[Question #7410] Infection from Handjob

3 months ago

Background: I've suffered from on and off prostatitis for close to 10 years. I found that the prostatitis is typically brought on by some sort of sexual activity, usually unprotected sex even if partners are tested/known to be STD free. I normally need a number of antibiotics, for a significant time, to recover. Since then, I make sure I always use protection to try and prevent onset.  Now the current situation:

Last week, a stripper gave me a 30 sec max 'handjob' with mostly touching the head of my penis; no oral or other sex what-so-ever. After the dance I noticed my privates were lubricated and which I suspect may have been from her touching her own 'privates' during the show; so could have been vaginal fluids. Next morning, , about 8 hours later, I feel the onset of the prostatitis; discomfort in the prostate but also discomfort at tip of penis like urethritis but all the time. I have a running script for suprax which I started once I felt symptoms come on. After two days, I was only getting worse with significant discharge from penis during bowel movement. Concerned, I went to quick clinic and they gave me a 1 gram shot of rocephin and doxy for 10 days. I also asked to be tested for Gonorrhea and chlamydia to be extra cautious. The Dr did warn me that the timing of test and the Suprax may invalidate the test. I am still awaiting the results. The antibiotics stopped the discharge but prostatitis symptoms still continue 5 days after shot and doxy. My questions; 1) because some bacterial must cause this, any concern about re-testing for bacterial STD or HIV? 2) 4 days later I noticed a small red patch (not blisters) just under glans which looks like irritated skin but seems to be healing. If it heals in another two days, should I be concerned about HSV or just move on? 3) Anyone make progress in understanding bacterial causes of prostatitis recently? All my tests have always been negative in the past.   

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum.

Your symptoms are not due to any infection from the exposure described. I suppose sex itself might trigger symptoms of prostatitis or similar problems -- but that's the only possible link between this even and your symptoms.

And the symptoms don't really suggest STD. Urethritis does not cause "discomfort at tip of penis"; without discharge, urethritis is unlikely. And expression of discharge during defecation is not abnormal; it occurs from time to time in entirely healthy men, more often in some than others; it's simply due to intra-abdominal pressure (from staining at stool) and feces passing over the prostate or seminal vesicles, expressing semen or prostate fluds. It does not indicate active prostatitis or urethritis. I believe it was unnecessary to take cefixime (Suprax), and I see no valid need for the ceftriaxone (Rocephin) or doxycycline. If your discharge improved after that treatment, I think it was just coincidence; or if you had active infection of some kind, it was not from the sexual event described.

Those comments pretty well cover your three specific questions, but to assure no misundersanding:

1) I disagree with the premise:  no bacterial infection (at least none from the sexual event described) was the cause of your symptoms. I see no need for STD testing. I am confident that any and all future testing for STDs will remain negative.

2) Herpes doesn't behave like this. Broat spectrum antibiotics such as you had can suppress normal bacteria, allowing yeasts to overgrow and cause inflammation. So if I had to guess, I would be most concerned that the antibiotic treatment resulted in a minor yeast infection.

3) To the best medical knowledge currently understands, most prostatitis is not due to infection, but to non-infectious inflammation. That's why antibiotics usually are not effective. Evolving research suggests that bacteria not detected by current culture methods could be playing roles in many inflammatory syndromes, such as otherwise unexplained prostaititis, bronchitis, urinary tract infections, and more. At this point, this issue is highly theoretical.

Perhaps the main take-home message for you is that problems like yours are quite common, but apparently harmless. There are no reports of long-term serious consequences or complications of chronic prostatitis. As best as medical science knows, this is an issue of symptoms only, not potential harm -- either to affected men or their partners. 

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

HHH, MD
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3 months ago
Hi Dr, 

Thank you for the prompt reply and your comments were clear. Summary: "no valid STD reason for treatment or further testing". 

I do have two clarifications but they won't change your assessment. 1) I am very confident I was STD and infection free prior to this incident due to testing, protected sex and lack of symptoms. 2) I've had success with treating the prostatitis with the single shot of ceftriaxone in the past 3 years where within 48 hours the symptoms were either completely gone or significantly reduced. I am not having the same luck this time around. Again, no non-normal bacteria could ever be found in prior cases yet this antibiotic worked while others did not.  My only claim to having a valid prostatitis issue is that an ultrasound did find swelling in the prostate. Otherwise I am a perfectly healthy and no urologist has really been able to help besides offering antibiotics and saw palmetto.  

Two follow ups: 
a) the in-office urinalysis found 'trace' blood in urine. The Dr. did not comment on it when I was in the office and I only knew about from reading the paperwork. Is this normal? No WBC were found and all else was normal. 

b) Just theorizing, is there any chance that my body just reacts oddly to "normal" but foreign bacteria like a faulty immune response? I've only had one partner in the past 10 years in which sex  (oral or vaginal) did not cause an issue. In actuality, I even had issues with her but then 3-4 months later it seemed to go away and stay away with no subsequent issues almost like I got used to it. Not sure you can comment on this since it is just speculation or even if there is a way to prove it. 

Thanks again. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Thanks for the follow-up information. However, these questions are going somewhat beyond my (and the forum's) expertise -- limited to STDs and we don't consider ourselves expert in non-STD genital problems. As I indirectly implied in my reply above, prostatitis and related syndromes are quite mysterious. However, if not done, I would recommend you speak with your doctor (presumably you have a urologist) about a "3 glass" urine culture:  bacterial infectsions (non-STD) cause some some prostatitis, diagnosed by differential bacterial quantities in the initial urine stream (glass 1), midstream (glass 2) and the first ounce of urine following prostate massage (glass 3). That your symptoms tend to improve after ceftriaxone may be a clue -- but honestly I think this could be just coincidental.

Reacting atypically to various bacteria could conceivably explain some apparently non-infectious cases, but this is speculative -- no data. Certainly hand-genital contact is not likely to introduce bacteria into the urethra in numbers sufficient to cause symptoms or infection. Any symptom exacerbation after sex probably has to do with the physiology of sex itself, not infection.

Scant amounts of blood appear in the urine from time to time. If not continually present and not associated with other symptoms, usually this isn't worrisome. But here too we are outside my experience and expertise.
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3 months ago
Thanks for the reply. Still haven't gotten back my results; been more than 10 days. I'll call next week but usually no news is good news in these cases. I'm sure it will be negative. 

As for me, I am starting to feel a good deal better; not 100% but definitely moving in the right direction. In fact some days I feel perfect then the next day it seems to come back. Obviously not something a standard infection would cause, would you agree?

I have been to maybe 5 urologists in 10 years, some of whom are 'experts' in prostatitis and I have never heard about the "3 glass" urine culture. It makes a lot of sense to try and see if there are different types or quantities of bacteria in the urine streams or prostate secretions. Next time I go to the urologist, I will absolutely be mentioning this. As of now, I don't intend to go as I seem to be getting better.  However, this suggestion alone was worth the $25. 

So for my future plans, I will wait for my annual STD tests next year. Seems reasonable?

Thanks again. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Glad to hear things are improving.

I'm not sure how frequently 3-glass urinalysis and culture are being used these days. First described by urologists at Stanford named Meares and Stamey (the latter being perhaps the first urologist in the US who trained and became expert in infectious diseases, 1960s-70s). The relative numbers of WBC in the three specimens can help localized inflammation or infection to urethra, prostate, or upper track e.g. bladder. Sometimes a 4th glass s well -- of prostate fluid itself, if expressed during massage.

I see no need for further testing now, and Im not sure about annual STD testing  -- depends on your age and sexual lifestyle. But Gonorrhea, chlamydia, and other STDs become quite rare after age 30-35, even in very sexually active populations. 

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