Sore testicles two days after unprotected oral sex

[sikman]

I've posted this on the forum but would like an an answer from a specialist.. Two weeks ago i had unprotected insertive and receptive oral sex and a brief frotting session (stupid i know!) with a transsexual escort, I climaxed but he/she did not. Literally two days later I noticed pain in my testicles. I did not and still do not have any symptoms that would be a red flag for chlamydia or gonorrhea. On the day i felt the testicle pain, I freaked out and took a dose of Suprax which was accidentally prescribed to me when I contracted chlamydia (3 months ago). Four days after the encounter, i went to get tested for chlamydia and gonorrhea but both came back negative. Could i have received a false negative for chlamydia because it was too early? Also not sure if the suprax would have caused ghonereah to go undetected if I did have it. Nonetheless two weeks have passed and i still have this pain in my testicles. It's not overly painful nor tender to the touch. The pain also seems to be more noticeable when I think about the possibility of contracting an STD. One thing that had me worried was that my testis were red on the third day but went away the next day. There are no sores anywhere in my penis or scrotum.

I couldn't find anything on the internet that would link any STD to having testicle pain as an early symptom (2 days after exposure). Also if for some reason I did have gonorrhea the suprax should have taken care of it. What else do you think I should test for? would you recommend i get retested for chlamydia and gonorrhea since i tested so early?
Thank you so much in advance

extra note - I sent a text to the escort and assured me that he/she tested the weekend before and was clean and promised i'd be fine, also said he/she normally does not do that with clients. Though i take that with a grain of salt since she probably didn't do a throat culture.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

I am drawn first to 'I couldn't find anything on the internet that would link any STD to having testicle pain as an early symptom (2 days after exposure)."  I agree.  No STD is a likely cause of such a symptom.

Second, oral sex is safe sex.  Not totally risk free, but much safer than unprotected vaginal or anal sex.  

Cefixime (Suprax) treatment could make a gonorrhea test negative -- but only because it cures gonorrhea with almost 100% reliability.  So whether or not you had gonorrhea to start, you don't have it now.  (And I'm quite sure you never did.  Gonorrhea without obvious urethral discharge is rare.)  The chlamydia tests are quite reliable at 4 days, as far as we know.  There's a bit of uncertainty about this, and no research has directly addressed how soon the tests become positive.  But the negative test is almost certainly reliable.  And you are correct that oral sex rarely if ever transmits chlamydia.  The organism doesn't take hold very well in the mouth or throat, so typically there is no chlamydia that can be transmitted from mouth to penis.  Between that fact plus the negative test, you can be certain you did not contract chlamydia.

I am inclined to agree with the opinion you had on the community forum -- that your testicular pain is psychogenic.  Whether that's the explanation or not, for sure no STD is the cause.  If it continues, see a health care provider about it. But you can be sure that no STD will turn up.

I hope this helps.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

The canker sore might have elevated the risk of HIV, but still the chance of transmission from a single oral exposure is under one in several thousand -- and even that assumes your partner had HIV, which most likely isn't the case. A negative antibody test at 24 days is probably 80% reliable. For complete reassurance have another test 6-8 weeks after the event.  Or find a lab that has started to offer the newly approved (in the US) combo test for both HIV antibody and p24 antigen, which is virtually 100% reliable by 4 weeks.  Spend a few minutes scanning the HIV forum for hundreds of other discussions along these lines.

[sikman]

Dr Handsfield,

I can post a new topic if necessary but I did have a couple of more questions that are relevant to original posting. As posted above, I performed recepitve fellatio sex with the transexual escort. I was just remembering that I had two canker sores inside my lower lip part of my mouth that day. They were starting to heal, but were still open. Again the transexual escort did not ejaculate but there was precum. I took a hiv rapid test (blood from finger) 24 days after exposure to calm my worries and it came back negative. Is that enough time to relax about it or is it not conclusive? Also do canker sore increase the risk of infection?

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  You're welcome.  Glad to help.

[sikman]

Thank you so much Dr. Handsfieled. Hearing this from an expert certainly is helpful. I can believe that it's psychological because of the fact that it kicks in as I'm thinking "what if" and I can kind of feel my entire lower torso tense. I'll drink some wine in celebration to convince my brain that the rush is over! You'd think i would have learned the first time.

Cheers!