[Question #933] Potential of Urethral Stricture due to Oral Sex

50 months ago
Drs,

I was the recepient of unprotected oral sex about 40 weeks ago.  This was outside of my normal relationship.  I never seem to have developed any of the classic symptoms of STDs that I am aware of.  I came to my senses 4 weeks after the encounter and tested negative for gon, chlamdiya, HIV (4th gen), syphilis, HSV 1&2 and the Hepatitises.  I tested again at least three times for all of the above mentioned STDs 7 weeks, 14 weeks, 16 weeks and 22 weeks post encounter.   I never did any swab testing for NGU.  Also two clean urinalysis' and a healthy urine dip test about 8 weeks post encounter.  I seemingly have developed or have a LOT more frequent occurrences of split stream urination.  No burning when I urinate or discomfort that I really can tell.  Could there be some pathogen that potentially is causing the issue, potential urethral stricture?  Can undiagnosed NGU cause this?  Could I harm my partner?  No antibiotics were ever taken on my end.

Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome to the forum. The bottom line is that you have no STD from the oral sex event 9 months ago.

Oral sex is safe sex -- not completely free of STD risk, but low risk for all STDs and zero risk for some. Among the zero risk, i.e. infections for which you had unnecessary testing, are HIV and hepatitis B; and arguably chlamydia, HSV2, and hepatitis B. The only STDs that occur with any frequency at all by oral to penile transmission are herpes due to HSV1, gonorrhea, and NGU, which often appears to be due to normal oral bacteria. This form of NGU is believed to be harmless both for affected men and their sex partners, and it probably clears up on its own within a few weeks. (In fact, some expert don't even consider it an infection in the traditional sense -- just the urethra's transient adjustment to some bacteria it isn't used to.)  In other words, you were seriously overtested.

As ofr your sympotms, there are no STDs that cause split stream without other symptoms, such as urethral discharge. It is conceivable you have warts in your urethra, which can cause this -- but warts are also rarely acquired by oral sex, and if that were the problem, the abnormal urination would occur pretty much every time, not now and then. In any case, NGU is not a likely cause -- and anyway, would cause an abnormal white blood cell test on dipstick urinalysis (the leukocyte esterase pad on the stick).

So my advice is to not have any more testing and continue sex with your regular partner without any worry at all. I'm sure you have nothing from the oral sex event. You can let that go with no further consideration. If your split urinary stream continues and especially if it increases in frequency, you should get it checked out professionally to check for things like urethral stricture. But for sure it's not an STD problem.

I hope this has helped. Best wishes--  HHH, MD

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50 months ago
Dr. Handsfield,

Thank you for your detailed response.  I have some follow up questions and your input is greatly appreciated. 
1)- Gonorrhea/Chlamydia - Total of three samples given at 4 weeks (midstream), 7 weeks (midstream) and 16 weeks (first void but wasn't sure on how much to give and added a bit of midstream).   All negative.  Still valid as far as results?
2)- Syphilis - 4 weeks, 7 weeks, 14 weeks and 21 weeks negative.  All rpr.  There aren't any chances of false negatives here correct?  3 weeks after encounter I was masturbating one night through dri fit material and noticed a sorr patch of what looked like raw skin on my penis head. I stopped and it healed like in 2 days.  I am assuming that was not a Syphilis chancre and just raw skin due to chaffing from masturbating.  Again all my tests were negative.  Your thoughts?

Thank you doctor for your guidance and knowledge.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
1) The standard gonorrhea/chlamydia tests are extremely accurate. Imperfect first void procedures make no significan differenence in test reliability. A single test would have been sufficient. With three negative results, it is impossible you were infected.

2) There is no such thing as false negative RPR tests more than 6 weeks after catching syphilis. The 4 week test was a bit early, but the 7 week test was 100% conclusive. The others were unnecessary. The test results are much more reliable than a patch of "raw skin" as an indicator of syphilis. Chancres never have such an experience.

Thanks for the thanks. I hope these comments settle things for you.

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50 months ago
Dr. Handsfield,

My final question(s) are in regards to possible HPV infections.  You mentioned if I potentially had a wart inside my urethra (sounds HORRIBLE) that that could be causing the split stream urination.  I am assuming the only way to verify that is see a urologist.  If I did by chance aqquire a wart there from the event, how likely could I pass that infection onto my partner? Especially inside my urethra, seems that would be difficult to pass, let alone acquire because don't you need good friction between an infected area and another dermal surface for it to jump?  How likely are HPV infections from unprotected oral sex?  These are my final questions.  Thank you so much for your time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
I've never seen a patient with plit stream urine as the only symptom of genital warts. In theory it could happen, but it's a very unlikely cause. But if you do indeed have a wart in there, you can assume you have been infectious for your partner since you acuired the HPV infection causing it. But HPV is rarely acquired by oral sex, so even if that's the problem, it's unrelated to the oral sex event 9 months ago. In any case, we all get genital HPV and assuming you and your partner both have had other partners, you can assume you could have exposed each other to HPV.

In any case, I remain confident the split stream urination isn't related to HPV or any other STD, or to the oral sex event. As I advised above, the only way to sort this out is to see a doctor if the split stream continues.

That finishes the two follow-up comments and replies that come with each question, and so ends this thread. Best wishes and stay safe.

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