[Question #7356] Advice sought on next steps

3 months ago
Hi folks, I hope you're keeping well. 

Uk based. On Aug 7, I had protected intercourse and unprotected oral (received) with a female (I'm male). I have not engaged in any sexual activity since. 

During the oral, I had severe pain and had to stop. This proceeded for a few days feeling like I had been cut after and then the following Monday (17) arrived as a burning sensation. Inside my urtheria there is the makings of a small cut/tear. It has not stopped slightly burning since nor showed any signs of healing. Best I can describe it is as exposed blood vessels. 

Prescribed end of Aug, early Sept... Macrobid 5 days, Doxycline 8 days, co-amoxiclav 7 days which I believe helped make it milder along with a constant hot water bottle. over the next few weeks up to the start of Sept. Midway through doxy, I ended up with the start of oral thrush. I have not been able to rid since. I've tried daktarin, nystatin and had no luck. Since then my anxiety has sky rocketed. At times using the hot water bottle I had night sweats & stopped using it last month, I have still had a few night sweats however. 

There is a feeling of pain in my groin ear my lymph nodes & had two bad trips to the toilet over the past two months. A fortnight ago, I started getting tender pain in my right armpit, this has not left since. A couple of weeks back, I had a really bad neck and head, it felt like tension and I do have a bad neck so hoped it would clear. This has since resolved. I've had no obvious sign of fever or flu from what I can tell, but two weeks in I had one day I felt really lousy.

As of now, I'm left with redness downstairs esp near the frenulum, the burning (it does not burn to pee), most of a constant weak burn, sore groin/lymph nodes, oral thrush, sore armpit and the odd night sweat where I wake up semi covered on my top. I've also noticed the odd miniscule individual petachie dots on different parts of my body too, I'm had a few of these before as I'm pale but I certainly think anxiety is driving some of this but I'm deeply concerned, scared and it's affecting the ability to do my job or concentrate for a few minutes at a time.

Testing wise. I have had negative so far on urine, swab and blood but I know my body and something is just not right. 

Two regular urine tests at doctors. 

2 weeksx2, 4 weeks, 7 weeks

Chlamydia trachomatis: negative (x4) 
Neisseria gonorrhoea: negative (x4) 
Mycoplasma genitalum: negative (X2) 
Ureaplasma DNA: negative (x2)
Trichomonas vaginalis: negative (X2) 
Gardnerella vaginalis: negative (X2) 
Herpes simplex I & II: negative (x2 & swab on urtheria sore area)

4 weeks: hiv / hepatitis / syphilis 
5 1/2 weeks: repeat (finger stick pot of blood sent to lab/4th gen ag/ab) 

The girl involved, a teacher, she has been very helpful and understanding. She unfortunately had a chlamydia infection at the time, resolved by Doxycline. A left over present of old partner....She has also done a complete test as above at week 7 now negative post encounter. A hiv test at week 9 and last Friday she completed a blood draw ag/ab 4th gen hiv test, it was negative. She is adament that is at least 13 weeks/3months since she last had unprotected sex. I have no reason to doubt her. The only thing she believes she has ever had bar Chlamydia is folliculitis when shaving... 

My next steps are a regular blood test at the doctors and a swab of the oral thrush but I'm still deeply worried about HIV. Will test at 3 months (Nov 9)I just can't shake the fear and currently don't understand what is going on. I'm a cross country runner and was in almost athlete fitness in July. I've lost a lot of weight (20lbs) recently although the anxiety, high heart rate and lack of regular eating is probably responsible.

With all your experience, do you have any advice on what to do next? I've reached out to Dr Hawkins in London too but I am just begging to find some degree of normality or if I was your patient what you would do with me to try to move forward.

I thank you for your time, if you have any need for further info I'd happily provide it.

R
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum. Thanks for your confidence in our services.

The bottom line is that I'm confident you have no STD and probably never did; and that it's time to cease any further attempts to explain your symptoms. Here come the details:

This is a complex situation with a much more extensive and mostly unnecessary evaluation than I would have thought necessary, based on your exposure history and symptoms. Your initial symptoms sound liess like infection than some sort of physical or chemical irritation. And I don't understand all those antibiotics. Nitrofurantoin (Macrobid®) is ineffective against any and all STDs; it's only potential use is for a non-STD urinary tract infection, and even then, almost exclusively in women. Did you have objective evicence of urethral or urinary inflammation, e.g. increased white blood cells by urethral swab or in urine? I would also not have prescribed amoxicillin-clavulanate or doxycycline without more evidence of an infection -- and for what it's worth, although doxycycline is excellent against chlamydia, it is not reliable against gonorrhea, and amox-clav isn't reliable or recommended for either one. It sounds like your doctor was reaching for treatment that might help without making any clear diagnosis -- right? I would have recommended against that approach.

Having said all that, since your partner turned out to have chlamydia at the time of exposure, it's conceivable you were infected, but it sounds like you weren't tested for it before being treated. If you had it, the doxycycline cured it: there has never been a proved case of failure doxycycline for 7+ days to cure chlamydia. You should have been treated for chlamydia (even if tested and negative) on account of your partner's infection -- but that's the only antibiotic you had that makes sense.

Was your oral thrush professionally diagnosed? If you really had it, i.e. an oral yeast infection, it's probably the result of your over-treatment with antibiotics. Broad-spectrum antibiotics like doxy or amox-clavulanate can trigger yeast infections by suppressing normal bacteria. Whether you had true thrush or not, this doesn't indicate any infection of importance and nothing from any sex partner.

Your test results:  All reliable except maybe herpes, more about which below. Ureplasma and gardnerella were wastes of money and time:  neither is abnormal in the male genital tract and not likely causes of symptoms like yours. I have a hard time understanding why any doctor or clinic kept ordering all those gonorrhea and chlamydia tests; one would have been enough. In any case, you have none of the organisms for which you were tested. Same for HIV, syphilis, and viral hepatitis.

Any genital "cut" or sore raises the possibility of herpes. However, herpes would not persist this long. Your negative HSV PCR (swab) test shows you didn't have active herpes at the time you were tested, but doesn't prove you are not infected with HSV1 or HSV2. A blood test can sort that out. However, if positive for either one, I would not attribute iyour symptoms to it, and probably would not be from the exposure described, but a more distant past infection. In any case, that's the only additional test I would recommend you consider.

Some genital symptoms just can't be explained. For sure you have nothing that will ever harm you or any future sex partner. It's common in such situation to worry about an emotional/psychological origin, i.e. anxiety or stress magnifying trivial symptoms or normal body sensations that otherwise would be ignored or not even noticed. Having not examined you personlly, I cannot make this judgment. But I am skeptical you have any physical cause for your symptoms. If you do, I'm confident it's harmless. I strongly recommend you spend no more time, money, or energy to this. (I don't know Dr. Hawkins, but if a certified GUM expert, it might make sense to follow thoruigh with plans to see him or her. If so, you can expect agreement with most or all I've said. Indeed, I would suggest you print out this thread as a framework for discussion.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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3 months ago
Thank you for your time on this, I've outlined as much info as I have below.

Regarding irritation, it is possible. The week inbetween the exposure and the burning, I was bathing everyday. I don't typically do this but stress of work etc, I felt the need to. 

In terms of antibiotics, this came from going to the doctor initially. They expected the urethra and couldn't see the redness. It is not visible without parting the urethra slightly however in a follow up with a nurse at a gum clinic, this was found and swabbed. The swab was extremely painful on the sore/cut but fine elsewhere inside the urthera. 

Macrobid was given after a dipstick test, the dipstick was normal but was given for the discomfort and burning that was going on. It was extremely uncomfortable at night typically as the day progressed. 

I had two urine tests prior to begining Doxycline. (believing it to be NSU) Both were for chlamydia and gonorrhea at 2 weeks. Both negative. Fully agree with you about a clear diagnosis. I'm still struggling now. The burning at points of the day still along with the groin pain & now armpit pain is extremely uncomfortable throughout the day & feels tender. Sitting in certain positions reduces it or walking. However when laid out, it is not normal. 

Also a tad concerned the amount of antibiotics in the space of a few weeks has disrupted my stomach. Intake of food leads to gargling and often gas and had some odd pins and needles in my hands in September, this has since passed, perhaps anxiety driven but was again uncomfortable. 

For the thrush, due to covid - multiple pictures were submitted to a doctor who deemed it thrush. As its not gone, I've been given a swab to hand back to them later this week. It scrapes off, cotton in feeling and has been thoroughly uncomfortable. Loss of taste & at the back of the tongue has been where most of it has formed. 

Throw in a fissure to the mix after the first bad trip to the loo back in September which finally feels like it's healing. 

Is there any concern with the night sweats? 

The volume of tests you mentioned, I believe they're just all ran when testing the urine that was provided. 

With regards to HSV, I have had 3 partners in my life and never had any form of symptoms prior to this. Immediately when the cut was located by the nurse, I did wonder if it was herpes, I'm happy to do an IGG and will locate one. I wish I was in the states at the moment as would have preferred to get the WB from Terri for accuracy. 

With the urthera redness, will it ever heal? It is clear on inspection by the nurse at the gum clinic that it is not similar to the rest of my urthera, Is there any particular cream or treatment that can close the wound? I have lucked out in my 32 years with injury and illness but I'm adament that this is affecting my health at present and I'm deeply concerned about infection, my groin and armpits firing off in pain, is that a sign that something is untoward? 

Does any of this concern you for HIV? I know that I've tested negative thus far at 4 weeks and 5 1/2 weeks via fingerprick blood sent to a lab for 4th gen ag/ab. The girl has also done 7,9 weeks and a blood draw ag/an 4th gen last Friday. At a minimum that is 11+ weeks but going on her word, over 13 weeks. 

For info, this is Dr Hawkins > https://londonmedical.co.uk/consultants/dr-david-hawkins/

Thank you by the way, I absolutely will print this off and forward to him in advance of consult as it provides him with a lot of information. Again if there's anything further to add please let me know or if you need any more info. Thank you. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Thanks for the additional information. Almost everything you write here reinforces my suspicion of psychological and not physical origins of your symptoms.

I'm skeptical your urthral redness is significant. Over my 4+ decades in the STD business, almost every patient I've seen who complaied of increased urethral redness had no visible abnormality. Will it ever "heal"? Likely there's nothing to heal. But all humans live with various unexplained symptoms from time to time:  the ankle that still hurts a year after the sprain has healed, abdominal discomfort, headaches, etc, etc. The genitals are no different. Not all symptoms (of the genitals or anywhere else) mean an important health problem. All your other symptoms also are perfectly consitent with the emotional/psychological possibilities discussed above. That doesn't mean the symptoms are not real:  they are. But they are not suspicious for anything serious.

Visible appearance without in-person exam is inadequate to reliably diagnose oral yeast infection (thrush). But as I said, at this point it doesn't matter one way or the other. If thrush, it will clear with time off antibiotics. Probably the same with your GI symtpoms.

True night sweats -- soaking night clothes and sheets -- are evidence of fever that breaks during the night. Take your temperature at bedtime and in the morning. If normal, you don't have night sweats. If abnormal, definitely discuss with Dr. Hawkins. But night sweats alone do not point to an STD, but to innumerable other conditions. (Worldwide, TB is probably the most common cause. Aside from advanced HIV/AIDS, I've never seen a patient with night sweats caused by an STD.)

You don't need an HSV Western blot, at least not now. WB is only done to clarify equivocal or uncertain HSV IgG results.

You don't have HIV. The current tests never miss it, and none of your symptoms is typical.

With the link you provide, I am reminded of Dr. Hawkins. The STD/GUM world is fairly small and he is a good sized fish in the pond, but I don't know him well. He probably would say much the same about me.
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3 months ago


Good afternoon, 

Please forgive me but I'm absolutely adament that there is damage in the urthera through either injury or infection. I've never had pain like this before and the raw redness is a big give away. Parting of the meatus reveals it, it is extremely painful to touch that particular area but fine elsewhere. If you are happy to consult, I will pay to have a consultation via your practise where I can supply further info with pictures etc such is the discomfort and situation I find myself in. 

The thrush swab was sent off today so hopefully find out shortly on that. Agree with you, I'm sure it can take a long while for it to clear along with GI issues, but I'm concerned as treatment isn't working at present. Two rounds of nystatin has yielded no progress. 

Re night sweats, thank you. I have a digital thermometer by the bedside now. It was normal this am when I woke up. With the window open and autumnal weather, I did not notice any sweat waking up through the night. 

Understood on the IGG, is 3 months a good time to take? 

Again, optimistic on the HIV test in November given the 5 1/2 week test & the girl testing negative at 3 months via blood draw ag/ab 4th gen. 

I'm sure Dr Hawkins will have a good word for you, again this conversation will probably help him proceed with all the information he needs. 

Can I just ask, the armpit lymph nodes, can the stress and anxiety of the past two months cause pain in these regions? 

Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Dr. Hawkins will be on top of your urethral discomfort and appearance, I'm sure.

Failure of nystatin to resolve the oral problem is pretty good evidence against yeast (thrush) as the cause. And I'm not sure what test is being done. Culture or other detection of yeasts may not be helpful, since yeasts are normal in the mouth. When thrush occurs, it isn't because someone acquires yeast from elsewhere. It results from increased growth of natural pre-exisiting yeast in the oral cavity (or the vagina or rectum in people with yeast infections of those sites). So a positve result would not necessarily explain your symptoms.

HSV IgG tests sometimes take up to 4 months to turn positive. 

Stress and anxiety can cause pain and discomfort pretty much anywhere. And repeated prodding to feel for lymph nodes can also cause or increase discomfort and pain.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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