For the past six months, I had unprotected oral 5 times with an escort. I never had any symptoms. On November 15th, I had a bad sinus infection and was given 500mgs of augmentin for 14 days which cleared it up.

After the augmentin finished, I had one episode of unprotected oral with an escort on December 5th. I decided to take a STD test on Monday the 12th and waiting for the results. My symptoms are 1) frequent urination 2) sometimes trouble starting a urine stream in middle of the night when waking up. Lastly, I took 4-5 CVS home UTI test which possibly show some leukrlyes  I do not have any pain urinating or any pus leakage.

I have the following questions:

1. Would the augmentin have cleared up a prior STD infection before the 5th? I know it may not be the drug of choice but it was 500mg 2x a day for 14 days

2. Do my symptoms now sound like a STI from my episode on the 5th?

The bottom line is that it is extremely unlikely you have any STD, for several reasons. First, assuming you use the term "escort" as we do (expensive female sex worker by appointment, in contrast to brothel workers, bar pickups, etc), it is unlikely your partners had transmissible STDs. They mostly know the risks, use condoms, get tested frequently, and their clients generally are low risk (men like you). And the risk they had active oral infections that could be transmitted by oral sex is low; and even when infection is present, oral sex is highly safe, with low rates of transmission to partners. Finally, absence of typical STD symptoms is reassuring (more to follow about your symptoms).

1) Gonorrhea is one of the more common STDs from oral sex. It is exceedingly unlikely you had it, since it almost always causes prominent symptoms you would not have missed (pus dripping, overtly painful urination). In any case, augmentin in the dose you had probably would be 100% effective if you had it. It also would abort syphilis, if you had been exposed or infected. Not reliable against chlamydia, but that almost never occurs after oral sex. Nongonococcal urethritis (NGU) from normal oral bacteria is a potential risk, and might or might not be effectively treated by augmentin. It gives no protection against viral STDs (herpes, HPV, HIV), but those also are extremely low risk from such exposures.

2) No, your symptoms are not typical. STDs do not cause urinary frequency or hesitancy or urinary symptoms of any kind other than pain during urination. The small no. of leukocytes on the home probably don't mean much. However, it would be reasonable for you to be on the lookout for urethral discharge, which could be scant (e.g. only when you wake up in the morning) and could indicate nongonococcal urethritis from oral sex. However, NGU does not explain any of your symptoms.

It's good your test was negative. Timing of urine collection makes little or no difference in test reliability. You can be completely certain you do not have gonorrhea or chlamydia (or any other bacteria for which you may have been tested).

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

HHH, MD

Thanks for your clarity and reassurance. Following up on NGU comments. Would that have been picked up on the urine samples? Or that is not included? How is that tested? I assume an antibiotic would clear that up as well? But only needed if I see discharge?

I assume at this time there is no real need to see a doctor or take antibiotics unless I see discharge?

I think the negative tests for STD for syphilis, gonorrhea and chlamydia should be relied upon 

The gonorrhea/chlamydia results are conclusive. Syphilis blood tests are not reliable before 6 weeks, but because of the augmenting, there is no chance you have syphilis and do not need further testing for it.

Thanks for confirming that "Timing of urine collection makes little or no difference in test reliability. You can be completely certain you do not have gonorrhea or chlamydia (or any other bacteria for which you may have been tested)." Again I used the first stream but it was about 20 minutes after I had urinated previously.

Dr. Hook advised another patient per below in the forum? I am just curious if he was just quoting the literature or if there was any misunderstanding of the circumstances.

From Dr. Hook:

My advice- consider testing for M. genitalium and perhaps ruling out other problems that I mention.  I would also urge you to be sure this is NGU or some other inflammatory process by demonstrating the presence of white blood cells in the initial part of a urine specimen (not a mid-stream specimen) collected after not voiding for at least an hour.  A portion of the same specimen can be used to test for M. genitalium

You are interpreting Dr. Hook's comment out of context. M. genitalium testing is advised only when people have known NGU that doesn't clear up with initial treatment, which is what he was discussing. In addition, you cannot have M genitalium, which rarely infects the mouth and therefore cannot be acquired by oral sex.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion was useful. You can move on with no further worries about this sexual exposure and STDs. Best wishes and stay safe.