[Question #9900] Oral STI or something else
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28 months ago
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Hx: 40 yo, male, oral HSV1 +, kidney stones, but current sx do not feel like past episodes. X-ray confirmed presences of existing stones, no changes to size/location
3/3/2023: received unprotected oral from SW. Next day, mild dysuria and discomfort on penis tip, no discharge.
3/13: Sx are worse. WBC & RBC: 10+, POC leuk trace, and POC RBC 50. 7 day Doxy & tested negative for Chla, Gon, Mgen
3/15: Symptoms same. Dipstick (normal) & culture (mixed flora), instructed to complete Doxy
3/20: Dysuria, frequency, & swollen meatus. Urinalysis normal, culture showed 4k Proteus Mirabilis - given 10 day Cipro
4/6: No change in sx after Cipro. Trich and syphilis negative, and dipstick (Hemo trace for POC O. Blood)
4/10, Prostate exam (normal), referred to urology for Prostatis w/ 45 day Doxy.
Urology is on 5/23. Dysuria, testicle pain now, aching tip pain, feels as if something is stuck inside. Not been sexually active since.
3/3/2023: received unprotected oral from SW. Next day, mild dysuria and discomfort on penis tip, no discharge.
3/13: Sx are worse. WBC & RBC: 10+, POC leuk trace, and POC RBC 50. 7 day Doxy & tested negative for Chla, Gon, Mgen
3/15: Symptoms same. Dipstick (normal) & culture (mixed flora), instructed to complete Doxy
3/20: Dysuria, frequency, & swollen meatus. Urinalysis normal, culture showed 4k Proteus Mirabilis - given 10 day Cipro
4/6: No change in sx after Cipro. Trich and syphilis negative, and dipstick (Hemo trace for POC O. Blood)
4/10, Prostate exam (normal), referred to urology for Prostatis w/ 45 day Doxy.
Urology is on 5/23. Dysuria, testicle pain now, aching tip pain, feels as if something is stuck inside. Not been sexually active since.
What is wrong with me?
TY!
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Edward W. Hook M.D.
28 months ago
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Welcome to the Forum. Thanks for your questions. I'll be glad to comment. The sequence of events you describe does not suggest an STI and is only coincidentally related to your receipt of oral sex from a CSW. This assessment which is confirmed by your lack of response to doxycycline, your negative STI tests and your positive culture for Proteus. I would do everything that you can to expedite your evaluation by a urologist- you may have a urethral stone or some other obstructive urological problem.
This is almost certainly not an STI. EWH
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28 months ago
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Thank you Dr. H
Clarification: between the end of Doxy & 1st Cipro, dysuria & frequency improved to occasional/mild occurrences. Other sx: itching and urethral pain stayed the same/worsened. Left testicle pain/tenderness & tip irritation are my chief sx now.
Questions:
Clarification: between the end of Doxy & 1st Cipro, dysuria & frequency improved to occasional/mild occurrences. Other sx: itching and urethral pain stayed the same/worsened. Left testicle pain/tenderness & tip irritation are my chief sx now.
Questions:
- If potential/minor Doxy/Cipro improvement , would my neg test be enough to rule out an STI / NGU? Is NSU urethritis from an enteric bacteria (E Coli, UU, etc.) or virus possible? If so, do I need a different antibiotic like Levo
- Is Epididymitis a concern? Assuming the negative cultures and testicle pain, are bacteria or virus (HPV / CMV) a risk?
- Positive urine cultures are generally around the 100k mark. At 4k, is it possible this is due to the Doxy removing competing bacteria? Would bacterial NSU appear on the cultures?
- Would my X-ray (on 4/6) rule out a potential urethral stone?
- Based on your expert opinion from this information, can I have unprotected sex with my wife or should I wait until after Urology?
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Edward W. Hook M.D.
28 months ago
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Straight to your follow-ups:
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- If potential/minor Doxy/Cipro improvement , would my neg test be enough to rule out an STI / NGU? Is NSU urethritis from an enteric bacteria (E Coli, UU, etc.) or virus possible? If so, do I need a different antibiotic like Levo:
- As long as your tests were taken before you were taking antibiotics, you should believe your results showing that you do not have an STI. The doxy would cure chlamydia or NGU if it were present. Further, chlamydia, M. genitalium and enteric bacteria like Proteus are not transmitted by oral sex
- Is Epididymitis a concern? Assuming the negative cultures and testicle pain, are bacteria or virus (HPV / CMV) a risk?
- Your testicular discomfort is why I have urged you do see a urologist sooner than May 23. You could have non-STI epididymitis. Levofloxacin is closely related to cipro but might be advantageous. Further, on some occasions prostatitis (which is what your symptoms suggest despite a negative exam) take more than 10 days of treatment
- Positive urine cultures are generally around the 100k mark. At 4k, is it possible this is due to the Doxy removing competing bacteria? Would bacterial NSU appear on the cultures?
- Bacterial NGU following oral sex is due to the irritating effect of normal bacteria being introduced into the urethra during the oral sex. The amount of Proteus could have been reduced by antibiotics but not cured
- Would my X-ray (on 4/6) rule out a potential urethral stone?
- X-rays sometimes but not always show stones. Ultrasound it the preferred test for examining the testicles and urinary tract
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- Based on your expert opinion from this information, can I have unprotected sex with my wife or should I wait until after Urology?
- You do not have an STI- there is no reason to nor have unprotected sex with your wife
EWH
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28 months ago
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Hello Dr. H,
I masturbated this afternoon which improved my testicles pain but now experienced clear discharge, oozing out regularly, even hours after the masturbation. I don't believe there was discharge before but at this point I don't know what to think.
Question:
I've read that Prostatis may cause discharge.
Re: testing, the Chla, Gon, Mgen tests occurred before Doxy was taken. The Trich and Syphilis test occurred after the 1st round of Cipro.
Question:
- Does this discharge change your diagnose and rule back in any STIs ?
- Does Prostatis/Epididymis typically have symptoms of discharge?
- Urology has me on the waiting list but it's unlikely they can see me sooner. Should I see my PCP to get the discharge tested and evaluate for anything else / other antibiotics are required?
- What questions should I ask urology to check for?
- Am I still okay to have unprotected sex with my partner (with this discharge)?
Thank you for all your support for the community.
I've read that Prostatis may cause discharge.
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28 months ago
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Dr H.,
Clarification: the discharge is about an eye drop amount or less, and occurs 4-5 times with the hour (give or take) from what I’ve noticed. Thank you again!
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Edward W. Hook M.D.
28 months ago
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As you know, we provide up to three responses to each client's questions. With this 3rd response this thread will be closed shortly without further responses.
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In response to your follow-up questions:
- Does this discharge change your diagnose and rule back in any STIs ?
- No. The discharge could be related to your masturbation or some other non-STI problem such as prostatitis. Your tests prove tha not discharge causing STI is present.
- Does Prostatis/Epididymis typically have symptoms of discharge?
- It certainly is a possibility.
- Urology has me on the waiting list but it's unlikely they can see me sooner. Should I see my PCP to get the discharge tested and evaluate for anything else / other antibiotics are required?
- Most doctors have regular cancelations. Let them know to call you if they ahve a cancelation. In the interim, seeing your PCP is reasonable. He/she may be able to assist you in seeing a urologist.
- What questions should I ask urology to check for?
- Describe your problems, your tests results and your response (or lack there of) to antibiotics
- Am I still okay to have unprotected sex with my partner (with this discharge)?
- Yes
This completes this thread. EWH
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Edward W. Hook M.D.
28 months ago
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If your discharge persists, your PCP should culture it for bacteria causing prostatitis and for STI pathogens (I anticipate these tests will be negative). EWH---