Stressed male

[Johnlde]

Hi,
Here is my situation:

July 7th: Protected exposure with female I met in bar (big mistake). Protected from start to finish although some concerns after removal of condom and contact with secretions.

July 15th: Tested -ve Gon/Chla but +ve Ureaplasma. NAAT PCR Multiplex Urine test
Read online that Ureaplasma was part of normal bacteria and therefore nothing to act on in absence of symptoms.

Early August: General groin pain.
Panicked, believing that previous test was false -ve as too early/not waiting enough time after exposure
August 20th: Re-tested - all negative - felt relieved at this point

Diagnosed with Epididymitis based on tender epididymis on examination.

Now highly stressed as in a monogamous relationship and was hoping I could put it behind me following two negative tests.

My questions:
1) Could I have had two false negatives? Or tested too early for the first one and too late on the second? None of the other symptoms associated with STD.
2) Could ureaplasma cause epididymitis? Note it vanished on the second test. I have read that stress can affect this bacteria.
3) PLEASE REMOVE THIS - TOO SPECIFIC TO MY CIRCUMSTANCES - if HHH, MD agrees. Also irrelevant to STDS.
4) Should I get re-tested?
5) Two months later, should I get tested for HIV/Syphilis with no symptoms present?

Thanks in advance

[H. Hunter Handsfield, M.D.]

I need a lot more detail to help decide whether your wife actually has genital herpes.  The "pubic area" usually means areas of pubic hair, but that is an unusual location for herpes.  To know whether she has herpes, lab testing is necessary.

It is common for genital HSV-2 to be passed asymptomatically.  You could have a blood test to see if you have HSV-2 and could have infected your wife.  If you do, it is probably not from your July 7 sexual exposure, but sometime before that.  If you have herpes, it is not the cause of the symptoms you have described.  It is definitely possible to have herpes for several years without symptoms, and then have an outbreak.

You misunderstand herpes prodrome, which does not cause the kind of pains you have had.

This whole business about herpes is getting well beyond the initial question you asked.  If you would like more advice about it, you'll need to start a new thread.  However, I would recommend you not do that until you have been tested (if you decide to do that), and ideally your wife has also had some lab tests to determine whether or not she actually has genital herpes.

So that will end this thread.  Take care.

[Johnlde]

Physical observation found small blisters in pubic area.

My question is whether it is conceivable to catch the virus asymptomatically and pass it on (I understand this is common)?  I think back to my pains and wonder if this could have been a form of prodrome.

Or to have HSV 2 for many years before first breakout?

[H. Hunter Handsfield, M.D.]

I agree it is unlikely your wife's apparent genital herpes is related to your sexual contact in July and I see no need for any futher STD testing. But if you can provide more detail about her diagnosis, we can discuss it further.  What symptoms did she have?  Exactly what testing was done to diagnose her genital herpes?  

[Johnlde]

Dear Dr,

Just to update and close the thread off for anyone who may review.

HIV test negative after 9 weeks
Syphilis VDRL negative after 9 weeks (assume reliable?)

Partner has recently been diagnosed on examination with suspected genital herpes. There is of course the thought that I could have passed it asymptomatically. Should I test after 12 weeks?

Confused at this latest development

Thanks

[H. Hunter Handsfield, M.D.]

Your tests indeed were reliable; you can be 100% confident you did not have gonorreha or chlamyda.  Anything else that conceivably could have caused some of your symptoms is pretty much harmless.  For example, there are no known long term health consequences for non-chlamydial NGU, ureaplasma, and so on -- either for affected men or their future sex partners.

Do your best to separate your guilt or shame over a sexual choice you regret with its potential health risks.  They aren't the same.  Deal with the former as you need to, but you can move on without concern about any adverse health outcomes.

Thanks for the thanks about the forum.  Take care and stay safe.

[Johnlde]

Thanks Dr
Much appreciated.

So to clarify - my urine tests were reliable and (two) false negatives unlikely? Also, pain in the groin over a month is not indicative of STI (no discharge, fever etc)?

I will, for completeness, test for HIV, syphilis and maybe Herpes. But is it fair to say that in the absence of symptoms, given my protected exposure, 2 months on, I can rest slightly easier? I have read that groin pain without sores can be an early sign. FYI: I have HSV1 and have had outbreaks on lip before.

My rational side says that if this type of exposure was as dangerous as my anxiety is high, STIs would be wider spread in the world.  I do need to manage my guilt and anxiety.

This is a great resource.

Thank you.

[H. Hunter Handsfield, M.D.]

Welcome to the forum. Thanks for your question.

Your choice to have sex with a bar pick-up indeed was an unsafe one.  But within that context, you did it with maximum safety.  Condoms work, and slight contact with genital secretions after removing a condom carries little or no risk -- and certainly no risk for a urethral infection that could explain your symptoms.

Your research on Ureaplasma urealyticum turned up exactly the right answer:  it's normal in the genital tract and doesn't explain any of your symptoms.  You undoubtedly had it before your July exposure.

Your symptoms are most typical of genitally focused anxiety, which causes pain in much the same way that tension causes headaches.  Specifically, it tenses the pelvic muscles, causing pain that usually is vague and difficult to precisely locate, but is usually described as involving the groin, testicles, lower abdomen, and sometimes the rectal area.  For more information, google "chronic pelvic pain syndrome" (there's an excellent Wikipedia article, and the information from the Stanford University Dept of Urology also is very good).  Genitally focused anxiety is pretty much the same thing, occurring more acutely, usually after a sexual exposure that is causing guilt, anxiety, regret, etc.  (Sound familiar?)

It's difficult to critique an expert physician after direct examination -- but just having a little testicular tenderness is generally not considred sufficient to make a definitive diagnosis of epidiymitis.  My guess is that your urologist treated you for possible epididymitis as a precaution, without actually having a high degree of suspicion.  When there is a high degree of suspicion, usually other tests are done, such as a testicular ultrasound exam.  But even if that diagnosis was firm, I cannot attribute it to your July sexual exposure.

To your specific questions:

1) I don't think any infection was missed by your tests.  You just didn't have any STD.

2) Ureaplasma is not known to cause epididymitis.  As noted above, I'm skeptical you had epididymitis at all.

3) A hernia is an entirely different anatomic issue.  It can't cause epididymitis.

4) I see no need for additional STD testing.

5) HIV and syphilis blood tests are routine whenever someone is evaluated for any STD.  Having had the gonorrhea and chlamydia tests, it makes sense.  But it's optional -- given the condom protection, plus the rarity of heterosexual transmission of either HIV or syphilis in the US, it's a soft call, and there is no way either of these explains any of your symptoms.  But if negative results would help you move on, by all means do it.

I hope these comments have helped.  Best wishes--  HHH, MD