Slight burning w/ penis

[gwt0199]

Hi Doc,

I'll spare you the "this was the worst decision of my life" bit, although truly it was.  I was in Sao Paulo on business, had much too much to drink and was persuaded by a sex worker on the corner next to my hotel to go upstairs for some "fun."  It's really hard to write that--it was the dumbest thing I've ever done.  We had protected sex twice, she gave me protected oral sex once, and--dumbest of all--we had an unprotected 69.  

Anway that was nine days ago.  Yesterday I started to feel some slight tingling/burning in my penis.  It didn't hurt to urinate, just a bit of tingling.  Today it's the same story.  Perhaps a little worse in magnitude, not much though.  

I've read through all of the herpes and gonorrea FAQs and symptoms and of course, at this point, that is what I am most scared of.  I haven't had any discharge of any sort.  I plan on getting tested on Monday for definitive word.

To make matters inifinitely worse, my wife is six months pregnant, and word of this will destroy her.  We've been married 13 years with straight rabid devotion until now.

Based on what you've read, are there any precautions I need to take to avoid passing whatever I might have to her (and the baby)?  We have not had sex (oral or other) since she started to show 3 months ago--she was against the idea of it--so I'm not much worried on that front.  I haven't had any signs of any herpes pimples or warts on my penis or lips, but should I avoid kissing her?  Any thoughts on what this could be?  What should I do?  Thanks.

[gwt0199]

Thanks Doctor.

Interestingly I went to a clinic today and they put a swab in my penis, examined the results under a microscope and were still inconclusive.  They also took some blood and said they would have results within a week.  They didn't prescribe any medication however as you suggested they might.  The pain remains about the same with no other side effects aside from an elevated amount of itching, but based on everything I've read, I'm discounting that as psycologicial or over-analysis.

[gwt0199]

Thanks Doctor.  I'll definitely follow your advice.

While I've read a great deal about Gonorrhea and know that it can be cured and treated, I can't find as much on NGU.  Is this a lif-long affliction or something that can be treated and hopefully cured?

Apologies ahead of time if I am missing infomration already available on the site.

And one last question, is it possible that it could be a warning sign fort herpes?  I've read that affected areas are often tender or itchy before lesions appear.

Thanks again.

[monkeyflower]

I'm just going to address the sexuality part of your post...

"We have not had sex (oral or other) since she started to show 3 months ago--she was against the idea of it."

I don't know, maybe she's creeped out by the idea of having sex with a fetus inside her. That happens sometimes. Maybe there are other reasons, like she feels sick, or fat, or tired, or whatever. But from your comment, I get the idea that for her, mommy = asexual, and that doesn't exactly bode well for your sex life after pregnancy, either.

I don't mean to scare you, but if sex is even a teeny bit important to you, you probably want to address this issue NOW. It's not going to get better on its own, and it'll probably get worse. I posted on the gyn board a few days ago about maintaining sexual desire after pregnancy. That was a different situation, but the basic info is the same. If this really is a problem for you and you can't resolve it between you, I think it'd be a good idea to see a sex therapist together--and if she won't go, you should go anyway.

[H. Hunter Handsfield, M.D.]

NGU is easily treated and has few if any long term medical consequences.  Complications are common with chlamydia, but mostly in women--and chlamydia isn't an issue from oral sex.

Herpes is not likely.  When it infects the urethra, the pain usually is excrutiating; and usually there are overt blisters and sores.

[H. Hunter Handsfield, M.D.]

You might have nothing at all.  However, the timing is right for the early symptoms of nongonococcal urethritis (NGU)--although abnormal urethral discharge usually would be present as well.  Gonorrhea is less likely; symptoms usually begin within 4-5 days and discharge usually is prominent.  Given protected vaginal but unprotected oral, if you have NGU, most likely testing for common STDs (chlamydia etc) will be negative; many orally acquired cases probably are due to entirely normal oral bacteria that cause inflammation in the urethra. In that case, there probably is little risk to your wife; nonchlamydial NGU has never been linked to any imortant health problem in women. Herpes or another virus (e.g., adenovirus) are possible but less likely.

You should see a health care provider, preferably one with considerable STD experience.  If you don't have that confidence about your primary care provider, your local health department STD clinic would be a good choice.  You should be tested for gonorrhea and chlamydia (even though both are unlikely).  Even if no urethritis can be clearly documented, most likely the provider would recommend treatment, most likely with azithromycin (1.0 gram, single dose) and a cephalosporin antibiotic against gonorrhea, such as cefpodoxime or ceftriaxone (by injection).

It would be wise to avoid sex with your wife until you are evaluated professionally and perhaps treated.  But in the absence of oral symptoms, there is no reason to worry about an oral infection or kissing.

Good luck--  HHH, MD