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Gonorrhea leading to 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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Gonorrhea leading to epididymitis?

I am married, in my early 40s.  In late December, I received unprotected oral sex from a young woman.  Otherwise, I have been faithful for many years.  Day 14, began to feel like I was sitting on my left testicle -- but I would adjust posture and be fine.  Did not consider STD as a cause.  Day 30, I urinated so frequently that I went to an outpatient clinic - "Clinic 1".  Urinalysis was clear and they sent out for urine culture.  That night I panicked, began to suspect STD after reading that one swollen testicle is a symptom of gonorrhea or chlamydia (although I have had no discharge or burning urination).  Day 31, I went to an STD clinic "Clinic 2" and they treated me for gonorrhea and chlamydia without testing me - an injection in buttock and 250mg Zithromax x4.  Day 33, urine culture from Clinic 1 results clean, but I suspect they only were looking for UTI (didn't discuss sexual history with them).  Day 37, back to Clinic 2 for peace of mind gonorrhea/chlamydia testing. Day 40: negative results on both.  
Day 43 and still feel like left testicle is swollen as has been throughout the time frame.  Burning feeling from back of testicle if I sit too long.  On 3 occasions in last two weeks it has gotten so painful I had to get out of chair and take a walk.  I am concerned that I got gonorrhea on Day 1, leading to epididymitis.  I am seeing a urologist this week.
1.  How unusual would it be to have no gonorrhea symptoms except for a swollen testicle?
2.  Was the "negative" test at the STD clinic on Day 37, 6 days after the injection, meaningful?  Assuming I did have gonorrhea, would it have still shown 6 days after treatment?
3.  Will the urologist be able to definitively determine if I have epididymitis?  If so, can he distinguish whether from STD or, instead, from another cause?
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Welcome to our Forum.  I am confident that your testicular symptoms are not related to the receipt of oral sex you describe above and suspect the relationship is coincidental.  Gonorrhea is rather rare following oral sex and had it happened, for the infection to be asymptomatic would be most unusual.  Further your negative tests and the absence of any response to the therapy you have had also help to rule out the possibility of gonorrhea or other STDs.  

In answer to your specific questions:
1.  How unusual would it be to have no gonorrhea symptoms except for a swollen testicle?
This would be most unusual.  Asymptomatic gonorrhea occurs in only about 1% of cases of gonorrhea and for it to then to present as a swollen testicle would be  most unusual.

2.  Was the "negative" test at the STD clinic on Day 37, 6 days after the injection, meaningful?  Assuming I did have gonorrhea, would it have still shown 6 days after treatment?
As clinicians we try to integrate all of the information presented to us, i.e. the sorts of exposures that have occurred, the timing, the signs and symptoms, the test results and, in your case, the (absence of) response to therapy.  Thus, while your negative test supports that you did not have gonorrhea, the combination of evidence allows me to be much more emphatic (and sure) that this is not gonorrhea.

3.  Will the urologist be able to definitively determine if I have epididymitis?  If so, can he distinguish whether from STD or, instead, from another cause?
Yes, the urologist should be able to diagnose epididymitis and, in most cases, determine its likely cause if that is the problem.


I hope my comments are helpful.  With a swollen testicle, seeing a urologist is the right thing to do.  EWH
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