Hi doctors. 12 months ago I had a sexual encounter with a street CSW, no high end escort by appointment. I received a blowjob from her and then had vaginal sex, all protected with condom. The condom was provided by hotel lobby so dont really know what kind or expiration date. Didnt really check the condom afterwards but there was no obvious breakage. 5 days after sex I started feeling pain in testicles and symptoms are still there to this day. I had the following test:

2 months post encounter: urethral swab for STI panel = all negative

4 months: urethral swab for STI panel = all negative. For this test doctor did a DRE exam and white discharge came out, the swab was taken with this discharge. Diagnosed prostatitis only by DRE, didtn peform any additional tests to this discharge besides the STI panel.

7 monhts: urine test for STI panel = all negative

11 months: urine test for STI panel = all negative

Ive also had multiple urine tests and urine culture and nothing ever shows up. Just one time some degree of "turbid urine"

Cefixim  400mg: for 10 days (1 month post encounter)

Bactrim: for 10 days (4 months post encounter)

Azythromicin 1G: one dose (5 months post encounter)

Amoxicilin/Clavulanic: for 10 days (6 months post encounter)

- Testicles discomfort

- Pain penis tip

- Pelvic pain

- Slow urine flow

- Little watery discharge from penis sometimes

All this symptoms get worse or better any given day with no apparent reason

Recently had a cytoscopy exam and was diagnosed with bladder neck hypertrophy, resulting in urine retention. My urologist says this is mostly caused by infections. So, what infection?  I must say after this exam I was prescribed with formicin for 7 days as preventive (still taking it) and this is the best Ive felt in a long time, dont sure if its placebo or the antibiotic is actually doing something to an undiagnosed infection

My questions:

1) Is it possible that lasting too long after exposure (2 months and more) could take the bacteria to other parts of the body as bladder and prostate and not being found in penis by urethral swab?

2) Could any STI be causing my discomfort or my recently diagnosed bladder neck obstruction?

3) Do you believe theres a chance of false negative result here? Considering my symptoms

4) For all this tests I took, some of the antibiotics I was taking could have interfere with the results? I tried to wait at least 3 weeks after any kind of antibiotic before testing

5) Do things like peeing shortly before urethral swab could interfere with the test?

6) Did the rectal exam my doctor did and taking urethral swab with white discharge at the mont could interfere in someway?

7? What else should I be doing/testing?

But I can only start with Wow! What an amazing battery of tests etc after a zero risk exposure for any and all STD. Not only was there no possibility of HIV or any other STD, but none of your symptoms (which I read very carefully) is typical for any STD. Your urologist is correct that some infections can cause some of your symptoms, but those do not include any STD. However, I disagree with him (or her) that such problem sare "mostly" caused by infections. In fact, although antibiotics often are tried, they usually fail resolve the symptoms -- because in fact infection usually is not present. (In theory, there are kinds of bacteria that science doesn't yet know how to detect, but most experts do not believe this is a likely explanation for most cases like yours.)

I suggest you google chronic pelvic pain syndrome (CPPS). The wikipedia article is good, and you also can find excellent information from various professional sources, such as the Stanford Unviersity Department of Urology. The symptoms you list are a textbook example of CPPS.

To your specific questions:

1) There is no such thing as testing too early for STDs (except within a day or two) or too late to detect any and all STDs that cause urethral or urinary infection.

2) No STD has ever been associated (in several research studies) with symptoms like yours.

3) No, there is no chance of false negative STD test results.

4) It is a common mistaken notion that antibiotics turn tests falsely negative. They generallly makes tests negative because they cure infection; it is rare to merely suppress a positive result. When that happens, the test becomes positive again within a short time after the last dose of antibiotic.

5) Although formal advice is to wait a while after urination before collecing urine or urethral samples for STD testing, in practice over 30+ years it has been apparent that in fact it makes no different. Your negative STD tests all were reliable. And as noted above, you weren't at risk for STD from the exposure described.

6) The rectal exam made no difference.

7) We don't advise on evaluation for non STD problems, so I have nothing further to suggest -- except to read up on CPPS and keep working with your urologist if your symptoms continue. In the meantime, don't be overly worried. There are no long term complications in cases like yours. You are not at risk for cancer, infertility, or any other serious outcome; and you have nothing that can harm a current or future sex partner. Indeed, many experts advise increased sexual outlets as helpful in men with symptoms like yours.

I hope these comments are helpful. Let me know if anything isnt' clear.

HHH, MD

1-Could you explain why you think I was at zero risk to begin with? I know the encounter was protected but protection is not 100% guaranteed and as I understand it was a very high risk partner. As opposed to what Ive seen in other replies in this forum like "high end escorts (not the street pick up or brothel) kind most likely dont have STD and they keep it safe". My partner was actually a street pick up and I cant really say I can assume the usual clients profile and behavior.

2-You say none of my symtpoms are suggestive of any STI, but isnt watery discharge a symptoms of STI? Also what about testicle pain in cases of untreated chlamydia or gonorrea? Doesnt this STIs cause testicle pain?

3-What could you say about currently taking Formicin and feeling slightly better the past few days? Could it be coincidence or would you suspect something there is going on undiagnosed?

4- Could undiagnosed STD cause bladder neck obstruction?

2. No, "watery discharge" -- especially intermittent and not continuous -- is not a typical STD symptom. STD related discharge is thick, stains underwear, and would have started within days of the exposure. And no, testicular pain is not a symptom, except for a severely (very tender) swollen testicle, i.e. epididymitis (which almost always is one testicle, not both). Ongoing discomfort of both testicles is rarely epididymitis and rarely a symptom of STD.

3. I think you mean fosfomycin? It's not an approved or regularly used antibiotic for any STD. I would suspect any improvement is coincidental. 

4. No STD is a plausible explanation. In my nearly 5 decades in the STD business, I have never had a patient with your symptoms (and there have been MANY of them!) in which an STD was ultimately found to be the cause.

Let me also remind you that you had several urethral or urine STD tests. Do you really imagine that ALL of them could have missed the infections they are designed to detect??

Really, don't worry about STDs. Once you decided on this sort of sexual experience, you did it with maximum safety and the condoms worked! Much of what you are experiencing may relate to genitally focused anxiety, which is common in many men after sexual exposures they regret or are worried about. Once you come to truly understand -- emotionally as well as intellectually -- that nothing important is wrong and there will be no signfiicant health consequences, most of your symptoms may just fade away.

1) The fact that my testicular pain started just a few days after the encounter and nothing has been diagnosed yet and the symptoms are still there? What would you make of it? What would u say caused this pain?. I just want to add to my symptoms that I get strong yellow semen from time to time.

In the light of all these Im sharing, do you truly believe is 100% safe for me to return regular unprotected sex with my long term partner? Ive already done it, but Im always feeling really scared during and afterwards.

1) Some or all your symptoms indeed may be related to the sexual exposure, but not because of an infection. Did you read about CPPS as I suggested? It has strong psychological connections. Just as tension headaches are stress related but have a physical cause -- increased tension in neck and scalp muscles -- so genitally focused anxiety probably increases pelvic muscle tension. The resulting pain or discomfort is physiologic and real, but the origin -- as for tension headaches -- is emotional and psychological.

2) Irrational thinking; that's an outlandish scenario. I have no suspicion you have any infection from the sexual exposure, as I have said repeatedly. This isn't a debate and I'm not going to change that opinion.

3) Your symptoms are not remotely suggestive of LGV, which also is among the infections that would have been cured by the antibiotics you took.

4) Yes, all possible bacterial STDs were covered, including chlamydia (which includes LGV), which for male genital infections always responds to azithromycin.

5) NO!!!

6) You were at even lower risk of syphilis than other STDs and it would have been aborted or cured by the antibiotics you took.

"do you truly believe is 100% safe for me to return regular unprotected sex with my long term partner?" YES!!!

Finally, "weak ejaculate" is not a symptom of any infection and certainly does not suggest STD.

You're just going to have to accept the apparently difficult conclusion that you have no STD. It is clear you are obsessed to a degree that prevents you understanding or believing the reasoned, science based evidence and advice you have had repeatedly both on this forum and undoubtedly from your own doctors. If you cannot, professional counseling is in order. I suggest it out of compassion, not criticism -- but it seems obvious you have some underlaying emotional issues that have elevated the importance of this particular sexual exposure far beyond its clinical significance. I hope you'll take this final advice to heart.

Finally, please do not return to this forum with any further questions about this exposure, your symptoms, etc. This discussion has been far more detailed than most on the forum, and you've had the nearly cost-free advice from (I say with humility) one of the world's top experts. Repeated anxiety driven questions are subject to deletion without reply and without refund of the posting fee, and you can be sure that there are no symptoms or circumstances you have now, or might have in the future, that will possibly be due to any STD from the sexual exposure described. When your concerns continue -- as I fear they will -- go back and read every word of this long discussion. The answers are here. Thank you for your understanding.