[Question #9358] Follow Up / STIs Worry

33 months ago

Hi doctor. As I shared on my last question, I had a sexual encounter with a colombian street hooker 7 months ago and ever since Ive been extremely worry about STIs. I received a protected oral job and then proceeded to protected insertive vaginal sex. 5-6 days post encounter I started feeling a sudden pain in my testicles, which basically started all this worry. Ever since the exposure Ive been having a lot of symptoms from flu like symptoms to GI issues, skin rashes and more. I wanted to completely rule out any STI so Ive had a complete STI panel almost every month for the last 7 months. My main worries are Syphilis and HIV. I had a 7 months post exposure negatives RPR test, HIV 1/2 Antibody test and Antigen P24 test. At 6 months I had Ag/Ab HIV test and PCR HIV 1 test also negative.

I kept visiting my urologist because of my testicular pain and anal discomfort and penis tip pain and more. At 4 months post exposure I did a urethral swab test to rule out Gonorrea and Clamydia. My doctor performed a DRE examen to make sure seminal fluid came out to take a complete urethral sample, and after he did this he stated my prostate was swollen and I had prostatitis. He then assure me that prostatitis at my age (less then 30) is mainly sexual caused and that I should stop sex with my regular partner until finishing the antibiotics.

At 7 months I went to a infectious disease specialist and now had a urine test for Clamydia and Gonorrea (again negative) but I mentioned the comment about prostatitis and his response was a little joke about how that encounter left me with a little gift (prostatitis). What worries me is that if condom was used all thru the event and it was intact (as I could see, not with water test) how a bacteria could get in to cause prostatitis?? If a bacteria could in fact caused this, then any other thing could have enter me, as any other STI and specially HIV, is my logic accurate?

33 months ago

Ive been having discomfort and upper leg pain specially after sitting for too long for more than 3 months now. With this Ive also had strong GI issues like gastritis (which Ive never experienced before) that is also lasting for the past 3 months with nausea, stomach pain and loss of apetite.

How sure can I be that my 4 months urethral swab and 7 months urine test to rule out Clhamydia and Gonorrea are reliable? (They were all negative)

How did I had any bacteria from this encounter that could have caused prostatitis if I was wearing a condom? Did it failed? That means I was exposed to other things

Is my 7 months RPR test reliable? Even if a never had any symptom?

Can HIV really be ruled out? Non of this other issues like prostatitis and gastritis could affect my HIV tests?

33 months ago

Sorry doctor just to clarify on symptoms:

- Testicular pain (started 5-6 days post exposure)

- Frequent urination (started at the same time)

- Anal discomfort (aprox 4 months post exposure)

- Penis pain mainly in tip (aprox 4 months post exposure)

- GI issues / nausea, stomach pain, loss of apetite

- Some weight loss

- Rashes that come and go on neck and chest

To this day (almost 8 months post exposure) still have some mild discomfort in testicles that come and go. Upper leg pain when sitting for too long and sometimes anal discomfort and feeling of fullness in area

Edward W. Hook M.D.

33 months ago

Welcome back to the Forum. I'm glad to hear that you saw a urologist and agree that some of the symptoms (scrotal discomfort, discomfort at the tip of the penis) you report may well be due to prostatitis. With all due respect however, I have to disagree that STIs are a common cause of prostatitis. Thus, not only is your risk low due to your use of condoms but the negative tests prove that STIs ar not present. Prostatitis can be challenging to treat. I trust you are still working with your urologist to address this problem. I also disagree with the suggestions that you should abstain from unprotested sex- you have conclusively proven that you do not have STIs which would be transmitted to partners through unprotected intercourse.

Regarding your test results, as our said in our earlier interaction "I will not review your test results one-by-one as they are all negative and have been taken at times when your results are reliable and conclusive. You did not acquire an further STI (including HIV) from the exposure you describe above. FYI, when health care providers are evaluating patient symptoms, they use tests to both make diagnoses and to prove that the problems tested for are not present. Because some STIs (HIV in particular) can cause such a variety of symptoms, tests for HIV are used in this way-i.e. to eliminate the possibility of HIV as a cause of symptoms. Your testing has proved that you did not acquire an STI. No further testing is needed and to continue to test for STIs would be a waste of time and resources." That response will not change. Currently available tests for HIV, gonorrhea and chlamydia are amongst the most sensitive tests in all of medicine. Your repeated syphilis tests, similarly prove that you do not have syphilis which would not cause the genitourinary symptoms you describe. You have tested multiple times and gotten the same, negative, results. It is time to believe them- they will not change.

Regarding your additional questions:

These are not STI symptoms. OTOH they may be due to anxiety or medications if you are taking medications for your prostatitis

How sure can I be that my 4 months urethral swab and 7 months urine test to rule out Clhamydia and Gonorrea are reliable? (They were all negative)

without any doubt whatsoever, you DO NOT have chlamydia or gonorrhea

How did I had any bacteria from this encounter that could have caused prostatitis if I was wearing a condom? Did it failed? That means I was exposed to other things

See my comments above. Not all prostatitis is due to STIs.

Is my 7 months RPR test reliable? Even if a never had any symptom?

Yes, this is a reliable result

Can HIV really be ruled out? Non of this other issues like prostatitis and gastritis could affect my HIV tests?

Yes, HIV is absolutely ruled out

Hope this helps. EWH

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Edward W. Hook M.D.

33 months ago

Penile, scrotal and anal discomfort as well as urinary frequency are all consistent with prostatitis. When symptoms are due to an untreated STI, they do not come and go but tend to be persistent. OTOH, when persons are looking for symptoms, they may notice otherwise normal sensations which would not be normally noticed and which are not apparent when otherwise engaged (distracted)

GI issues and weight loss are not STI symptoms but have many possible causes including anxiety.

Leg discomfort with prolonged sitting is not a symptom of any STI, including HIV.

You need to accept that, despite the fact that this all began about the time of your interaction with the Columbian commercial sex worker, you did not get an STI. Really. Believe the tests.

You have one follow-up remaining. EWH

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33 months ago

Hi doctor. Thanks for your answers. Although I did work with my urologist regarding all this, he seems to have "given up" and to believe most of my symptoms are caused by anxiety and that I should only stop worrying so much and the pain will cease. Ive read many answers from you and Dr Handsfield and it seems that CPPS really match my symptoms, even more because although prostatitis is hard to treat, Ive tried a lot of things from 2 different urologists (from antibiotics as trimethoprim/sulfamethoxazole, to alpha blockers to relax the muscles and even anxiety pills) and non of this seems to really help me stop my symptoms for good.

You are right Im extremely worried because all of this was very coincidential with my encounter. Before that day I was consider a very healthy person and ever since Ive been feeling really bad with all sort of feelings. I already shared a few with you but there are a lot more and none of it with a real explanation.

Just to clarify my doctors (2 urologists and 1 infections disease specialist) dont think this was caused by an STI, but rather think it was cause by some bacteria that enter my urethra during the exposure.

1) Thats why I ask you, if this is true, then this means my condom failed and I was exposed to any other bacteria and possible STI??

2) Regarding Syphilis, Ive read in other answers from you in this forum that Azythromicin can somehow affect Syphilis testing and prolong positive results. In my other question I asked about antibiotics effects on Syphilis and you answered that Syphilis test are very reliable and Augmentin in any case would have cured the disease. I recall that even the Augmentin package stated that it could prolong the diagnostics of Syphilis and its symptoms. But besides that I need you to know I also took Azythromicin around 1 month before testing. Could any of this impact the test?

3) Ive read that RNA PCR test can go undetected if enough time has passed after infection (or acute infection) in my case I took this test 6 months post exposure. Is it possible that I could have had the infection but undetectable viral load?

4) Some people online claim to have had negative HIV test at 3 months only to turn positive later on. I know the internet has a lot of misinformation but you see a lot of people talking from personal experience and you cant help to wonder. Is this at all possible? Ive had negative test results up to 7 months and I cant seem to find peace with this because of all the information.

5) If by any chance I was exposed to and contracted HIV 2, can I be 100% sure for this too with the tests Ive taken so far?

6) What can help me differentiate prostatitis from CPPS? If antibiotics are not working to stop my symptoms this means is not bacterial and is something else?

7) How sure can I be that Im free for ALL STIs? Is there anything else I should be looking for? Anything else to look for about this groin pain, discomfort while urinating, upper leg pain, etc.?

8) What do you think could have cause my testicular pain 5-6 days post exposure in the first place? I was not worry at all about the exposure and not thinking about it at all, so I could not say it was mentally caused.

Edward W. Hook M.D.

33 months ago

Thanks for your thoughtful follow-up. Particularly following the information regarding your earlier treatment, although I have not had the opportunity to examine you myself, I am inclined to agree with the three doctors you have seen- i.e. your anxiety is likely to be contributing to your perceived symptoms. From reading other posts on the forum, you'll know that on occasions when someone is worried and looking for "symptoms" they tend to notice otherwise normal sensations which would otherwise overlooked. I suspect this is contributing to your difficulties and is likely a component of CPPS. That siad, I'll now address your final questions in this last reply:

1) Thats why I ask you, if this is true, then this means my condom failed and I was exposed to any other bacteria and possible STI??

Nothing you described suggests in any way that your condom failed- quite the contrary. Multiple tests have shown that you do not have an STI.

You are overreading what you have read. Certainly antibiotics can slightly delay positive tests for syphilis. Your 7 month test results are unequivocally conclusive- you do not have syphilis

Again, you are mis-interpreting things. Current PCR tests do not become negative. Even if host response lowered levels of HIV to a place where levels were below the limit of detection, then tests for antibodies, which are part of all 4th generation tests, would be strongly positive.

Your statement that "some people" claim to have negative tests at three months in incorrect unless they have been taking anti-HIV therapy

5) If by any chance I was exposed to and contracted HIV 2, can I be 100% sure for this too with the tests Ive taken so far?

Again, your results are conclusive- you do not have HIV-2

6) What can help me differentiate prostatitis from CPPS? If antibiotics are not working to stop my symptoms this means is not bacterial and is something else?

There is much verlap between prostatitis and CPPS. Working with a urologist may help.

This completes this thread. Further questions regarding the possibility of any STI including HIV from the encounter you have described may be closed without a response and without return of your posting fee. You need to believe your tests. Please consider working with a trained counselor to address your unwarranted continuing concerns and their contribution to your perceived symptoms. EWH

7) How sure can I be that Im free for ALL STIs? Is there anything else I should be looking for? Anything else to look for about this groin pain, discomfort while urinating, upper leg pain, etc.?

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