[Question #9547] Long Lasting Symptoms / Worry Possible STI

Avatar photo
31 months ago
Hi doctor. Almost 10 months ago I had a sexual encounter with a CSW: Condom protected oral (I only received oral sex) and condom protected vaginal sex. Ever since the exposure I have tested multiple times for all common STIs and got negative results always.

A few days after the exposure I started experiencing testicular pain. I went to the urologist and did a few exams but nothing came out. I was then diagnose with prostatitis with a DRE exam and treated with Bactrim, but the treatment didn't do much for my symptoms to be honest. 

Its been almost 10 months and I still dont feel quite well, with this symptoms to date:
- Testicular discomfort
- Penis tingling feeling
- Leg pain
- Occasional rectal pain
- Abdominal pain
- Stomach issues

I know some of this symptoms are not specific to any STI, but Ive read that untreated Clhamydia or Gono could cause some serious complications from pelvic pain to some arthritis and some of this symptoms are very weird like the pain/discomfort on my testicles now spreading to my legs sometimes reaching my knees.

1) Could untreated Clhmamydia or Gono for 10 months be the cause of this?
2) Ive also read that HIV virus sometimes affect the muscles and cause aches, is this possible?

My last tests post exposure were:
6 months: Hepatitis A, B & C, Herpes 1 & 2
7 months: Urine test for Clhamydia and Gono (and some other bacteria)
9 months: HIV Ag/Ab, RPR & FTA-ABS

A few weeks after the encounter a had a sperm test and my WBC results from that test stated: .........../c........3-4 (which I know is a little bit higher than usual.
3) Could this mean something?

All of my complete urine tests turn out normal over this months when I take this test during the day, last 2 tests I took were first void in the morning and I received unusual results in both tests:
- Aspect: turbid
- Mucus: moderate
4) What does this means?
Avatar photo
Edward W. Hook M.D.
31 months ago
Welcome to the Forum. Thanks for your question.  The encounter you describe was a virtually no risk event and the results of the comprehensive testing you have received validates that there is no STI present.  Many of the symptoms you describe are those which we see with prostatitis which can be challenging to treat, sometimes requiring multiple ling (4-6 week) courses of therapy.  In response to your specific questions:

1. These are not symptoms even vaguely suggestive of gonorrhea, chlamydial infection or any other STI
2.  Your HIV test is conclusive.   Recently acquired HIV can cause a flu-like syndrome which includes severe muscle aches but the symptoms last a week or so at most.
3.  I'm not sure what the results of your sperm evaluation showing ": .........../c........3-4 " but it does does not suggest any STI.
4.  The presence of turbidity and mucous in a urinalysis are not suggestive of an STI.  I am not a urologists but I wonder if this might be compatible with continuing prostatitis.

Bottom line- nothing you suggest suggests an STI of any sort.  The symptoms and finding s you report make me wonder about continuing problems with the prostate.  My advice would be, if you have not done so, to return to the urologist who diagnosed your prostatitis (see the one you saw before so he/she does not need to start your evaluation again and has your earlier findings to compare your current state to) for further evaluation.  On some occasions, as I mentioned above, management of prostatitis can be quite challenging.

This is not an STI.  I hope my assessment will help you to eliminate at least one possible concern as you address your problems.  EWH
---
Avatar photo
31 months ago
Thanks doctor.

Most info online talk about the complications of untreated long lasting Clhamydia and Gono, even that some asymtomatic people could have the infection for years before noticing causing all kinds of damage. In this forum Ive read multiple time that this infections are cure by the immune system after a few months.
1) Could you please explain why the different info? Can this STIs really be clear without treatment and how long does it take? My exposure was almost 10 months ago

2) I had symptoms as you describe for recently acquired HIV first few weeks after exposure. Flu like symptoms, diahrrea, even loss around 12 pounds of weight, fever, heavy night sweats. Do you think theres a reason to suspect false negative results from my HIV tests? 

3) To clarify: my sperm test showed higher white blood cells than the usual parameter. It should be "0-2" it was "3-4".  What could this mean? Does this hint anything? It was just 2-3 weeks after exposure

4) Ive try comming back to my urologist a few times but It seems the only answer he gives me is that I should just relax and wait. In case this is indeed something prostate related, why should I ask him to do? What kind of tests? (I know this is not your area so I will understand if you couldnt answer)

5) Any suspect that my RPR test at 9 months could be false negative and this muscle aches are parte of the "great imitator"?

6) After all these test I resume unprotected sex with my regular partner. Soon after this she started presenting with some white cottage like secretions from her vagina, nothing that comes out, but it seems like after sex this secretions stuck to my penis and when I pull out I could see the remaining on my penis. Is very thick and cottage cheese like. She says she doesnt feel anything down there and havent seen that secretion before. Could this be related? She also started having some nausea, diahrrea and mild fever
Avatar photo
Edward W. Hook M.D.
31 months ago
I'm sorry that you are having trouble accepting your test results.  It appears that you, like so many of our clients, have been led astray by the internet.  Please remember that much of what is to be found on the internet is incorrect and it is very hard to someone not directly familiar with the topic being searched to distinguish what is correct and what is wrong, either because it is out of date, taken out of context, misinterpreted, or just plain wrong.  I'll go straight to your follow-ups.

1) Could you please explain why the different info? Can this STIs really be clear without treatment and how long does it take? My exposure was almost 10 months ago.
Indeed a proportion of STIs can be asymptomatic and do resolve without treatment as the result of host immune responses.  Not all do and asymptomatic infections can lead to long term complications and be transmitted despite being asymptomatic.  Testing however would detect asymptomatic STIs.  You've been well tested- I once again encourage you to believe your tests.  Please note as well that you have apparently been directly examined by trained clinicians who, like me, see little, if anythng, to raise concerns about STIs.

2) I had symptoms as you describe for recently acquired HIV first few weeks after exposure. Flu like symptoms, diahrrea, even loss around 12 pounds of weight, fever, heavy night sweats. Do you think theres a reason to suspect false negative results from my HIV tests? 
No.  When symptoms are present due to recently acquired HIV, tests are invariably positive and remain so.  Believe your tests.

3) To clarify: my sperm test showed higher white blood cells than the usual parameter. It should be "0-2" it was "3-4".  What could this mean? Does this hint anything? It was just 2-3 weeks after exposure.
The modest elevation of semen WBCs you report could well be normal variation.  Alternatively, it could be a manifestation of your prostatitis which you know you have.  

4) Ive try comming back to my urologist a few times but It seems the only answer he gives me is that I should just relax and wait. In case this is indeed something prostate related, why should I ask him to do? What kind of tests? (I know this is not your area so I will understand if you couldnt answer)
I really don't know what should be done.  As a fellow clinician, I would defer to the knowledge and experience of the urologist, as I hope you would.

5) Any suspect that my RPR test at 9 months could be false negative and this muscle aches are parte of the "great imitator"?
I'm not sure why you would say this.  Syphilis tests are reliable, particularly that long after possible infection.  Further, muscle aches are not a symptom of syphilis

6) After all these test I resume unprotected sex with my regular partner. Soon after this she started presenting with some white cottage like secretions from her vagina, nothing that comes out, but it seems like after sex this secretions stuck to my penis and when I pull out I could see the remaining on my penis. Is very thick and cottage cheese like. She says she doesnt feel anything down there and havent seen that secretion before. Could this be related? She also started having some nausea, diahrrea and mild fever.
Apparently you are perceiving a problem that your partner is not and is unaware of.  If she has a problem, or if you think she has a problem, she should be examined.  

I hope these responses are helpful.  EWH
---
Avatar photo
31 months ago
Thanks doctor.

Sorry I didtn quite understand you argument about clearing up infections by itself. Worst case scenario if I was indeed infected with Gono or Clhamydia, should I be sure my body already cleared the infections for me by now? Or this is not something that happens as often.

You suggest my partner get examined if I think something is wrong. I hope you understand this is very fragile and what I wouldnt like to do is disclose that I may have infected her with something out of my indiscretion with another woman. What I would like to know is if you think it could be possible? Regarding what I tell you that shes only experiencing this white cottage like secretion (That appartently are only inside her vagina because its only visible after we have sex because its stuck in my penis). Do you believe this could be an STI I have given her?
Avatar photo
31 months ago
Also would like to add about HIV, I understand there could be some patients that dont produce antibodies.. I have also had a PCR test at 5 months and was undetectable. Will someone with HIV absolutely test positive in PCR test at 5 months? Where does that leave me regarding this disease?
Avatar photo
31 months ago
Sorry doctor one last question. Just want to make sure I did my tests fine

How does this tests work?
I did urethral swab 2 months post exposure. How good is this test? Is it better than urine test? I dont know how long I stayed without peeing before the test is this important?

I did Urine test at 7 months. It was first urine in the morning but I gave a whole cup. Should I just give literally the first void? Was it too much and could this dilute the sample? I took a course of Augmentin and Azytromicin like 3 weeks before the test, could this compromise anything?
Avatar photo
Edward W. Hook M.D.
31 months ago
As you know, we provide up to three responses to each client's questions.  This will be my final response.

You asked about clearance- yes it occurs in a relatively small proportion of untreated cases over time.  That however is irrelevant to you since, if you were infected, your tests would have been positive.   If you are thinking that the symptoms you have described are the result of past gonorrhea or chlamydial infection which was cleared before you tested, that is not the case either as the symptoms you report are in no way suggestive of gonorrhea or chlamydia, past or present.  

Your perception of signs of infection in your partner, which apparently she does not appreciate, suggest that you are "looking" too hard for signs of infection.  Regarding your partner and disclosure- there is nothing to disclose- other than your own guilt and anxiety, you have been tested and examined by professionals who feel that there is no indication of an STI or need for additional treatment.  Further, your perception of "cottage cheese" discharge following sex is something that apparently you, but not she feels is abnormal.  If you think there is something on your penis following sex, you should mention it to her and she if she agrees and go from there.  There is no need for disclosure of your indiscretion related to your sensation that something appears on your penis following sex.

The idea that some people who have HIV do not produce antibodies is an internet-based urban myth.  Further, hypothetically, if you were infected and did not produce antibody, the virus would be detected as antigen in the antibody/antigen test and as HIV RNA in the PCR test.  Both tests are negative at times when the results are entirely conclusive.

Bottom line, despite strong evidence from reliable tests AND from evaluation by a trained professional, as well as my assessment of the information you have shared that there is NO evidence that you acquired any STI, including HIV from your indiscretion, you are apparently having trouble accepting this.  You should.  Further testing is not going to change things, I find myself thinking that your guilt and/or perhaps shame over your misstep is causing you to perceive problems that are not there or to attribute lingering symptoms related to your prostatitis to your encounter with the CSW.  If possible I would urge you to discuss your concerns with a trained, confidential professional counselor if you cannot get by your concerns that the symptoms you perceive are the result of something you caught during the encounter you described.  I say this out of concern for you, nothing more.  

This concludes this thread.  I wish you the best.  EWH
---