[Question #8318] Likelyhood this is an STI?

46 months ago

Have had some great answers over on MedHelp.com and would like to get another weigh-in.
You are welcome to read if you prefer:
https://www.medhelp.org/posts/STDs---STIs/Not-usual-STD-symptoms/show/3067192

History:
I am male, Sexual encounter with a femail escort, unprotected aural (both) and outercourse, protected intercourse.
A few weeks later, a prostate biopsy (showed nothing immediately actionable)
Somewhere around 50 days post-encounter/20 days post-biopsy symptoms apparent.

Symtoms:
Prominent: discomfort in groin, more frequent urge to urinate.
Less: some pain near tip of penis (almost like referred pain I felt once when passing kidney stone), momentary now and then.
There has at no time been any visible signs, such as drip, puss, discharge, sores, discoloration - nothing.

62 days post-encounter/29 days post-biopsy, GP Doc did on-the-spot urine test "something is going on", started Bactrim Abx (SMZ/TMP DS 800-160 2x daily for 10 days)
73 days post-encounter/43 days post-biopsy, self OTC urine stick test. Neg Nitrate, Pos Leukocytes
Bactrim 10 day course seemed to lessen symptoms, but not gone.
GP Doc called in Cipro (500 MG 2x daily for 10 days), been on that for 2 days now.

Both GP and Urologist (via phone, no physical visit) would prefer to do a culture, but are going along with my plan to try Cipro, and I am currently traveling.

My suspicion is this is not an STI, but NGU, UTI, or something related to the biopsy and not the sexual encounter. Testing is, I assume, not accurate while on Abx. I am in a State where it is mandatory to report every STI. I am concerned that blood/urine testing to rule out STI's would end up notifying my wife. I am concerned that even a urine culture might detect or point to an STI with the same affect.

My questions:
1. An STI? Knowing you cannot rule out absolutely with out tests to go on, what is your best estimation and level of confidence about this being likely or unlikely an STI?

2. Urine culture: Someone very knowledgable on medhelp.com stated that urine cultures never test for STI's, but just look for other causes and what Abx will kill it - and that while on Abx the culture might not be acurate anyway. Can you confirm that and that I would not have a disclosure risk with a culture?

3. Abx With your best experienced guess, do we think Cipro will clear this up? And should I be concerned about passing someting on to my wife?

Thanks for your always thoughtful answers!

Edward W. Hook M.D.

46 months ago

Welcome to our foreman thanks for your question. I’ll be glad to comment. The exposure you describe was low risk for acquisition of any STI and the antibiotics you have taken would have cured mini STI‘s if one had been present. To elaborate, as I suspect you know, kind of protected sex is safe sex, STI‘s are not acquired as a result of outer course, and both receipt and giving oral sex to an infected partner Really results and infection. Finally, all of the statements above presuppose that your partner was infected when in fact, most commercial sex workers do not have STI’s.

Additional comments:

1. Your symptoms are far more consistent with a urinary tract and or prostate infection then an STI. STI’s do not cause urinary frequency or the sort of discomfort at the tip of the penis that you described.

2. The Bactrim that you took would have cured chlamydial infection if present. The ciprofloxacin you have taken would’ve killed some but perhaps not all gonorrhea but again, your symptoms are not at all suggestive of gonorrhea.

3. I agree with your doctors of the benefits of a urine culture. I suspect that this may be a complication of your biopsy or other prostate related problem. Prostate infections are often challenging to treat, requiring prolong therapy. A urine culture would help to guide this therapy and would not detect any STI even in the unlikely situation that one were present.

4. The presence of white blood cells in your urine test is suggestive of inflammation within the urinary tract. Whil STDs can cause such findings, so can your infections and infections of the prostate.

I believe the replies above address the questions you ask however I will now address your questions one by one:

1. I am quite comfortable in telling you that the likelihood that your symptoms are due to an STI is vanishingly low. The timeline is wrong, the symptoms are wrong, and you have an alternative explanation which makes perfect sense – a prostate or urinary tract infection.

2. You are correct, no STI would be detected with a standard urine culture.

3. Nothing you’ve described raises. any concern for me that your wife is at risk. Ciprofloxacin is one of the medications, like Bactrim, which is often used to treat prostate infection. With either anabiotic, on occasion four or even 6 to 8 weeks of therapy may be required to eliminate the infection.

I hope the information I provided is helpful to you as you consider a year problems. I agree with you doctors that are urine culture to guide therapy would likely be helpful. A short course of ciprofloxacin may buy you time that may not cure the infection. That may not mean that ciprofloxacin wouldn’t work, but that it may need to be used for a longer period of time.

If there any further questions or any part of my reply is unclear please feel free to use your up to two additional follow-up questions for clarification. EWH

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46 months ago

Thank you so much for your thoughtful answer, Dr. Hook.

This being an STI forum, I don't really have any more questions about that subject that you haven't cleared.

I am almost done with the Cipro, which seems to have cleared it up. However, as you point out, that may just have bought some time. My guess is that I will need to finish the Cipro, see if symptoms return, and if not, wait at least a week or so to get a culture so it will not be skewed.

Thank you again. You deliver a very valued service!

Edward W. Hook M.D.

46 months ago

Thanks for the follow up. I’m pleased that you were symptoms appear to have responded to the Cipro. Given the likelihood that this may be coming from the prostate where prolonged therapy is often necessary, my advice would be to discuss with your urologist whether at this point, and as long as you are tolerating the Cipro well, it might be advisable to simply prolong the course of ciprofloxacin. Of course this decision is up to you and the urologist but given the fact that you’ve been back-and-forth on this several times, I would personally err on the side of over treatment. Take care. EWH---