STI or UTI?

[claren39]

I am a 26 year old male.  Earlier this year, I was diagnosed with Chlamydia and was treated.  I was tested later and it was determined that everything had cleared up.  Approximately three weeks ago, I engaged in protected anal sex, but stopped after I noticed the young lady was bleeding.  She removed my condom with a tissue.  I also wiped my penis off.  She put on another condom and gave me protected oral until the last few minutes when she gave a hand job without protection.

Shortly after that I began to experience symptoms similar to the first time I had chlamydia - mostly an itchy urethra and frequent urge to urinate.  I also have felt some discomfort in urination but I wouldn't call it burning.  I really am worried because I thought I was being safe.  I am even more worried because approximately two weeks ago, I had unprotected sex with my girlfriend.  

One other note, when my girlfriend and I had sex, it was after she had been working out.  We rested a bit (three hours) and had sex again.  

Is this and STI or UTI?

[claren39]

Doc, I just wanted to let you know that I received my test results back and I am clear of all STD's.  I"m going to have to see a urologist it appears to handle what I think is urethritis.  Again, thaks for your comments and feedback.

[Edward W Hook, MD]

Certainly less likely to be a new STI.  Wait for your test results and act assordingly.   last response.  EWH

[claren39]

Last bit of clarification.  Am I undertanding your statements to mean that if the condom was used properly, it is less likely to be an STD?  FYI, the frequent urge to urinate has subsided and I'm not feeling much of anything when I do urinate; however, it is the urethra that is still bothersome.  I have seen no discharge.  Could all of this be just a bacterial infection from E-Coli or someng else?  I have been tested with results due tomorrow or Tuesday.  I should just hold my horses, but the anxiety that I might have infected my partner is killing me. In an effort to tend to my anxiety, I have attempted to contact the sex worker and have had no response. Thanks for your assistance and this service that you provide.

[Edward W Hook, MD]

The clarification helps and makes re-infection a bit less likely.  In men under age 30, NGU is the most common cause of urethritis by far but not the only cause.   Occasionally other illnesses/processes can yield similar symptoms but those are best diagnosed in the context of careful examination and the swab test mentioned above.  

FYI, for persons with nonchlamydial NGU, recommended treatment is erythromycin for seven days, along with a single dose of metronidazole.  The details are available in the CDC STD Treatment Guidelines which are readily available to your health care provider.  EWH

[claren39]

Thanks for your comments.  The first person was not a previous partner and was a commercial sex worker.  The second was a previous partner and had been tested before we had unprotected sex.  Was it possible to receive the non-chlamydial ngu from anything other than sex (might be reaching)?  Also, should I be worried about anything else based on what I've shared?

[Edward W Hook, MD]

One of the reasons that chlamydial infections are so common is that the symptoms, if present at all, are mild and can be attributed to other causes.  You appear to be a careful observer and have recently noticed symptoms reminiscent of which you had chlamydial infection.  That suggests to me that you need to be evaluated again.  You could have chlamydia again, you could have non-chlamydial nongonococcal urethritis requiring different treatment, or you could have something else.  The best way to have this evaluated is by a knowledgeable health care  provider.  A few additional comments my help you in your interactions with your health care provider.

As I understand it, in the past month you have had at least two partners, the one mentioned in the 1rst paragraph and your girlfriend.  Is this correct?  Are they both previous partners?  If so, were both treated for chlamydia when you were diagnosed and before you had sex with them again?  All of these questions are leading towards, could you have been re-infected by an untreated, perhaps asymptomatic partner.  It is very common.

If you partners were all treated and your exposure three weeks ago was a new partner, could the condom have failed to protect you?  Yes.  Condoms provide excellent but not quite 100% protection, usually because folks are not using them correctly.  It sounds as though you are using them well and I doubt that these symptoms represent re-infection through condom failure.

Could it be a UTI--unlikely.  UTIs in 26 YO men are very, very rare unless there is something else contributing to it.

Could it be anxiety.  Yes, that too plays into things and could be present as well.  As you note, the symptoms are mild and there are no signs.

Bottom line, you need to be evaluated, to have a urethral gram stain of a specimen taken at least two hours after the last time you voided, and probable repeat tests for chlamydia, etc.  Hope this helps.  EWH