-31 m in the uk

- married with my wife (active sex life)

- cheated on her with other men (4-5 over a few years) 

- the encounters with the other men are oral sex only (both way) 

- most over two years ago - most recent one year ago. 

- Jan last year (which was actual a day after my last encounter) I got a symptom of frequent urination. Doctor wasn’t worried but gave me doxycycline. Took doxy and in day 5 I tested for STI as my anxiety got the better of me these was all negative (chlaymidia and Ghonnaria) my symptoms do subside 

- Feb start to panic again and my frequent urination comes back - test again (not on meds) negative. Ring docs who does urinalysis. Negative for everything.  Once again symptoms subside

- April time get a twitching feeling in penis, as well as uncomfortable urination I’d say. Did another tests negative - urine is cloudy. Symptoms subside 

- May twitching comes back for a few days. Then pain at the end of my penis. On holiday so can’t test. 

- ring GUM on return (already getting better) who say no more tests needed confident in clear. And it’s anxiety. 

- symptoms (pain in penis 1.5 weeks it lasted) 

I have been having regular sex with my wife throughout so I’m guessing if this penis pain was an STI… NGU? then I caught it from my wife. I haven’t tested since the penile pain and it hasn’t come back. 

So my questions are as follows.

1) what’s my risk from oral sex 

2) what’s chances I gave my wife something doxycycline cured it and she gave me it back in April after my last tests. 

3) humour me and if it was an STI would it be expected for a STI symptom to clear in 1.5 weeks? Spontaneous? 

5) do any of

4) what do I need to do going forward.

I have read both doctor Hook and Handsfied say that oral sex is “safe sex not zero but” and in the absence of penile discharge or painful urination in 10 days you would continue sex with your partners. Would you still stand by this statement?. 

I am in agreement with the advice you have had from the GUM clinic(s). First, oral sex with other males -- in both directions -- is not entirely risk free in regard to STIs, but it is relatively low risk for all infections and virtually zero for some. Second, the tests you had are reliable in excluding urethral gonorrhea and chlamydia, the main infections you could have transmitted to your wife. (NGU from oral sex is believed to often result from entirely normal oral bacteria, probably with no risk of health outcomes in exposed female partners.) Third, the symptoms you report are not consistent with urethral STIs (gonorrhea, chlamydia, NGU), but are indeed highly typical for genitally focused anxiety. That applies to both the symptoms themselves (like urinary frequency and pain at the tip of the penis) and their intermittent nature. (My forum colleague Dr. Hook was the senior investigator on a recent research report confirming that urethral STIs do not cause such symptoms:  https://pubmed.ncbi.nlm.nih.gov/29465655/).

Those comments largely address your specific questions, but to be explicit:

1) Your non-marital male partner oral sex exposures are fairly low risk, but not zero. However, all evidence is you have had no urethral infections. More about the possibility of pharyngeal (oral) infections follows below.

2) This scenario is very unlikely. Any such infections would have been readily detected (gonorrhea, chlamydia).

3) The immune system indeed clears urethral gonorrhea, chlamydia, or NGU, but not so quickly:  typically several weeks for gonorrhea, several months for chlamydia. NGU unknown, but surely 1-2 weeks is much too soon.

5) The on/off nature of your symptoms is inconsistent with any infection but very typical of genitally focused anxiety.

4) What to do now? It sounds like you have not been tested for pharyngeal STIs, for which you have been at risk. Given the passage of time, the chance you have any infection at this point is low, but for reassurance you could be tested for oral gonorrhea and chlamydia if not yet done. (I would have thought that would have been done at the GUM clinic -- but you say nothing about it.) Pharyngeal chlamydia is uncommon, but testing is almost always done along with gonorrhea -- so you could be tested for both. That said, the immune system clears pharyngeal gonorrhea over several weeks, and persistent infection for months or years is unknown. Also, these oral infections are rarely transmitted, especially to female partners, by either kissing or cunnilingus. Finally, you all don't mention syphilis and HIV testing. These too probably were done at one or more of your GUM clinic visits -- but if not, you could do them now for reassurance.

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

HHH, MD

Your right some of my tests was missing as I was running out of words! 

I have been blood tested for HIV and syphillis negative. 

And I have had my throat swabbed also negative. 

I think my concern is, and wish I pushed it at the time is the penile tip pain I got in April was very severe. I’d describe it as a bulging feeling at the end of my penis. Which I hadn’t had with any of the previous bouts of “symptoms” so it’s worrying me I didn’t persue testing at the time. 

I also know that the antibiotics the doctors gave me at the beginning over complicated the whole thing and that’s a worry. 

Just to be explicit with my understand a few follow ups. 

1) how much belief can I put on my chlamydia and Ghonneria tests done 5 days on a 7 day doxy course? 

2) the doctor did a dip test prior to the doxy on my first void urine. How much belief can I put in that. 

3) in regards to the body clearing clymidia ghonnaria etc, that’s not what I was asking I’m asking would symptoms last only for a week or two ? Or would I stay symptomatic until taking antibitocs or my body clears the infection (which would take more than two week) 

4) just to make sure we are both clear the symptoms have been constant but seemingly self limiting. 

Urination lasted a week but was constant for the week

Twitching last a week but was constant for a week

Pain at tip lasted a week but was constant for a week. 

Just if that changes anything. 

I'm glad to hear you were tested and negative for oral STIs and for syphilis and HIV. Good show.

2) Looking for evidence of inflammation by dip testing urine is less important than the negative tests for gonorrhea and chlamydia. But it provides soft confirmation you were not infected.

3) Sorry I misunderstood. No, once symptoms of urethritis start -- whether due to gonorrhea, chlamydia or NGU, usually they would continue for several weeks, i.e. not likely to resolve in only 1-2 weeks.

4) Understood.

Don't overthink this. Combining the past distance of your non-marital exposures, test results, and the nature of your symptoms, there simply is no realistic chance you have (or have had) any STIs from those events. However, I will add that your genitourinary symptoms are consistent not only with anxiety, but also with prostatitis or the male chronic pelvic pain syndrome (related to chronic prostatitis). Neither of these is an STI. Consider googling CPPS (spell it out) for more information, to see if your symptoms match; the Wikipedia article is good, as is information you can find from the Stanford University department of urology. But really, you can put your STI worries aside!

I have read the wiki on CPPS and agree a lot of what that says marries up with my symptoms I have had in the past. I do find it hard to believe this happened so close to a sexual encounter I have come to regret but I guess symptoms of everything have to start some time. 

So just to draw a line under all this … and finally move on. 

1) You really think this is a no worries situation, let by gones be by gones and move on without worry for me or my wife. 

2) check my understanding of my risks. Receiving oral sex is pretty limited to Chlaymidia, Gohnnaria, NGU and Herpies. Ghon, NGU and herpies are ruled out by not having obvious symptoms as my symptoms don’t match. So the only real risk I run is Chlaymidia been asymptomatic in me passed to my wife prior to doxy my doxy cleared the infections before my test and I didn’t catch it back in the three months of testing. Something that you think just wouldn’t happen? 

3) sorry didn’t press this before but my urine has been cloudy on occasion (mentioned this in my original write up) and also having bits in it, is this a concern? 

4) If I did have Chlmyidia or anything else for that matter could it stay asymptomatic or atypical (urination, penile tip etc) for a period of time or would I eventually get discharge and the more common signs of STI? I have been symptomless for 9 months now. Although I have taken other antibiotics along the way. 

5) the Only thing that I have read that doesn't match CPPS is the duration of symptoms over a 4 month period I have had a week of urination x 2 a week of twitching and a week of penile pain. So only about 4-5 week all in all. Would CPPS present this way the word CRONIC suggests not - I know it’s not an STI so maybe asking the wrong person but any help would be appropriated. 

6) the link you have sent me the study Dr Hook was involved in states that adding irritation finds 95% of NGU. Which implies that irritation is a symptom that can manifest on its self. Can you describe what irritation means? As in was what I had irritation? But even if it was it would not clear in a week as discussed prior so I can forget about it yes?

Thanks for your help through this discussion. I owe you a drink if ever our paths cross. (I know this is unlikely don’t worry)

7) finally from a STI point of view I’m not missing anything at all am I. Please tell me if I am. I’m willing to discuss with my wife if she’s at risk, in any way. Other than that I’m going to move on. 

I think I’m finally ready to move on. If you was in my situation would you? 

Please look after yourself and your family. Your a fantastic human and deserve a lot of happiness. 

2) Correct except for chlamydia:  it is rare in the oral cavity and therefore very rarely acquired by oral sex.

3) Cloudy urine is not a sign of infection. Everyone's urine is cloudy from time to time:  it depends primarily on diet and fluid intake.

4) Already discussed:  No urethral infection causes such symptoms, which originate from the bladder or prostate, not the urethra.

5) CPPS and its recognition and diagnosis are too complex for me to comment on your particular case.

6) This is not an approriate setting -- I'm not going to re-read the study with care or comment further on it.

7) Correct.

All is well from an STI standpoint. Return to the GUM clinic or see a urologist if you have any ongoing genital or UTI symptoms.

That concludes this thread. I hope the discussion has been helpful.