[Question #7239] Risky Behavior and Bad Symptoms

7 months ago
Hi Doc,
I’m a married man 42 years old, and have had some extramarital encounters over the past 6 months. 

I engaged in unprotected oral sex with a CSW over 30 times (me receiving oral sex) over the course of 6 months. No penetrative sex. She was the only one that I’ve been doing this with. 

4 weeks ago, I started to experience a really bad itch around my penis head and urethra. The itching began to subside after a week, but I’ve been left with urethritis symptoms. These symptoms include  a Constant stinging sensation in my urethra. It’s most prominent right after I urinate, or ejaculate. There’s a hot sensation constantly at the tip of my penis, and i feel constant irritation.  This has been going on for the past 4 weeks. I don’t have any discharge. I got tested for Chlam/Gon/trich/Mycoplasma/ureaplasma 1 week after onset of symptoms. All tests negative. I re-tested for Chlam/Gon 2 weeks later, and still negative. 

The scary part is that my wife began to experience symptoms in the same exact week as me. She had extremely itchy vagina with discharge that was both yellow and green. Needless to say I was terrified. She went and got a wet mount done, and they did not find anything. No trich. I’m unsure if she was tested for chlamydia/Gon. They diagnosed her with BV/yeast infection. They prescribed her antibiotic and antifungal pill. She finished it, but the itching has returned, with some yellow discharge still present. 

What could this possibly be? We both are experiencing symptoms. I’m terrified. 

Could this be mycoplasma gen? Or any of the other ureaplasma groups? I know you say it can’t be transmitted orally, but given the duration/frequency of the encounters, could it have been passed to me? Could I be getting a false negative? I know that it’s really hard to detect. It was urine test.  

Really needing advice here. 
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Welcome to our forum. Thank you for your questions. I’ll be glad to comment. Amongst potential sexual exposures, receipt of oral sex is amongst the lowest risk. To my knowledge there have never been cases of HIV acquired by receipt of oral sex, chlamydia is very rare, and gonorrhea occurs occasionally.   Data on mycoplasma genitalium are still being developed but it too is a rare, at most, cause of urethral symptoms following receipt of oral sex.  In addition to infections caused by the pathogens mentioned above, receipt of oral sex also can transfer oral bacteria from one person to another person’s genitals. This sort of transfer can cause non—chlamydial NGU which is characterized by burning on urination or a slight urethral discharge and negative tests for STD pathogens.   Most specialists do not feel that non—chlamydial NGU following oral sex necessitates therapy however when it is treated it responds rapidly to therapy using Doxycycline  or is it through Azithromycin.

I suppose that a fungal infection introduce through oral sex might be causing your symptoms but this would be quite unusual.

Your symptoms however are not typical of urethritis. Discomfort following urination or ejaculation is not a sign or symptom of urethritis.  

My suggestions are as follows: if you have not yet been tested for mycoplasma genitalium, I would do so. There is no reason for testing for other mycoplasmas or Ureaplasma’s.  I see no reason for further testing for the STI’s that you have already been tested for.  If your test for mycoplasma genitalium is negative I would look for other reasons for the symptoms you are experiencing, perhaps with a urologist.

I’m sorry I don’t have a better explanation for your symptoms. I hope the comments that I have provided offer some reassurance and comfort. EWH


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7 months ago
Thank you for your prompt reply Doc. I have a few questions for you. 

1. In regard to mycoplasma gen, I have tested negative for it 2 weeks after onset of symptoms. Are you saying that this result could be a false negative? Should I retest for this? Given that I’ve tested negative for everything else, this seems to be the one STD that could possibly be the culprit. 

2. Does the sudden onset of my wife’s symptoms at the same time as mine indicate that this might be an STI? Does MGEN typically cause BV and the symptoms that she’s experiencing? And if it’s not MGEN, could NGU be transmitted to her? I’ve seen many posts on here where guys are over analyzing their symptoms, and causing these phantom symptoms. I don’t believe this is the case with me, as I can feel the burning/irritation constantly even when I’m not thinking about it. The fact that my wife is also experiencing symptoms is a big concern. Since the BV antibiotics, and yeast medication didn’t work, does that mean that she could possibly have MGEN? I’ve read that it commonly causes these symptoms in women. 

3.  I’ve read through many posts in this forum where you have confidently stated that MGEN isn’t transmitted via oral sex. Does the frequency of my unprotected oral encounters make you feel that I could possibly be in that tiny percentage of folks who might have gotten it this way? 


Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
1.  Thank you for your clarification. I didn’t realize when you stated in your original question that you had been tested for mycoplasma genitalium.  In that case there is no reason to test again. FYI, ongoing research on mycoplasma genitalium indicates that the organism is occasionally present in the pharynx and that it is potentially transmissible. These events appear to be quite rare however.

2.  I suspect that the simultaneous occurrence of your wife’s symptoms are coincidence.  Mycoplasma genitalium does not cause BV.  When women are infected with mycoplasma genitalium they are most often asymptomatic.

3.  Please see my comment regarding oral mycoplasma genitalium above. EWH
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7 months ago
Hello again,
I just wanted to follow up. I have since visited my urologist for further evaluation on this. He seems to think that I may have mycoplasma Gen. in my prostate. He took a urine sample, and said it was clean. (No WBC) I explained my symptoms, and everything else that I discussed with you previously in this post. He recommended that I submit a semen sample that he will send off to labcorp for MGEN testing. He will also be testing for ureaplasma, mycoplasma hominis, and another one that I can’t remember. He seems to be pretty confident that it may be mycoplasma gen that has taken root in my prostate. I’m conflicted here. Everything that I’ve read about mycoplasma gen on this forum states that it cannot be passed orally. However, my urologist seems to think otherwise. 

1. Do you agree with the assessment of my urologist? 

2. If MGEN is in my prostate, could that be the reason that my urine test came back clear of MGEN the first time I tested? 

3. Could any of the other mycoplasma groups be the culprit? 

4. I had taken a 7 day course metronidazole 3 weeks ago, when my spouse was prescribed it for her BV. I took it as a precaution in case they missed a trich diagnoses on her, and I wanted to be sure that we both were cured in case it was trich. The medication did not help my symptoms at all. Since I took the antibiotic 3 weeks ago, is it too soon for me to test for MGEN right now? Since the medication may produce a false negative. 
Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
Thanks for your follow up. I am going to respectfully disagree with your urologist. The clinical spectrum of disease is caused by mycoplasma genitalium is still being described but prostatitis it is not a major concern. Most persons with prostatitis, and particularly symptomatic prostatitis, will have white blood cells in their urine.  Mycoplasma hominis, Ureaplasma‘s, and other mycoplasma species are all normal parts of the genital microbiome and do not cause disease in normal hosts. There is a widespread misperception that STI‘s are a relatively common cause of prostatitis. This is incorrect.  Superb studies carried out by urologists at the University of Washington have repeatedly Demonstrated that STI’s are a very rare cause of prostate infections. In the majority of prostatitis no obvious pathogen is discovered. Thus, in response to your specific questions:

1.  I respectfully disagree with your urologist. I would be astonished if your urine or ejaculate tests for him genitalium were positive.

2.  As I noted above, when persons are found to have prostate infections, urine test typically show the presence of white blood cells. This is particularly the case with the infections are symptomatic.

3.  No.

4.  Metronidazole is not effective in treatment of mycoplasma infections. A test for mycoplasma taken at this time will provide accurate results. 

I hope that this information is helpful. EWH
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7 months ago
Hi Dr.
I just wanted to follow up since my last post. I have since submitted a semen culture, and urine test for mycoplasma groups. 

I am still awaiting the urine results, but my semen culture results returned positive for abnormal “moderate” levels of Enterococcus faecalis. This was the only thing detected in the semen sample. 

Could this be the reason for all of my symptoms? From my research, it appears that this is a pretty common bacteria inside of many people? Is it common inside of the prostate/semen? Should I seek treatment for this or leave as is? My symptoms have persisted for the past 2 months now without relief. 

1. Can this be sexually transmitted to my spouse? Should I refrain from sex? Including oral sex? 

2. Should my wife also get tested for this? We did have sex regularly over the past few weeks. 

3. Since they did a culture, and not a PCR test one my semen, should I request a PCR test to rule out any of the mycoplasma groups? (I’ve read that mycoplasma’s cannot be cultured, and can only be detected via a PCR. 


Edward W. Hook M.D.
Edward W. Hook M.D.
7 months ago
This will be my final response. Typically we provide up to three responses to each clients question. This will be my fourth response.

E. Faecalis Is a bacterium normally found in school and occasionally as a cause of urinary tract infections. It is not a sexually transmitted infection.  I would suggest you discuss the significance of this finding with your urologist. In answer to your specific questions:

1.  See above. This is not a sexually transmitted infection. It is not transmitted through oral sex. It is not transmitted through sex of any kind.  There is no reason to abstain from unprotected intercourse because of the presence of this and you were ejaculate.

2.  No, there is no reason for your wife to be tested for this organism.

3.  Mycoplasma genitalium cannot be cultured for Clinical purposes. It is only detected by PCR tests. As I explained earlier, culture for other genital mycoplasmas would not provide useful information as these organisms are normal parts of the general micro biome, not pathogens.

This completes this thread. I will not close the thread immediately as I hope that you will notify me of your test results for mycoplasma genitalium with they are available. Other than perhaps a response to that however there will be no further responses to questions related to this issue. I hope the information I have provided has been helpful. EWH

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