STDs Expert Forum
Diagnosis and Prognosis??
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Diagnosis and Prognosis??

Dear Dr.,
Exactly a week ago, a stripper performed unprotected oral sex on me for a very short period of time.  As I understand the risks after reading countless post, there is a relatively small but real probability that I was exposed to HSV, gonorrhea, and non-chlamydia nongonococcal urethritis- and a theoretical probability of being exposed to syphilis.  I was tested the first day after the event and those test came back negative.  But because I know that the test are more accurate after several days, I went back after five days for an additional test.  My doctor said the test came back negative for gonorrhea and chlamydia (although as I understand it, chlamydia does not thrive in the mouth and thus my risk of inflection is relatively low).  I asked him about non-chlamydia nongonococcal urethritis and he said my urine was negative for bacteria but that sometimes those bacteria are more difficult to detect.
I would be happy w/ these result, except yesterday evening- six days post the event- my bladder started to feel like there was pressure on it and a frequent need to urinate.  This ordeal, however, has caused me a great deal of stress because I'm usually not one to take sexual risks and I do wonder if my symptoms are psychosomatic or the result of drinking a lot of water to make myself urinate- given the results of tests came out negative- or if I actually have an NGU infection.
I described on the phone to my doctor the symptoms and he said it was possible I had an NGU infection and advised me to come back to his office the following day for an additional test and an Ofloxacin prescription IF I continue to experience the same sensation overnight.  
I wonder if you agree w/ the doctors diagnosis and prognosis.
Many thanks,
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Welcome to the forum.  You have learned a lot by reviewing other threads, and you accurately cite Dr. Hook's and/or my responses to similar questions.  It really helps when questioners do that.  Thank you!

Bladder "discomfort" and urinary urgency rarely are STD symptoms at all.  The discomfort associated with NGU is strictly localized to the penis (usually felt only at the tip) and generally occurs only during urination.  And usually, but not always, there is an obviously abnormal discharge of pus or mucus.  On the other hand, general bladder and lower abdominal discomfort, and a sense of somewhat frequent or urgent urination, are classical symptoms of genitally focused anxiety.  That is probably what you have.  I'm reinforced in that opinion by your own words:  whenever someone suspects his or her own symptoms have an emotional or psychological origin, probably s/he usually is correct.

Should you be treated?  No, not in my opinion, unless you develop objective evidence of urethritis -- discharge, increased white blood cells on a swab from the penis, etc.  If your doctor decides to treat you without that evidence, it's really a shot in the dark -- probably no infection, and perhaps just reinforcing your anxieties about this.  In any case, the standard treatments for NGU are doxycycline or azithromycin, not ofloxacin or related drugs.

I suggest sitting tight.  If your symptoms persist, get examined directly -- don't accept a phoned-in decision.  My bet is your symptoms will fade, and that you don't have any infection at all from your oral sex encounter.

Regards-- HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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