[Question #7587] Risky encounter

2 months ago
On 1/16 I had unprotected oral and protected vaginal with a sex worker. When I couldn’t finish it was followed by 5-10 mins of incredibly fast and rough jerking.  When I woke up the following morning my penis was swollen in the mid section roughly a half inch around the entirety of my penis.  After two days past it went completely away but the following day(day4) I felt one swollen lymph node on the right side of my groin.  I went to my dr who confirmed the  swollen lymph node and wants me to get sonogram of node.  That side of my groin is even somewhat swollen and raised as of today, with a dull ache that comes and goes.  I Had urine done for chlamydia and gonorrhea at day 6.  Get those results tomorrow.  Will  test at six weeks for all others stds.  I guess my question is do you think my swollen lymph node and pain  is related to this encounter ie an std.  Thanks for the upcoming response and the wonderful work you are all doing here 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Welcome to our form. Thanks for your question.  It provides me with an opportunity to comment on the function of lymph nodes and why yours is tender and swollen. Lymph nodes are part of our bodies defenses against all sorts of sources of information.  Most people have lymph nodes which, if they looked hard enough, can be felt.  This is normal.  When lymph nodes become tender or start to enlarge, this is a sign that they are reacting to something.  This includes infections, external irritants, and the effects of trauma. In your case, the inflammation that you noted on your penis which was most likely the result of vigorous masturbation resulting in inflammation as part of the healing process.  Just as the area of inflammation has resolved, I would anticipate that your swollen node will improve rather quickly.  If it does not, then further evaluation is warranted.

I hope this makes sense.  If there are further questions or anything I’ve said is unclear, please don’t hesitate to use your follow up questions for clarification.  EWH 
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2 months ago
Hey Dr. Hook and thanks for the quick response.  My original question was a little rushed so I failed to mention That I received the unprotected oral and also I am  married.   So another dilemma of mine is future intimacy with the wife.  Chlamydia and gonorrhea were both negative 6 days out.  So I think my other concerns would be  Hpv, herpes, and syphilis which I am doing a ten panel test at 6 weeks.  
(1) From my exposure what are the std’s I am at risk of getting and their probability.
(2) When do you think Its safe to resume intimacy with my wife.  
(3) In regards to the lymph nodes, I can now see how it may be related to the penis inflammation.  It has been 3 days now and I can feel it with certain motions such as getting up from sitting down or tying sneakers.  My question to you is do you think I should go ahead with the sonogram although I’m skeptical it can show anything except confirm it is enlarged.  Also at what point (I guess how many days or weeks) if it doesn’t go away should I be concerned that my lymph node being enlarged is due to something else.  Again thank you so so much.  
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Few STIs are transmitted through receipt of oral sex.  Your sympathetic not typical of any STI.  They do not suggest herpes or HPV.

1.  Your shod not suggest any typical STI.
2.  At this time, with your negative tests for STI.  I would not hesitate have unprotected sex with your wife based on what you have described.
3.  As I said earlier, if your swollen nodes improve over the next few days, I would not be concerned.  Otherwise a sonogram might be helpful.  This is something to work with your own physician about.

Hope this helps. EWH 
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Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Sorry for the typo.  Reply number 1 above should read - “Your symptoms do not suggest any typical STI.”  Sorry for the typos. EWH ---
2 months ago
Ok so I am now 13 days post exposure and 8 days from start of swollen and somewhat painful lymph nodes with dull aches.  I am sorry to report while my right side has gone down some (not completely gone) my left side is now experiencing the same.  Kinda freaking out here.  Any input to help me ease my mind.  I googled and we all know the paths google can take us.  Thanks again.  
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Thanks for your follow up.  I’m glad that you are working to avoid this unnecessary worry that Google causes on these matters.  Is the swelling on your left side tender?  Is there any redness in your genital are?  If so, where?  Have you been examining your lymph node areas?  Upon receiving this and any other information you wish to share, I’ll provide,some final comments.  EWH 

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2 months ago
Thanks for letting me reply dr.  Ok to answer your questions I was feeling sporadic throbbing on both sides of groin last night.  I sometimes even  feel something  when I make movements that involve the groin.  So last night I felt around the throbbing on left side and found 2 enlarged nodes.  It is a little tender when the node is pushed.  I  have a redness on my scrotum but don’t think that’s out of normal appearance.  Yes I have been manipulating them on occasion but only to gauge there size though and how many are enlarged.  I’m really just a mess here.  It is totally stressing me out which might be making everything worse.  Anyways any recommendations on which kind of dr I should try to make an appointment with.  
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Sorry for the delay in responding, our server was down for several hours.  

Most people can feel lymph nodes if they feel for them.  This is normal and not a concern.   In addition, repeated examinations can irritate lymph nodes so that they become a bit tender.   In Addition, the lymph nodes you have been feeling for are adjacent to the femoral artery, one of the largest arteries in the body. Thus the throbbing you have experienced may actually be the artery, not the node.  The fact that your discomfort has improved on one side while becoming somewhat more apparent on the other makes it unlikely that this represents an infection.

Given your anxiety over the situation I would suggest that you see a healthcare professional. My recommendation would be to see your regular doctor or if you don’t have one, an internist or family practitioner. I would encourage you not to go to the emergency department as emergency room physicians all too often treat their patients “just in case” without really knowing what is going on. I believe it is important for you to find out whether what you are feeling is abnormal or not, as well as what might be causing it, if it is abnormal. I am confident that it is not an STI.

Normally this thread would be closed at this time. I will leave it open but not respond further in the hopes that you will tell us what you decide to do and what the healthcare professional UC says. Take care. EWH
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2 months ago
Hey Dr.  So I went to my doctor and he said yes they were inflamed but probably due to the inflammation on the penis.  He said we will test for stds at 6 weeks.  But in the meantime he wanted to run some other  blood work.  He is supposed to call me tomorrow after his day he said around 8. Pm.  Since I have an online account I was able to see my blood work when it came in.  Being I don’t know the depth of his std knowledge I would like to ask you one more question.  If I have to purchase another question I will just let me know in a response to do so.  So everything came back within range except two tests. My auto immature Granulocyte % was high .8 normal range              ( .1-.3) and my Auto Monocyte # was .66 normal range being (.10-.60). 
WBC  count 7.22nin Normal range and RBC also normal range but barely. 4.87.  All of this might as well be another language to me.  So if you could give me any insight on why they would be elevated.  My lymph nodes just as of today feel like they are trending in the right direction and bothering me less and less.  If it is viral what are we thinking cuz as of now that’s my only symptom 16 days post exposure.  Kinda freaking out if it might be mono or cvm and am trying to keep distance of my saliva with my three children and wife until I know what’s happening but that is very hard task to pull off.  Thanks again dr
2 months ago
Sorry forgot to mention today do to pain I noticed  nodes around ribs to be enlarged as well. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago

Thanks for the follow-up.  As far as follow-up testing is concerned, 6-week testing is needed only for evaluations for syphilis and HIV, both of which are most unlikely.  Testing for more common STIs like gonorrhea and chlamydial infection at this time will provide conclusive results. 

Your white blood count is in the normal range.  Your monocyte and immature granulocyte counts are slightly but not dramatically elevated;  these are non-specific tests which are usually normal in persons with STIs including recently acquired HIV.   Your could get these sorts of test results with something benign like a non-STI, community acquired viral infection.  I would not worry about them.  They do not provide clues to your symptoms. 

Nothing you have described suggests any need to worry about spreading an infection to your children or wife.  I would not worry and see no need to distance yourself from them

it would be unusual to have swollen lymph nodes around the ribs.  Wat you have felt may be something else. 

This ends this thread.  Once again, I urge you not to worry that your misstep led to acquisition of an infection or that you are a danger to your wife and kids.  Please don't worry. EWH

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