STDs Expert Forum
Epididymitis
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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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Epididymitis

Hello Doctor.  I've been posting in the medical support communities (titled "First post - very concerned) where Grace has been very helpful.  I would like your expertise as well.  This may take two posts as I want to be sure I include good detail.  First, on 12/9 I had unprotected oral sex with a stripper, there was a handjob as well.  That same day and the next I experienced soreness as one might expect especially right where the head meets the shaft.  That soreness continues to this day and has somewhat improved but can be transient.  48 hours after the oral, I noticed some testicular pain (ache).  Not debilitating but definitely there.  I also had mild flu-like symptoms but with no discernable temp.  This lasted about 2 days or so but the ache remained but with no dramatic swelling that I could see.  I held out until 10 days passed before getting tested to ensure an accurate result.  On 12/19, I visited a clinician for an exam and testing.  I was diagnosed with epididymitis based on my description of symptoms primarily.  Was tested for chlam/gon and treated with 1000 mg of Zithromax #4 tablets (one time dose) and an injection of ceftriaxone just in case. However, two days later the test results came back negative for both conditions.  I am still awaiting culture results.  Within 48 hours after receiving the meds, I experienced what can only be described as a sensation of "burning skin".  I did not see a rash, but I felt this all over especially face, groin, arms and scalp.  This passed in about another 48 hours.  Likely a side effect of the meds but not sure.

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The purpose of the 2,000 character limit is to require the initial question to be reasonably brief; the entire question must fit in the initial question field.  The moderators do not have time to read long essays, and I have never seen a question on this forum that could not be asked within the limit; indeed if I were setting the rules personally, it would be a maximum of 1,000 characters (about 200 words).  (Many MedHelp moderators set their preferences so they never even see any comment windows.)

I will respond after you compress your question to the 2,000 character limit (preferably a lot less) and post it in a new comment window.

HHH, MD
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Avatar_m_tn
Part 2 of post:

Here is my current situation: The testicular ache is gradually improving but is still present when I move a certain way.  I have some itchy "hot spots" in the groin area.  These have no lesions that I can make out and are not really even red. They do however itch on occasion.  They are located on each side of my groin where my thigh makes contact with my scrotum.  In some ways, these almost seem like an ongoing manifestation of the "burning skin" I described earlier.  Lastly, the area just between the head and shaft of my penis continues to feel irritated.  It almost feels to be in the same place where my partner gripped the shaft (pardon the graphic description).

Here are my questions:
1. The chlam/gon test was performed over 10 days from exposure which I assume was sufficient for an accurate result.  Since it was negative, what else could have caused epididymitis?  Also, would the two meds I was given take care of any other bacteria that could have been responsible?

2. The "hot spots" I mentioned are worrying me.  There are no lesions or even redness but they feel hot and have a prickly itch on occasion.  They seem to be exacerbated by rubbing.  They do not continually itch but just feel like irritated skin.  Could this be an indicator of herpes?  Or might it be Jock itch brought on by the antibiotics I was given?

3.  For the transient pain between head and shaft, could this be a residual irritation or infection from the handjob which was pretty rough?  Even though it's been nearly 3 weeks now?  Would applying bacitracin ointment help?

4.  Lastly, I followed up with the clinic yesterday by phone and they stated it would be fine if I resumed sexual activity.  Different information can be found on the internet - what is your opinion?  Also, based on the above description, what do you feel the chances are that I acquired Herpes?  Are there any signs I should be looking for?  Should I even consider unprotected sex at this point?  Of course, this would only be with a safe partner.

Thank you very much for your time and my apologies for the long post.
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Avatar_m_tn
Sorry, Doctor, hopefully this is concise enough:

On 12/9 I had unprotected oral sex with a stripper, there was a handjob as well.  48 hours after the oral, I noticed some testicular pain (ache). I also had mild flu-like symptoms but with no discernable temp.  This lasted about 1-2 days.  The ache remained but with no dramatic swelling. On 12/19, I had an exam and diagnosed with epididymitis based on my description of symptoms primarily.  Was tested for chlam/gon and treated proactively with 1000 mg of Zithromax #4 tablets (one time dose) and an injection of ceftriaxone.  However, two days later the test results came back negative for both conditions.

The testicular ache is improving but is still present.  I have some itchy "hot spots" in the groin area.  These have no lesions that I can make out and are not really even red. They are located on each side of my groin where my thigh makes contact with my scrotum.  Lastly, the area just between the head and shaft of my penis has felt irritated since the actual intercourse. Again, no redness or lesions.

Here are my questions:

1. The chlam/gon test was performed over 10 days from exposure.  Since it was negative, what else could have caused epididymitis?

2. The "hot spots" have no lesions or even redness. Mainly just feel like irritated skin but with an occasional itch. Could this be an indicator of herpes?  Or might it be Jock itch brought on by the antibiotics?

3.  For the transient pain between head and shaft, could this be a residual irritation or infection from the handjob which was pretty rough?  Would applying bacitracin ointment help?

4.  Lastly, I followed up with the clinic by phone and they stated it would be fine if I resumed sexual activity - what is your opinion?  Also, based on the above description, what do you feel the chances are that I acquired Herpes?  Are there any signs I should be looking for?

Thanks.
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239123_tn?1267651214
Welcome to the forum, and thank you for compressing your question.

To start, I am quite skeptical of the initial diagnosis of epididymitis.  That the doctor diagnosed on the basis of symptoms only suggests you did not have testicular swelling or overt tenderness; this alone makes the diagnosis very unlikely.  My guess is that he treated you as a safety precaution not because he really thought you had it.  Equally important, 2 days is way too soon for onset of epididymitis due to STD, of which there are only two causes, chlamydia and gonorrhea.  You can't get chlamydia from oral sex (or so rarely it can be ignored); and if gonorrhea were the cause, you would have had pus dripping from the penis for at least a few days before the epididymitis itself began.  Finally, epididymitis doesn't cause vague testicular aching, and almost always involves a single testicle, not both.

So if not epididymitis, what was it?  Probably genitally focused anxiety.  Your symptoms and timing of onset were typical.  And you certainly had a relatively safe sexual exposure that was statistically unlikely to result in any STD.

Those comments largely address your specific questions, but here are some direct comments for each one:

1) 10 days is plenty of time for accurate testing.  The negative result supports my impression that you didn't have either gonorrhea, chlamydia, or epididymitis.

2,3) Both these symptoms also sound anxiety related, especially if there are no visible abnormalities of the affected area.  Most likely anxiety is inflating your awareness of minor body sensations that you otherwise wouldnt' notice.

4) I agree with this advice.  Almost certainly you do not have (and never had) any infection from your sexual encounter, or anything else that could harm your current or future sex partners.

Many people are upset when we diagnose genitally focused anxiety.  But you should not be.  It's good news, since it suggests you do not have (and never had) anything harmful.  And it's an exceedingly common reaction in men who have had a sexual exposure they regret.  The pain is real, and does not imply an abnormal mental healt status.  As implied above, the human mind is very good at subcconsciously magnifying normal body sensations or other minor discomforts into sensations of real discomfort or overt pain.  In any case, my expectation is that your discomforts will fade with time.  Certainly you should not be at all worried at this point.  No harm will come to you or your regular sex partner(s).

I hope these comments are helpful to you.  Happy new year--

HHH, MD
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Avatar_m_tn
Doctor Handsfield, thank you for your comments.  Two additional questions:

1. Would a non-std bacterial infection result in symptoms that quickly?  Also, if that is involved, would the antibiotics I've already taken address it?  I am awaiting the culture results which I should get hopefully today.

2. I mentioned that there was no dramatic swelling which is true.  The examiner also said that most who come in with this are in debilitating pain.  I was palpated and did not feel any substantial discomfort.  However, I can't say that there wasn't swelling at all as the scrotum did seem somewhat inflamed.  I suppose this could have been anxiety driven but mild pain is listed as a potential symptom.  Also, the ache seems more localized into my right testicle but I can't say that has been the case throughout. Does that change your opinion?

I assume you would prefer the herpes questions be asked in that forum but would appreciate any general comments.  Thanks again for your help.  This has been a trying time for me and your input is really appreciated.
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239123_tn?1267651214
No, there are no other infections you could have caught from the sexual exposure (or otherewise) that could explain your symptoms.  Herpes questions are fine in the STD forum.  But that's also barking up a useless tree. There is no chance that herpes explains the symptoms you have described.

In other words, the additional information you provide does not change my opinion or advice.  In the very slight chance you had any infection at all from the sexual exposure described, it did not and does not explain any of your current symptoms, and would have been adequately treated by the azithromycin and ceftriaxone treatment you received.  However this started, you can be 100% confident that at this time you have nothing that could ever harm you or any sex partner.  Please try to understand and accept that judgment, and ignore any "what if" scenarios that might come to your mind.  Do your best to put this incident behind you and move on with your life.

That will end this thread.  Take care and good luck.
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Avatar_m_tn
Thank you, Dr. Handsfield.
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Avatar_m_tn
Dr., yesterday I developed a small blister/pimple on the shaft of my penis about midway up on the right hand side.  It is not overly red or painful.  It is very small and shaped more like an oval or rectangle (approximately 2mm x 1mm).  The day before yesterday I masturbated,  really just to assure myself there would be no pain with my regular partner.  No issues there but I did not use any lubrication.  Perhaps this is just a blister?  I suspect not as it does not seem to be painful or irritated.

Should I be concerned about this new development?  I posted this in the Herpes doctors forum but have not received a reply yet.

Thanks very much.
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239123_tn?1267651214
You're a far better judge than I can be about whether the masturbation was sufficiently vigorous to cause a traumatic lesion.  From the description alone, herpes might be possible -- but if so, it would mean you have been infected for a long time, maybe many years, not from the sexual exposure described.

That's definitely the end of this thread.  Any further comments will be deleted without reply.  You can't keep returning with every additional minor concern that pops into your head.
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Avatar_m_tn
Dr., sorry to extend the thread further - I was ready to put the matter to rest until this new development.  I appreciate the information and your response.  I also appreciate your brevity and candor.  Sometimes that is what's needed.

Best.
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