STD Potential

[Van_1977]

Dear Dr. Handsfield/Dr. Cook
I am travelling in Latin America, with no immediate access to appropriate medical attention.  5 days ago, I had sex (and 4 ejaculations) with a couple of CSWs in Dominican Republic.  As long as I concern, all were protected, but the condom(s) might have broken without me noticing (I was under effect of alcohol).  About 15 hours later, I started to feel burning sensation at the tip of my penis (between urination and a bit less while urinating) and urge for urinating.  The burning subsidises after urination for a few minutes, but comes back shortly after.  I have had no discharge so far and no physical changes.  Mild testicular pain started from yesterday.  
Just to add, I had a very similar story (with the same symptoms) at the very same place a year ago, but at that time I noticed the condom broke and the situation caused me 2 months of anxiety until I get my HIV test done.  
Here are my questions:
1. Can symptoms of a STD start as early as 15 hours?
2. Can a STD include burning sensation but no discharge, and no intensification of burning while urinating?
3. Overall, do you think it may be a STD? If so, should I seek any treatment?  I only have Cypro with me.  Is it wise to start taking them and with what dose?
4. If these symptoms suggest an STD, should I assume that the condom broke and be concerned about HIV?
5. Is it possible that the symptoms are related to a UTI or allergy caused by swimming in the salty ocean water in this area?
6. I am planning to continue my trip for the next 3 months, do you think that the situation are so that to cut my trip short and go back for testing/treatment?

[Van_1977]

Thanks Doctor Hook;

I did not take Azithromycin.  Will take that today and if the symptoms do not resolve, I will start prostatitis treatment you mentioned earleir and before I access proper laboratory testing.

Wish you luck and appreciate all your great feedbacks.

[Edward W Hook, MD]

The cefixime should have cured gonorrhea.  You don't mention if you took the azithromycin or not.  If you did, the possiblity that this is STD related remains rather low.

There are two major possiblities.  You list one of them and the one which I suspect is the more unlikely of the two. The other possiblity is that you have prostatitis and your partial, brief treatment caused symptoms to resolve for a few days but was not curative.  You need some laboratory tests and probably an examination.  Ask around and see if there is someone you can see.  EWH

[Van_1977]

Hi Dr. Hook;

I was w/o internet for a few days and couldn't see your reply.  I had one single dose of Cefixime 400, five days ago and the symptoms subcidised significantly.  However, since yesterday, the burning feeling and testicular pain are back and I noticed very small milky discharge (by pushing tip of the penis).
Is there any possible explanation for that?  Is it possible that I contracted Gonorrhea and Chlamydia and Gonnorhea symtoms cleared up after taking Cefixime and now, after 12 days of possible exposure the Chlamydia symptoms shwing up?

Regards;  

[Edward W Hook, MD]

Your symptoms still do not suggest STD, given the nature of your contact, and would be far more compatible with a prostate infection.  If this is prostatitis, the preferred therapy would be an antibiotic taken for about 3 weeks - preferred antibiotics ould be trimethoprim-sulfamethoxazole or a quinolone antibitoic such as ciprofloxacin or, preferrabley, levofloxacin.  EWH

[Van_1977]

Dear Dr. Hook;

My apologies for bugging you again.  At the moment, you are my only reliable source of medical advice.  I am now on day 7 after burning started at the tip of my penis, and with some more symptoms, I want to ask your second thought.  I doubt that it is only in my mind.  Even in the mornings, as soon as I open my eyes, I have the burning.

- Burning continues, perhaps even more.
- Sometimes I see white semen like discharge, while having bowel movement.  No other discharge.
- I have mild testicular pain and contraction feeling extends back to the anus.
- The burning is more intense in the morning and less in the evenings.
- If i hold myself from peeing, the burning reduces after a couple of hours.
- 10 years ago, at the age of 23, I was diagnosed with E-Coli which was treated.
- Last year, with the very same symptoms, at the very same place, under the same circumstances, I tested for all STD one week after.  All came back negative, but it was after taking Amoxicilin for 1 week.  My questions are;

1. Do you still think that it is not STD?
2. I managed to get some Zythromax and Cefexime.  Should I start taking them as a precaution?  Even if it is UTI, they might help as the burning is really annoying and has hindered my normal life.  
3. With this symptoms and my history, do you think UTI is possible?  If so, I can open a new thread in the UTI forum.  

Thanks in advance for your time and patiance.

[Edward W Hook, MD]

Welcome to our Forum.  I suspect there is little risk for ahving acquired an STD from the exposures you describe.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times. The sort of burning discomfort you describe is typical of this.  Furthermore, if your condom had broken, it would have been obvious- condoms do not leak, when they fail, they break wide open.  Finally, when people get STDs symptoms never start within 24 hours of exposure.  I would not worry.

In answer to your specific quesitons:
1.  No, STD symptoms would not occur this quickly/
2.  Burning alone can be an STD symptom but with STDs the burning is typically more obvious on urination than between urinations.
3.  STD is unlikely, for all of the reasons I have given.  I would not start treatment at this time.
4.  No.
5.  UTIs are uncommon in men.  On the other hand, peole can get irritated from water exposures.
6.  No, I would go on and enjoy your trip.

EWH

[Van_1977]

I Should add that I am 33 year old male and had diagnosed with E-Coli about 10 years ago, which was treated.