[Question #8620] Over complicated risk assessment needed

41 months ago

Hi Doctors

Thanks for you help but not sure what you can do now. But have read your site in past.

-long term partner.

- had three extra marital msm oral sex encounters. Older man in 60s oral on me only.

- over this two month regular sex with wife at the same time as no stress/anxiety.

- approximately two days after the last time is saw this man (two weeks after 2nd time maybe 3week after first) I get a really sensitive penis tip when it touches my boxers it’s really uncomfortable. A day after this I get a twitching feeling throughout my penis. Day after that a fullness/uncomfortable/pain feeling in my penis head this is hard to describe. Maybe like a urge to urinate constantly at the tip but I find it hard to explain. Sorry.

- few days of this feeling it dosnt go so not registered at doctors so go to Urgent care. Tell about my predicament and he does a urine dip test on my urine says that’s normal and isn’t worried about STI and says maybe just irritation. I press a bit more he gives me doxycycline and sends me on my way. No STI test and your site helped me quantify risks.

- symptoms start to clear on doxycycline and by day 5/6 all gone completely.

- continue sex with my wife for a week or two then the same symptoms come back. In the same progressive manor sensitive tip, twitching, penile fullness/irritation/pain.

- panic now about STI as if this is a STI gave it my wife and re caught it.

- got an online test that’s in post for Claymidia and Ghonnaria I eagerly await results.

- appointment with GUM next week.

- symptoms today seem to have cleared up on there own but I have had the pain/fullness feeling for just over a week.

Extremely panicked now that I have a STI as timing fits.

1) realistically what’s the odds here anything I can hold onto until i get results

2) what’s going off here do you think

3) wife starting to be suspicious do I need to tell her now or better to wait for results.

Edward W. Hook M.D.

41 months ago

Welcome to our foreman thanks for your question. I’ll be glad to comment although the definitive answer to your questions will be derived from your test results. Receipt of oral sex is a low risk exposure. There are no cases of HIV acquired through receipt of oral sex and the most common STI acquired in this fashion is gonorrhea. Non-chlamydial NGU is also sometime acquired in encounters of the sort but that syndrome is noninfectious to partners and not associated with complications so there’s not something we were a great deal about.

In the absence of lesions or a visible discharge, the symptoms you describe- urinary frequency and urgency, penile twitching, and increased Pinar sensitivity or not symptoms associated with any STI. Yes, in response to your specific questions:

1. You have not developed symptoms with your suggestive of an STI. If you were required Gonorrhea you would’ve most likely become symptomatic by now. And I anticipate that your test results will be negative.

2. In the absence of a rash or lesion I don’t have a good explanation for the penile sensitivity and discomfort you describe. On occasion with persons have engaged in encounters that they have come to regret they tend to notice symptoms which would otherwise be overlooked or experience them in a heightened state. Perhaps this is what is going on. As I’ve already said, I anticipate that your test will be negative.

3. Disclosure is always the best course of action however many of our clients are not comfortable doing this. As I’ve already said, I anticipate that you will find that you do not have an STI.

I hope the information I provided as useful to you. I anticipate that your test results will be negative. Take care. EWH

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41 months ago

Emergency!

Just had the most anxious half hour of my life.

My results came back on an online portal.

Chlamydia- Positive

Ghonnaria - negative.

Only to receive a call half hour later. Saying ignore the results as they are “undetermined” but will treat me as I’m chlamydia positive just in case. Only after explaining my situation (partner) they decided best to retest. Which of course is another week. I did press for what happened the woman was flustered but did say she is not concerned I have a STI but to retest is only way forward.

I understand Chlamydia from oral sex is rare but may have just won the unlucky lottery I guess. I’m trying not to panic as you said “anticipate results to be negative” but this has rocked my confidence a little.

Luckily have an appointment at GUM who will test anyway but here I go again another week of holding out.

Can I ask follow ups and I’ll save my last one for result day if that’s ok.

1) the NHS states urithirtus symptoms as

a white or cloudy discharge from the tip of your penis
a burning or painful sensation when you pee
the tip of your penis feeling irritated and sore

I know you have stated that without discharge penis pain is not a symptom. Is that always the case. I think I’m confusing the matter with my inability to explain how it feels. I don’t have urinary frequency or urgency it’s just a way of explaining the feeling. Like a constant fullness feeling in my penis that feels as if I’m going to urinate (but nothing in my bladder, that’s how I know when to go however I am only going normal amount of time) it’s hard to tell you if I’m having pain when urinating as that constant full feeling is ever present.

I have no discharge and have checked a bit but not over doing it (seen comments before warning for this) the inside of my penis if I part the head/lips appears moist but not sure if normal or not.

Sorry to push just need to ask again - is this or anything mentioned a sign of STI or at least could it be.

2) how often do you see claymidia as a result of oral sex. I have seen you say rare I have seen Dr HHH say almost never. Just how often do we see it?

I was under the impression it’s very rare but now I’m wondering if I have chlamydia for obvious reasons. Suppose very rare means nothing to the 1 in a 1000 but just curious to know how much hope I can hold onto.

Like I said I know question 1 is a bit repetitive but just wanting some thoughts and figures if possible and I’ll save my last follow up for results.

One messed up day this is.

Edward W. Hook M.D.

41 months ago

Thanks for the additional information. I’m sorry your laboratory results were not conclusive. Acquisition of chlamydia from receipt of oral sex is 5 to 8 times less common than acquisition of gonorrhea. In contrast with genital or anogenital contact chlamydia is 2 to 3 times more common than Gonorrhea. In our recent study of over 2000 persons at risk for STI‘s, less than 1% had oral chlamydia while nearly 6% had oral gonorrhea. Indeterminate results are the worst possible outcome. I would urge you to consider seeking repeat testing before you start therapy. This will help you to determine where are you really stand.

1. As I said before, you are difficult to describe increase sensitivity of the tip of the penis is not characteristic of STI’s in the absence of a rash or A lesion.

2. Regarding the frequency of chlamydia from receipt of oral sex, please see my comments above.

EWH

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41 months ago

Thanks Dr Hook.

I have submitted another test at the GUM, and waiting on results. Anxiously. I was going to hold on for results but had some developments and want your input in it.

So the hard to explain penile feeling has changed. It almost subsided but has come back today with avengance and is no longer hard to explain. It’s a burning feeling in the bulb of my penis. (End bit, but definitely internal) the pain dosnt change on urination but is still present before after and during. It’s maybe a 5-6 on the pain scale but it’s a definite burning feeling that seems to be coming from inside but is located inside the head.

The GUM clinic has done a urine test as well as some blood tests but did try and press my partner get tested too as they are worried even if results negative i could have passed her something prior to my antibiotics.

I asked the GUM nurse about my penile pain but at the time was still the hard to locate hard to describe feeling I gave you as well as almost cleared. I asked for a swab for NGU but they only do that with discharge so she checked my penis and couldn’t see anything (discharge). She commented my meatus is slightly red on the outside, but I told her it’s always look like that (it has) and she wasn’t worried. She said let’s see what the results say before we talk about symptoms. But she did said penis pain can be a sign of chlamydia and Ghonnaria but not often. (Before it got worse)

So my last questions for you, and if YOU want to keep the post open I will give results for others to see if you want (if not don’t worry)

1) penile burning inside the head as I can now describe better this is present all time. STI symptom or no?

2) if I am negative is the risk to my partner enough to confess and get her tested or do you think in your experience and if this was your family is the risk low enough to forget about it and move on?

I’m normally quite laid back about this but with the symptoms and tests all over the place it’s getting a bit hard to separate fact from reality.

Hopefully I can get results by this weekend and move on. But with the nurse pushing my wife to be tested I think I’m in for many more weeks of stress. But that’s my fault. Thanks in advance.

41 months ago

Just thinking about question 2 a bit further.

Would a safe middle option be for me to retest in say 3 months and if still negative move on? Rather than confess. As you can tell I would like to avoid confessing if I can safely. What’s your thoughts on this as a plan?

Edward W. Hook M.D.

41 months ago

Thanks for the additional information. I'm a bit surprised that it seems to take more than a few days for you to get test results. Once received in the lab running the test takes just a few hours. When telling clients to call for test results, sometimes clinics provide a "cushion" in case there is a hold up in transportation or reporting. I'd suggest a call in a day or two to see if your results are back sooner than expected.

Also, at the GUM clinic, when your urine was looked at, were there any abnormalities? Sometimes this is a clue. In continuing to think about your symptoms, several other thoughts occurred:

A. Rarely genital herpes can case pain on the inside of the penis without external lesions. This seems unlikely however as when symptomatic herpes, as well as other STIs cause continuuing, not intermittent symptoms.

B. If there was blood , even microscopic amounts) in your urine specimen, kidney stones might cause the intermittent discomfort you are experiencing.

C. Other causes of symptoms such as yours are the Chronic Pelvic Pain Syndrome (CPPS) which is well described in Wikipedia. This syndrome is often manifest as unusual symptoms. Fortunately, it is NOT typically associated with STIs.

If your GUM tests are negative, you might describe your discomfort to your wife and ask her if she was experiencing symptoms of any sort. This is not quite disclosure which is obviously the best but sometimes a difficult path.

I'll keep the thread open so you can post your results. I continue to think that an STI is improbable. EWH

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41 months ago

Hey doc

Results are in! And are all negative. Wow thank you.

I also think I have won some sort of sick lottery as my wife has been struggling with sinusitis for a few days and it’s bad enough she went to a&e today they gave her 1g azithromycin supervised and sent her on her way.

I feel like this is somewhat fortunate (minus the sinus issues) as if I’m right this is the recommended dose for chlamydia right? So in the unlikely scenario that I gave her chlymidia this would be killed by her meds right? Is azithromycin still effective for chlamydia? I see suppose to use doxycycline now and the uk recommend 1g day one followed by 500mg day 2 and 3 but in the states the US still do 1g.

Spoke to a doctor today who gave me my results who says nothing abnormal in urinalysis but chlamydia and Ghonnaria negative which is only STI that could cause my symptoms so I have an app at docs to look at non STI issues causing my symptoms.

She also says nurse was over zealous with getting my wife tested and is happy for me to move on.

I asked about herpies and she dosnt seem to think it’s that, I have also hsv1 in my mouth so I think this reduces my risk some what. Wife has no symptoms of anything f

So thanks for your help. And just for closure if I had an STI before my meds and gave it to partner.

1) would the meds my wife got cured chlamydia if she had it.

2) no discharge in me no Ghonnaria right?

3) move on and relax lesion learned right?

4) I’m going to retest in three month just to check if I reinfected from wife GUM clinic happy for me to do this. Would you think this is safest all round.

Thanks and goodbye

Edward W. Hook M.D.

41 months ago

Final responses:

1. Cure rates for azithromycin 1.0 gram are about 95% for genital infections. Remember, you don’t have chlamydia and there is no evidence, just your anxiety to suggest she does.

2. Over 90% of men with Gonorrhea have discharge. More importantly, your tests are negative.

3. Absolutely

4. I doubt that it’s necessary but if you choose to do so, I anticipate that the tests will be negative.

Final advice- address your guilt over your missteps. EWH

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