[Question #7654] Epididymitis

3 months ago

I am an adult  male.  I visit a sex worker every week and have been doing so for many years.  I practice safe sex, and use a condom for oral and vaginal sex.   Except there was a period of 1 month when I received oral sex without a condom, and I ended up contracting epididymitis. I tested negative for all STIs (gonorrhea, chlamydia, syphilis, etc).  My urine culture and urinalysis were normal.


My questions:


What caused my epidymitis? 


Isn’t receiving unprotected safe oral sex for a male basically a safe sex practice?  Was I unlucky?


No judgemens, pl.  What is safer sex, vaginal sex with a condom or receiving oral sex without a condom?


Thank you.


Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Welcome to the forum and thanks for your questions.  I’ll be glad to comment.  Epididymitis occurs when bacteria move from the penile urethra into the epididymis which transports ejaculate from the testicles and associated glands to the urethra.  Not all epididymitis is caused by STI bacteria.  As we age, more and more infections are due to urinary tract bacteria such as E. Coli.  Receipt of oral sex can introduce mouth organisms to cause epididymitis as well.  Fortunately, these organisms respond well to antibiotics, most typically given for at least 14 days.

My guess is that this was just bad luck.  I congratulate you on your commitment to safe sex.

If any of this is unclear,please use your up to two follow up questions for clarification.  EWH 
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2 months ago
Thank you for your prompt response.  A follow up question (all from a male perspective) - 

Can you please comment on how risky is receiving unprotected oral sex for a man?  Is it "almost safe" sex? 

Which is lower risk - vaginal sex with a condom or receiving oral sex without a condom.  If one were to pick one of these two, which should it be (contracting a STD being the only concern).

Warm regards.

Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Good question.  Condoms remain the best prevention for acquisition of STI as long as they are worn from beginning to end and do not break which occurs about 1% of the time they are used.  Amongst unprotected sex acts, oral sex is lowest risk by far.  There are no proven instances in which HIV has been acquired from receipt of oral sex and infections such as chlamydia and Syphilis are curiosities.  Gonorrhea is the main STI acquired from receipt of oral sex.

Hope this helps and congratulations on your commitment to safe sex. EWH 
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2 months ago
Dear Doc,

A 1% condom failure rate is rather high.  Given that, and the nature of STDs contracted via vaginal sex and receiving unprotected oral sex,  it seems to me that as far contracting a STD is concerned, vaginal sex with a condom and receiving oral sex without a condom are roughly equivalent.   Can you please comment.

Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago

If all of your sexual partners had STIs and STIs were transmitted on every exposure then perhaps the comparison would be correct.  That said, most persons, even commercial sex workers do not have STIs (in fact, many CSWs are particularly careful to be checked regularly and thus may be at lower risk than a casual partner picked up at a bar).  In addition, most sexual exposures to infected partners do not lead to infection. Thus I would still rank condom protected vaginal sex at somewhat lower risk for acquisition of STIs than receipt of oral sex.  That said, there are to scientific comparative studies and both activities are at very low risk for acquisition of STIs.

I would add parenthetically that with condoms, when they break, you know it because breakage is obvious while with oral sex one may need to either wait for symptoms to occur or test for detection of asymptomatic infection.

I hope these comments are helpful. As you know, we provide up to three responses to each client's questions.  I hope that the information I have provided has been useful.  EWH

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2 months ago
Your responses have been extremely useful - thank you very much.  This thread can be closed. 
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Thanks for your thanks.  Take care. EWH ---