Testicular Pain

[stupid76]

OK here I go:
May 27th I received unprotected oral sex for maybe a few minutes at most.  Around June 8th my lower back started to hurt, and as of June 13th my left testicle has been in pain.  I have been taking anti inflam. for pain, but concerned that I contracted either non chlamydial NGU or Gonorreah.  I understand from reading posts that these are the 2 bacterial infections one can catch from receiving oral sex?  There are no other symptoms such as fluid from urethral opening or spotting on underwear, however one week ago after having sex with my wife she spotted the sheets a few days before her period, so I was worried that i contracted then infected her.

If this is a NGU do symptoms ever present with just testicular pain
And same for Gonorreah infection?

I also read that chlamydia is rare from oral, but i read that back pain is often a symptom of chlamydial infections could this be from chlamydia?

[Edward W Hook, MD]

Testicular pain as a consequence of STD is almost always a problem called epididymitis in which it is not the testicle as much as the epididymis which to the long coiled tube which goes from the testicle to the penile urethra which gets infected.  In addition, back pain as part of epididymitis is quite unusual.  

You statements about NGU and gonorrhea being the major consequences of oral sex are correct.  Epididymitis following them occurs but is rare and typically does have urethral (penile) discharge which accompanies it.  

The back pain which is associated with chlamydial infection is a chromic, not acute problem and part of a very, very rare syndrome called reactive arthritis.

I would suggest the following:
1.  You should have the beginning portion of a urine specimen or a swab specimen taken from the penis checked for white blood cells.  If none are present you do not need to worry about NGU, gonorrhea or epididymitis and should seek some other cause of your discomfort.
2.  If white blood cells are present, epididymitis may be present but some other sort of problem is more likely.  Non-STD problems such as prostatitis, a kidney infection of kidney stones should be considered.

My suspicion, given both your symptoms and the circumstances, is that this is unlikely to be an STD which you acquired from a brief episode of oral sex.  Hope these comments help.  EWH

[stupid76]

The city std clinic is by appointment only in cincinnati, and you have to call at a certain time to get an appointment a week later, unbeliveable.  I do have an appt tomorrow at planned parenthood.

Just to ease my concerns until then:
Does the timetable i outlined above concur with either NGU or gonn.?
Could one lead with testicular pain and trail with other symptoms such as redness around the tip of my penis which i now have?  I am wondering if i will have discharge next?

[Edward W Hook, MD]

How frustrating.  You might call the Health Department.  They should have a local STD clinic which can provide these services, typically on a walk-in or close to it basis, at little or no cost.  EWH

[stupid76]

General commentary:
I went to an urgent care facility in a metro area here with over 2MM people, and the doctor refused to test my urine for WBC and refused testing for gonn. or chlamydia via urine.  Since i had no discharge he said he could not do the swab test.
He did offer to pre treat me for both which I refused.  It is amazing that a facility that says the do STD testing will not test you but will pump you full of drugs.
I will try planned parenthood next but they will not test men with symptoms.

[Edward W Hook, MD]

Straight to your follow-up questions:
1.  If you have not been tested for gonorrhea and chlamydia already you should be, in addition to the test for WBCs.  As I already mentioned, the chance that you got chlamydia from receipt of oral sex is close to zero.
2.  No clear connection at this time.  Projection of your concerns onto any health issues your wife may be having is not productive at his time.   Rather than hypothesize, get tested.
3.  The timeline makes it less likely that your testicular pain is related although not impossible.  That's the reason you need to be tested (see a theme developing here?)
4.  No effect of NSAIDs
5.  The test for WBCs is best if you have not voided for at least an hour.  Two hours is better. EWH

[stupid76]

Doc:

Just a follow up and I appreciate your comments above, I will see a doctor today for a urine sample, but should i be actually tested for Chlam or gonn or just the wbc from the urine sample?

Also, and thoughts as a connection between my testicle pain and my wife spotting both after sex before her period, and after her period in her urine, last night?

Also, based on my timeline, do you think it is unlikely that this is caused by  the incident back in May? In other words if this is caused by NGU or Gonn. is it likely that no discharge occured and testicle pain 2 1/2 weeks after oral encounter?

I mentioned that I am taking a NSAID, will that affect the WBC?
Finally, should I try to not urinate a certain amount of time before the test, for the test to be accurate?