[Question #995] Hyper Vigilent or real symptoms after exposure

49 months ago
Hello Dr- 
I asked a question recently about the risk of receiving unprotected oral sex.  A sex worker performed on me. She was very rough in it (a lot of saliva) and deep. 

 3 days later  I engaged in unprotected sex with my regular partner.  The next morning I felt sore (burning tip) and had a strong urge to urinate most of the day.  I started to get very nervous but was able to calm myself In reading your advice which said its a relatively low risk event. Through the weekend I felt fine for the most part but yesterday my burning tip and  urge to pee returned. 

I went for a blood and urine 10 panel test yesterday (8th day since being a exposed by the CSW).   I'm waiting on those results. 

I often dribble a lot after urination (often a wet urine spot in underwear) and I've had this burning issue on occasion after ejaculation from time to time.  However, right now it is strongly pronounced and I'm freaking out.  I'm convinced I will receove a positive result (results could come earliest thurs, latest Mon). 

I'm wondering if the fact she had a lot of saliva on me increases chance of infection? Also, would my dribbling issue cause burning?  I understand hyper vigilant anxiety could be at play but the awareness of burning at the head seems very real.  But, why did it go away through the weekend?

Also, no discharge or pain of other kinds. 

Any insight would be appreciated.  


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome back to the forum. However, I cannot find another question with username Michael that matches your description ("the risk of receiving unprotected oral sex"). If you will let me know the question number, I might have more comments.

Your "10 panel test" probably won't be helpful. There is little or zero risk from oral sex for most of the tests likely to be included in such a panel, so most probably were unnecessary. Second, no STD blood tests can be positive after only 8 days. These results might serve as a baseline against which to compare future testing, but won't say anything about newly acquired infections. However, if you had a urine test for gonorrhea and chlamydia, that would give useful information.

With extremely rare exceptions, the only STDs transmitted oral to penis are gonorrhea, herpes due to HSV type 1 (the usual cause of oral herpes), and nongonococcal urethritis (NGU), perhaps often caused by normal oral germs. Syphilis can be transmitted by oral sex, but is currently very rare in CSWs in the US. In any case, of these, only gonorrhea or NGU might cause symptoms like yours, but these don't fit your symptoms. No STD causes urinary hesitancy, slow flow, dribbling, etc. Pain or "burning" of the penis, with or without urination, could be an STD, but usually is not, unless also accompanied by obvious urethral discharge -- i.e. mucus or pus dripping from the penis or staining underwear (not a wet urine spot).

In general, saliva does not transmit STDs, so the amount of saliva to which you were exposed makes little difference.

As for whether "hyper vigilant anxiety" could explain much of what you are feeling, I will just say that whenever someone suggests his or her own symptoms have an emotional or psychological origin, usually s/he is correct. Further, STD symptoms would not come and go -- so the clearing of your symptoms over the weekend also is more consistent with anxiety than infection.

All things considered, it is unlikely you acquired any STD from the oral sex exposure. But let me know if anything isn't clear.

Regards--  HHH, MD

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49 months ago
Hi Dr - 

I did have the urine test so hopefully that will alleviate the Gonnoreah and clamydia concerns.  

I don't know what is going on but I'm urinating often, have a sting at the head of my penis.  No discharge.   Also, going # 2 a lot which is loose and not coming out so easy.  

These symptoms were present last Thursday all day, were better Friday and thru the weekend and returned worse since yesterday. 

I'm hoping you are correct it's not an STI. 

With that said, the guidance given by the DR's in this forum is that STIs are very hard to acquire thru receipt of oral.  But... It can happen.  Sounds like if it does happen, you'd be in a very small percentile and be the unlucky one or two out of a hundred. 

Anything else you can say or tell me about my case based on what I've shared?  

Thanks!




49 months ago
In reading your reply... I want to clarify, I'm urinating often with soreness at head of the penis.  No discharge or stains.  
49 months ago
Sorry for the multiple comments since your response....  Also, how hard or common is acquiring Gonnoreah orally? Is it also fairly a rare occurrence?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
You are exactly right that "STIs are very hard to acquire thru receipt of oral.  But... It can happen." Your symptoms should be evaluated in person by a physician; lab tests alone are unlikely to give an answer. Conceivably you have NGU, herpes, or gonorrhea from the exposure. Another possibility is adenovirus, not really an STD in the usual sense, but a common cold virus that can be transmitted to the penis by oral sex. Or maybe you have prostatitis -- which isn't an STD, just unlikely timing. Or other non-sexually acquired urinary tract infection. Probalby not -- your symptoms are not typical of any of these -- but personal evaluation is the only way to know. 

So stop just hoping, and stop relying on self-selected testing. See a doctor, preferably one who knows STDs well, such as your local health department STD clinic, if there is one nearby; or a Planned Parenthood clinic. I would like to hear back about the findings after you have been examined, but further speculation by a distant forum expert isn't going to get you any further along in knowing the answers. 

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49 months ago
Well Doc -  The results are in .... and.... all NEGATIVE!!!  I cannot believe it.   I went to a Urologist today who examined me (this was before I received the results from the service I used) and the Dr said he did not think there was anything wrong based on the urine analysis, examination, and the story I told him.  He implored me to calm down and "just relax".    Anyway, thanks for your guidance and that of Dr. Hook.  It helped me get through a difficult period.  

I really believed the symptoms were real.  I felt pain in my areas.   I guess the mind can do things that are very good for people if they believe it, and negative too if they believe.

I'm just glad this worked out and I can walk away with peace.  Lesson learned!!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
I'm very glad to hear it. Thanks for the follow-up. I'm glad I was able to help.

Best wishes and stay safe--   HHH, MD

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