Stupid mistake, possible infection...

[jvrg1974]

Hi Dr.

About two weeks ago I stupidly engaged in unprotected oral sex with another man. I both received and gave with ejaculation. He assured me that he was clean and disease free but I have the following:

A dull ache in my right testicle. It is not tender to the touch, it feels as if the ache is inside. It is always worse as a go about my day (i.e. when I wake up there is little or no discomfort). It does not appear swollen to my eye, but in the last day the color on that side of the scrotum has changed a bit. The skin around that testicle seems lighter than before.

I have no pain during urination and no discharge. Just this annoying ache that won't go away. It has been there for about 5 days.

I went to an urgent care center and complained about the testicle (I didn't mention anything about STDs). The doctor looked at it and touched it and checked it for tersion(sp?) hernia or epiditimis. Didn't find anything wrong. They took a urine test and saw no bacteria in the urine under a microscope. The urine analysis showed no white or red blood cells. There were some crystals and the ketones were a bit high. She didn't prescribe any antibiotics due to not seeing bacteria in the urine and the testicle not being painful to the touch.

The doctor said she was going to send the urine for a culture just to be safe, but that she didn't suspect they would find anything. If I didn't hear from them I am to call for the results within 2-3 days (tomorrow)

I was wondering what were the chances that this could be gonorrhea or some similar ailment.

Also, am I at risk for any other STDs?  Would the urine culture catch STDs? Would they have seen the bacteria in the urine under a microscope?

Sorry for the barrage. I appreciate your help.

[H. Hunter Handsfield, M.D.]

The testicular pain conceivably could be epididymitis, but your doctor obviously thought of that possibility and doesn't believe it is likely.  From your description, I also would not think it very likely; epididimitis generally causes overt swelling and marked tenderness of the testicle to touching.  But you need to follow up with your doctor when the final lab tests are available.

The only STD that one acquires from oral sex that is likely to cause epididymitis is gonorrhea, which can be transmitted from throat to penis.  However, it seems unlikely your partner had oral gonorrhea.  Even more important, when gonorrhea causes epididymitis, it almost always first causes overt urethritis -- that is, you would have had discharge of pus or mucus from the penis, probably with painful urination, typically starting 2-5 days after the exposure.  Chlamydia is the other common cause of sexually acquired epididymitis, but oral infection is rare and therefore is not normally transmitted by oral sex.

Routine urinalysis and bacteria testing doesn't detect STDs.  However, your doctor probably understands that STDs commonly cause epididiymitis and my guess is she ordered gonorrhea and chlamydia tests on you.  But you'll need to ask to be sure.  Of course, it would have been best for you to describe your sexual exposures to her, in which case she would known for sure to include those tests -- but for the reasons stated above, it probably won't make much difference if she didn't do that, since I doubt you have an STD or any other infection from the oral sex event.

Bottom line:  I doubt anything is seriously wrong here.  Follow up with your doc.  If final test results are negative and you don't develop more typical STD symptoms, you can rest easy.

Best wishes--  HHH, MD

[jvrg1974]

Thank you for the response.

Just for clarification: Is it accurate to say that gonorrhea doesn't cause epdidymitis until it travels up the urethra and gets to the testicles? I ask because when you look up symptoms online they list testicle swelling/pain but it doesn't provide much of a context. Some sites also confuse because they say gonorrhea can be asymptomatic. I guess you are saying that it isn't likely for the disease to be asymptomatic at the start and then show symptoms when it progresses up the urinary tract. Correct?

I hope you are right that the doc at the urgent care center would have ordered STD tests. She did ask me if I had discharge or noticed any lesions on my penis, which leads me to believe that STDs were on her mind.

Thanks again for your help.

[H. Hunter Handsfield, M.D.]

"Just for clarification: Is it accurate to say that gonorrhea doesn't cause epdidymitis until it travels up the urethra and gets to the testicles?"  Yes.

Gonorrhea indeed can be asymptomatic in men.  As it happens, I am the researcher who did the initial research on asymptomatic urethral infection, more than 35 years ago.  However, it is rare -- much less common than it was in the 1970s, for reasons that are too complex to explain briefly.  But even in the old days, I never saw a case of epididymitis due to gonorrhea in which the urethal infection was asymnptomatic.