oral sex was protected. Is this considered risk free or should I test for hiv too?
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome to the Forum.  Thanks for your question and your detailed history of exposures.  I've written my comments below but would also like to ask your age.  In men over 40 sometimes symptoms such as yours relate to an enlarged prostate.

Regarding the exposures you mention, as long as a condom is worn throughout a sexual encounter and does not break, the chance of acquiring an STI such as gonorrhea, chlamydia or NGU is vanishingly low.  Remember, most CSWs do not have STIs, most exposures to infected partners do not lead to infection, and condoms work really well.  Further there is no risk whatsoever of STI acquisition from receipt of masturbation.  Whether of not there might have been some sort of trauma related to your last receipt of masturbation is hard to say but the chance that your symptoms were due to an STI of any sort are about zero.  OTOH, your symptoms may reflect a UTI.  Sadly, as you were not tested, the azithromycin you have taken will hinder efforts to test for infection.  I suspect your wife's current symptoms are coincidental.  Were she my patient I would evaluate her with a urinalysis looking for a bladder infection.  I see no need for you to pursue testing. 

Regarding the infectiousness of saliva, again, even when saliva is used as a lubricant, there is no evidence that receipt of masturbation represents a risk for any STI, including HIV.  I would not worry about your exposure from Mexico.

I hope that these comments are helpful.  EWH

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14 months ago
Thank your your reply. I'm well under 40 years old and also the somewhat intermittent nature of my symptoms (they tend to get worse when I'm stressed and after I start to focus on the symptoms more closely after feeling some unpleasant sensation and they get a bit better if I'm immersed in something else) lead me to believe that the most probable explanation is genitally focused anxiety and guilt. In this light I feel if I could get even more reassurance by correct information, I feel it might help me feel better. So a few more questions:

1. Is it true that bladder uncomfort and tension and urethral burning and tingling in the absence of burning during urination or penile discharge, is an uncommon presentation of STD such as Chlamydia, NGU or Gonorrhea? Of Gonorrhea I read that the symptoms are usually grave and symptomless or nontypical presentation almost never happens but are these symptoms uncommon also for Chlamydia?

2. Would the Azithromycin have cured these infections if I had them? How long after taking 1g of Azithromycin would a person not be infectious anymore?

3. What is the reason for these pathogens to not being infectious in vaginal fluids outside human body anymore when used as a lubricant during masturbation, even as large quantities?

Thank you for the work you are doing.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thanks for the additional information.  FYI, as you suggest, the symptoms of STIs are rarely intermittent and rarely go away when otherwise occupied.  In answer to your questions:

1.  You are correct that typically the discomfort associated with gonorrhea or chlamydia are most prominent during urination, not in the intervals between voiding.  Most persons however expect the symptoms or these infections to be worse than they actually turn out to be.  Symptoms are more prominent with gonorrhea than with chlamydia and both infections can be asymptomatic in men- gonorrhea about 5% of the time, chlamydia about half the time.

2.  Azithromycin would cure virtually all urethral chlamydial infections and about half of gonorrhea.  Person who were successfully treated would be non infectious 2-3 days after taking the medication.

3.  The answers to this question are complex and multiple.  Among other reasons are exposure to the environment outside the body makes them non-infectious and that with each transfer the numbers of organisms present decrease many-fold.  This observation is validated by countless observations by trained scientists.

Hope this helps.  I am increasingly confident that this is not an STI.  EWH

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