[Question #8651] Grindr addiction
41 months ago
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Hi Doctors
Just wondering if you can help, I’m very impressed with your sciantific based responses to other posters so wanted to ask my own questions. I also want to say it’s refreshing to see two doctors no scaremongering around STI, other doctors are not so reasoned.
So basically I’m a bisexual married male have been married for some years to a woman who I do love. But my bisexual side is very alive. Unfortunately over the last few years I have developed a addiction of kinds to random man on man hookups on Grindr. In respect to my wife (who I still have sex with) I have kept my meets to low risk as possible. Mainly kissing, masterbation and oral sex. I have also tried to pick my male partners as risk free as possible, older age, talking first etc.
To my shame I have in the past not tested for STIs as it never really occurred to me that it was an issue (invincible I am… not)
Recently I have developed some strange symptoms in my penis a twitching feeling that is constant as well as the tip feeling sensitive and painful on occasions. This started 2 days after a recent encounter but also had some other encounters around this time scale.
My GP is working from home so all appointments are over the phone and on the call he diagnosed presumptive Urethritis but wasn’t able to tell me if it was an STI or not (from your forum I now know it is) anyway he prescribed me (and my wife) 1g azithromycim. No idea how I got away without my wife thinking this was a STI the doctor said to my wife best to do this just in case.
Anyway symptoms didn’t clear and seemed to get somewhat worse - not satisfied with my doctor I ordered a STI test by the time this came it was 5 days after “treatment” they were negative possible unsurprisingly after meds. Also by this 5th day my symptoms had pretty much gone and cleared by the 6th maybe 7th day.
So this has rocked my confidence a little bit about what I believed was to be low risk encounters. I have done a look back on my “addiction” and over the l
41 months ago
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3 years I have had 4 different men perform oral sex on myself. Each male approximately 2-3 times. So maybe 10-11 blowjobs.
1) what’s the chance one of these gave me a asymptomatic STI
2) if they did, then what’s the chances 1g Az cleared it in me and my wife (even if long standing infection)
3) I have seen posts on here prior and it’s general said that twitching is not NGU so not really worried about that but can you just confirm I’m on the right track.
4) what’s the chances Az cleared in me (negative test) and it didn’t work for my wife ?
5) what’s my risks?
6) are my tests at 5 days post treatment any good I have read that NAAT can pick up “dead non viable DNA” so was it a waste of time or money or do you think it would most likely still have been positive if I was infected?
7) next steps if possible.
(Sorry to go over the word count)
41 months ago
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Actually amendment to 4) he gave my wife 1g Az and me 7 days doxycycline (sorry for confusion I got carried away typing. Don’t know if this over complicated things or not so may as well give you the facts.
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H. Hunter Handsfield, MD
41 months ago
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Welcome and thanks for your kind comments about our services.
First and most important, the symptoms you describe don't sound like urethritis. The main symptom is abnormal discharge from the penis (pus, mucus, etc), usually with uncomfortable or overtly painful urination. But not "twitching" or penile pain when there is no discharge or other visible abnormality. Perhaps there's more detail you haven't mentioned, but it seems your doctor overreacted. And if you indeed had urethritis, but with no diagnostic tests, you were under-treated. Azithromycin is effective against most nongonococcal urethritis (NGU), but treatment also should have included ceftriaxone (or cefixime by mouth) in case it's gonorrhea and not NGU. I have to conclude your GP isn't up to speed on STIs.
Failure of your symptoms to clear promptly within a day or two following azithromycin tends to confirm you didn't have urethritis. If you did, your tests likely would have been positive if you had gonorrhea or chlamydia: even with effective treatment, the tests can remain positive for several days. So even if you had urethritis, it probably wasn't either of these STIs. Accordingly, I remain unconvinced you have have (or had) any STI at all, but that of course could change if you can arrange for in-person evaluation by a knowledgeable expert. You really should do that -- ideally a public health STI clinic, or an NHS GUM clinic if you're in the UK, for example.
To your numbered questions:
1,5) Unprotected oral sex primarily risks gonorrhea, NGU (often due to entirely normal oral bacteria, i.e. not an STI in the usual sense), genital herpes due to HSV type 1, and syphilis. Chlamydia is very low risk, as are all other STIs. There is no appreciable risk for HIV from oral sex. With no ongoing symptoms, probably you have had none of these, but a syphilis blood test would make sense one of these days.
2) For the reasons implied above, your wife likely didn't need treatment, and there's probably pretty low risk you have infected her with anything significant.
3) I agree, as discussed above.
4) If you had an STI that responds to azithromycin, it can safely be assumed it would have also been eradicated in your wife.
6,7) Discussed above. It would make sense to see a knowledgeable physician who understands STIs. At this point, it probably would be reassuring -- but likely you'll never know for certain whether you had any STI at all. I suspect not, but can't be certain with the information available.
Final comment: In my experience, spouses almost always understand that if treatment is recommended because of something diagnosed in his or her partner, it's an STI. You know your wife and I do not. But unless she is a very naive person, it seems likely she at least suspects you've had an STI and must have other partners.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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41 months ago
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Your comments are fair and correct my doctor seems miles away from your expertise. My doctor explained to my wife actually spoke to her and explained that he was giving her a tablet because of my symptoms and have her explanation saying not an STI etc etc my wife is not nieve but does trusts doctors. But who knows maybe she does suspect
Sorry doctor it seems you missed my amendment he gave me doxycycline and my wife Az (not sure why the difference but he did)
Understood your advice. Main concerns are gohnnaria so let’s home in on that for a bit.
How good is doxycycline and how good is az for gonno.?
My hope is doxy is useless against it so I know for definite I never had it.
That said dosnt Ghonnaria almost always cause obvious discharge ?
Syphillis I’m a blood donor they test my blood for that. I will of course test again properly to cover recent exposures.
I’m of the same option as you no STI. I have checked for discharge morning etc and nothing not a speck.
I have in a bit of a panic when I contacted you this morning also contacted my GUM clinic. Doctor phoning me tomorrow the nurse wasn’t too concerned.
Like you said I’m fairly annoyed my doctor has screwed any chance of a definitive answer but that’s my fault too.
I have tried to limit my contacts I have only had the one extra partner recently who has performed oral on me twice over a month period before that it was 6 months ago other exposures over a year. So they aren’t all in close proximity. Hopefully this lowers my risks further as the old exposures should have shown symptoms by now surely?
Sorry for the essay and loads of questions between inadequate GP and a desire to protect my wife I hope you understand.
(I have cancelled my account on Grindr and also I you contact them they block your IP from accessing if anyone else is “addicted” to it and wants to get out, like me)
41 months ago
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Also timing. The twitching came on at day 2 after exposure, like 30 hours after maybe.
The time prior to that was a month before. I have managed to get my messages so I know dates: no exposures between.
41 months ago
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I was still taking doxycycline when I tested.
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H. Hunter Handsfield, MD
41 months ago
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Sorry I missed your statement on doxycycline.
Gonorrhea almost always has overt pus dripping from the penis and painful urination. (Side note: In the book and TV miniseries Band of Brothers, about the US 101st Airborne Division in WWII, a character with gonorrhea says "I'm pissing razor blades." [see footnote*] However, the earliest symptoms may be mild, only becoming severe over another day or two. Therefore, it is conceivable you were treated so promptly that gonorrhea hadn't had enough time to cause its usually prominent symptoms. And onset of symptoms after only 30 hours is compatible with gonorrhea, but not with NGU.
If you had gonorrhea, the doxycycline would be expected to cure around 80% of cases. And azithromycin 1 gram -- the dose your wife likely received -- would have been 60-70% reliable. Your absence of current symptoms is essentially 100% proof you don't have it now (if you ever did), but it's not possible to be so certain about your wife. Ideally she should be tested to be maximally safe. All that said, "twitching" really doesn't suggest gonorrhea. So we're left with inherent uncertainties -- the downside of your doctor jumping the gun with treatment before proper diagnostic testing (or perhaps your own insistence on it -- your comment about shared responsibility seems apt).
Next steps? See what the GUM specialist says when s/he calls. If in doubt, it might be best to arrange an in-person visit, at least for you and perhaps your wife. You could consider printing out my comments as a framework for discussion and see what s/he has to say about it all.
* The guy's name was Guarniere; his buddies riffed on his name and called him Gonorrhea for the rest of the war. Har har.
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41 months ago
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I mean the good news is I haven’t slept with my wife since last meeting (and not since first too, luckily) last exposure to a different male was 6 months ago. And no symptoms.
I’ll take your thoughts on this and if you still think need for testing my wife I’ll confess.
I also had maybe 3-4 days of twitching prior to doctor and started treatment day after so 5 days after exposure, it didn’t progress.
And I have now had my negative result.
I’ll speak to the GUM see what they say tomorrow and pay for another round of chats if I have anything needing cleared up.
Would the risk be too high to risk resuming sex with wife and monitoring for symptoms in my self over the next few months?
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H. Hunter Handsfield, MD
41 months ago
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Hmm... I assumed you had had sex with your wife after the event that preceded your symptoms. If not, why did your doctor treat her? Maybe just being careful, thinking of the possibility that she was the source of any infection you had? Anyway, azithromycin is more effective as prophylaxis than treatment of established infection: even if you had persisting gonorrhea or other STI after you were treated, she would have been protected. If this is the case, I see no need for her to be tested, and it seems safe to resume sex with her. But here again, make sure your GUM physician clearly understands the sequence of events, then follow his or her advice.
My final advice is this: Assuming you will continue your sex with other men, you should plan on regular STI testing, including HIV and syphilis. There are no hard and fast rules on exact frequency -- it could be anywhere from 3 to 12 months. In addition to those blood tests, urine tests for gonorrhea and chlamydia and a throat swab for gonorrhea would make sense. (Oral chlamydia testing isn't really necessary -- it infrequently infects the throat -- but chlamydia testing is pretty much automatic along with gonorrhea.) (I'm assuming that oral sex occurs in both directions. Of course your throat need not be tested if you don't perform oral on your partners.) Also please keep condoms handy: many men in your situation eventually find themselves tempted to progress to anal sex, which is where the really high risks come in, including bad things like HIV and syphilis. Also discuss this the the GUM clinic: they may have more specific advice about frequency of testing.
---That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. I don't think it will be necessary to come back here, barring a surprise positive test result or something of the sort.