[Question #7010] Swollen testicle after treatment

11 months ago
Hey there. I’ll be descriptive but brief. 

On May 22nd I had a high risk encounter.  

I slept with an escort. I’m sure she was high risk. Nonetheless it was covered sex but there was  uncovered genital to genital contact (tip may have rubbed against vagina without penetration).  Can’t fully remember.  There was aggressive oral to me off and on over 45 minutes.  

Afterward I was highly aware - checking for any symptoms.  Over time I developed a heaviness and discomfort in groin.  I was starting to get trace discharge so I got a prescription for Azithromycin (1 g) which I took single dose on May 31st.  

Any discharge subsided but heaviness and discomfort in groin persisted.  Felt slight swollen (both testicles).  Discomfort behind and around groin.  

June 5th was prescribed another 1 g of Zithromax Azithromycin (4 x 250 mg tabs) which I took all at once.  I was also prescribed Cefixime 400 mg which I took also.  

I was also prescribed Cipro which I’ve been taking twice daily.  (14 day supply)

June 15th I slept with my wife unprotected but I still have this heaviness and ache in groin. I can’t sleep on stomach - and am still swollen.  There is no discharge.  Just constant dull ache that won’t go away.  I’m taking ibuprofen three times a day to manage swelling. 

I wasn’t able to test (yet) for chlamydia and various std as we are remote and have not been able to get to clinic. 

I have the following questions:

A) given what I took, how likely was I actually cured of chlamydia? Would two doses certainly kill chlamydia despite it being same antibiotic within six day period?

B).  Given the window, 15 days after first dose of antibiotics and 9 days from second - was it possible I infected wife? (If I had had chlamydia?)

C) when should I test before I’m clear of any potential dead bacteria? (I want to go in this week)

D) how long will symptoms last - even if free of chlamydia?  Normal to last weeks of swelling after treatment?

11 months ago
Couple clarifications also:

The scrotal discomfort - testicles are not painful to the touch.  Discomfort more so above and behind testicles.  For awhile was more so right testicle and now it’s left side?

Discomfort increases through day (less noticeable in AM).  More pronounced after physical activity. 

I do wonder if Cipro impact on hip joints may be causing masking symptoms but not sure. 
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

Welcome back to the Forum.  I feel like we've been down this path before.  I'll suggest that you review our earlier interactions on both the importance of testing which you once again have not pursued and the issue of genitally-focused anxiety.  I think we can both agree that when you engage in your episodic extramarital encounters you then tend to look for signs and symptoms of infection.  This practice often leads to mis-identification of normal sensations as abnormal.  Self treatment only obscures and complicates things.  With this pre-amble, let me make a few comments:

1.  Your encounter with a CSW was relatively low risk (certainly lower risk than if you had picked up a casual partner in a bar for instance).  Most CSWs do not have STIs, most exposures to infected partners do not result in infection.

2.  condom protected sex is safe sex.  If you wore the condom throughout your genital sex you can be confident that your risk for infections such as gonorrhea, chlamydia or NGU from the genital sex was very, very low.  The risk for unprotected oral sex is also relatively low.  Chlamydia is only VERY rarely acquired from oral sex and when gonorrhea is acquired persons typically have overt, not subtle urethral discharge.

3.  The azithromycin you took (twice) would have cured nearly all chlamydia and gonorrhea is present as well as over half of gonorrhea.  The cefixime when take with azithromycin would have cured nearly all gonorrhea.

4.  Heaviness and non-specific groin discomfort are not symptoms of STI.  The dull abdominal discomfort you describe is not a symptom of STI and if it persists warrants evaluation by your doctor.

5.  Scrotal discomfort of the sort you describe likewise is not suggestive of any STI. STI-related scrotal and testicular problems do not move from side to side and for them co occur or persist while taking ciprofloxacin suggests that something else (non-STI related, if anything) may be going on.

In answer to your specific questions:

A.  IF you had chlamydia, the chances that you would have been cured by your multiple doses of azithromycin are substantially greater than 99%

B.  Unlikely.

C.  Test ASAP.  You need to have a good examination and testing to sort this out. Considerations should not be limited to STIs and should include prostate problems.

D.  It's not clear exactly what is swollen but STI related swelling would have certainly been gone by now.

Hope this helps. Please see a health care provider and get evaluated and tested.  EWH

11 months ago
And to clarify testing question.  Although likely no infection.  Given time frame - had I had chlamydia and was successfully treated. Should t I wait one more week to ensure no false positive? Dead remaining cells?
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago
My advice would be to go on and get tested. If the test is negative great! If it is positive then at least you know you had chlamydia and consider whether or not to disclose this to your wife. I would be happy to discuss that unlikely probability upon the availability of your test results. EWH---
10 months ago
Results are in.  They are negative (For chlamydia and gonorrhea).  It appears also I have an inguinal hernia - which is being looked at. 

I do have one more question Doctor and I’m sure it’s not within your scope but maybe you can direct me to a good resource. 

I’ve struggled with being faithful - which is apparent by my constant need of this resource. 

I hate it.  I’ve researched so many different ways to change but despite support groups, habit research - it always comes back to this.  I live in constant shame and sadness.  

Not sure if you know of any literature that can help people like me who want to change but I’d love to know who you’d recommend.  If it’s beyond your scope I understand.  I really appreciate what you do.  It means a lot. Otherwise feel free to close this convo.  Take care. 
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
Thanks for the follow up.  I’m pleased to hear of your alternative diagnosis.  I hope you will be able to move forward from here.

Regarding how to modify your behavior, I have a suggestion.  I trust you will agree that your efforts to change your behavior by yourself have not succeeded.  This is not surprising to me as such behaviors are often deeply rooted.  My advice at this time is to seek the assistance of a professional counselor with whom you can be honest.  Professional assistance may be helpful.

I hope these comments are helpful.  As you know, we provide up to three responses to each question.  This is my third response.  Therefore the thread will be closed shortly.  Take care.  I wish you the best.  EWH