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STD concern for epididymitis?

Hello.  I'm a 33 year old male who received unprotected oral sex from a csw 5 weeks ago.

- A few days after the exposure, there was a slight burning at the tip of the penis on the start of urination, but not during and after.  Went away after a few days… I hadn't drank as much water during those days which could contributor to urine acidity?
- 2.5 weeks after the incident, had an std urine test where I peed about 40 minutes before.  I initially filled up the cup, and then emptied half of it after seeing the instructions on the wall.  Results were negative for c/g.
- 3.5 weeks after the incident, I was feeling pain in my left testicle. Visited my doctor and was told it could be epididymitis. Told him of my exposure and had another urine test done. I peed in two cups… presumably one for urinalysis and the other for stds (don't remember which cup was labeled which). Urine test came back negative for c/g and negative for leukocyte esterase. Ultrasound was done and showed a left varicocele, everything else was normal (color doppler, spectral analysis, epididymis head, testicle)
- Testicle was visibly swollen and tender to the touch for the next few days.  Didn't see any discharge or any penile pain/burning aside from what was said above during and the few weeks before the pain.

Was given a shot of ceftriaxone plus doxycycline tablets.  The testicular swelling and pain went down within a few days and now everything is back to normal.

Just had a few questions:
1)  How reliable are the urine tests I took?  How is the sensitivity of naat tests in regards to midstream catch?  Sensitivity for short time gap between urination + volume of urine?
2)  Would I have elevated wbc if I had an std?
3)  Do I need to have my regular partner tested or can I safely assume this was not std related?
4)  What other possibilities could it be?  Seems it should be bacterial since the antibiotics seemed to have helped?

Thanks for your input!
3 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
What you describe sounds like testicular difficulties possibly unrelated to any STI.  in you want to discuss this with a health care provider, my advice would be to discuss with a urologisst.

As brief answers to your follow-up questions:
1.  In regards to the antibiotics I took, roughly how long would it be effective in my system?
Antibiotics would remain in your system for a day or two.  However, you can only kill a bacteria once.  I'm not sure you are asking this question.

2.  In cases of epididymitis without obvious urethritis, does the std bacteria remain in the urethra and is thus detectable via urine test?
If you had STI-related epididymitis (and I am not sure you did), the offending bacterial would be detectable in your urine.

3.  With epididymitis resulting from an std, does urethritis/discharge typically go away, or is it normally occurring at the same time as the epididymitis?
If anything the urethritis would resolve more quickly than the epididymitis.

I am concerned that you have now moved into the realm of "what if" questions which, in my experience, are almost never of help or use.  I remain skepical that your symptoms were epididymitis related to your exposure more than 5 weeks earlier.   EWH
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Avatar universal
Hey Dr Hook,

Thanks for responding to my initial inquiry, the comments were most helpful.  Just to update, I had resumed unprotected sex with my significant other roughly 4-5 days after completing my course of doxycycline (we had sex once before the epididymitis and after the csw encounter). Since that time I was tested once, a month ago, with negative results. The swollen and tender testicle has gone away, however I notice that occasionally the left testicle will get hard and uncomfortable (more noticably after masturbation or penile stimulation). The discomfort seems to come from under the testicle which I presume is the area where the epididymis resides. Usually this is accompanied by soreness in the groin region. It seems that having proper underwear support helps in preventing soreness or discomfort. I have not noticed any discharge or burning during urination.

Just a couple of follow up questions:

1.  In regards to the antibiotics I took, roughly how long would it be effective in my system?
2.  In cases of epididymitis without obvious urethritis, does the std bacteria remain in the urethra and is thus detectable via urine test?
3.  With epididymitis resulting from an std, does urethritis/discharge typically go away, or is it normally occurring at the same time as the epididymitis?

I'm going to get another std test in a week just to be on the safe side.  I realize that my current issues are not likely due to an std due to the lack of urethritis, discharge, and prior tests.  I've read a little bit about prostatitis and cpps and may follow up on this with my gp.  Thanks again for your time.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum. I will try to help.  The exposure that you describe was low risk for STI.  IN addition to gonorrhea, oral organisms can be introduced into the urethra and sometimes their presence can cause inflammation and signs of irritation.   If you did have epididymitis from the oral sex you received, you are the first such person I have encountered with this situation.  It is possible however.  Your varicoele may also predispose you to infections and similar problems.  One additional unusual aspect of your situation is that you did not have penile discharge accompanying your possible epididymitis.  the good news here is that you are feeling better.

In answer to your specific questions:
1)  How reliable are the urine tests I took?  How is the sensitivity of naat tests in regards to midstream catch?  Sensitivity for short time gap between urination + volume of urine?
Currently available NAATs for gonorrhea and chlamydia are the most sensitive tets for these infections we have ever had and while you did not collect your first test in optimal fashion, the combinatin of your two negative tests does effectively rule out the possiblity of gonorrhea or chlamydia.  I would not worry about thes problems further.

2)  Would I have elevated wbc if I had an std?
You would have had WBCs in your urine but not necessarily an elevated WBC in your blood.

3)  Do I need to have my regular partner tested or can I safely assume this was not std related?
There is no indication here for your partner to be treated or tested.  Your testing rules out this need.

4)  What other possibilities could it be?  Seems it should be bacterial since the antibiotics seemed to have helped?
As I mentioned above, this may be related to oral organisms introduced into your urethra, be related to your varicocoele, or be something else entirely.  

I hope these comments are helpful.  As I said above, the good news is that you are feeling better.  EWH


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