STDs Expert Forum
Unprotected Oral
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Unprotected Oral

I received unprotected oral on 1/30. The following day I started to urethritis and just general pain in my groin, slight fever and chills. No discharge but a wet hypersensitive feeling on the tip of my penis.

I was tested 2/1 urine and blood all negative (I know it was too early) Dr. wrote a script for 500mg Suprax and 7 days 100mg doxycycline twice a day as a preventative measure.

I made an apt with a different Dr. Feb 6th as the pain hadn't subsided and spread to my testicles. I've had epididymitis before and that's what the Dr. decided I had. He really wasn't concerned about and STD risk from the unprotected oral.  Gave me 500mg ciprofloxacin twice daily for 10 day.

Feb 13th ultrasound done for epididymitis. Impression: slightly less vascular flow and more striated heterongeneous echotexture. No mass. Could relate to hypovascular orchities. No varicosities or hydrocele. Small cyst/sperrmatocele on left testicle.

2/20 retested (4 days after completing cipro) for Gonorrhea and chlamydia (requested trich and NGU) they could do trich from one swap and didn't tell me about NGU... Came back negative. The GP didn't see any lesions to raise concerns and the ultrasound didn't alarm him. Refered to urologist, apt on 3/4.

I still have some discomfort in my pubic area (right side) and warm tingling sensation on my shaft and glads of penis. Do I have an STD? I have a regular partner that I need to protect from STD's and have been abstaining from contact since this encounter.


239123_tn?1267651214
Welcome to the forum.

I am skeptical you have (or had) any STD from the exposure described, and I'm also inclined to doubt you had epididymitis.  I'm guessing you told your doctor about your past epididymitis and your current symptoms, and s/he went along with that possibility -- rather than clearly diagnosing it as epididymitis.

First, oral sex is low risk for STDs -- not zero risk, but quite low.  Second, your symptoms began too soon; no STD can start to cause urethritis the next day.  Third, your symptoms are not typical for urethritis; I don't buy a "wet feeling" without visible discharge, nor is a "hypersensitive" feeling of the sort you describe.  Fourth, the only STDs that cause sexually acquired epididymitis are gonorrhea and chlamydia, and you tested negative for both. (Your test was not too early to be reliable; 2 days after exposure is fine, especially for gonorrhea, and chlamydia is almost never transmitted by oral sex.)  Fifth, epididymitis of any cause -- sexually transmitted or not -- is exceedingly unlikely to develop following the antibiotics you had.  Finally, the persistence of symptoms despite all the antibiotics you have had is additional evidence against any infection as the cause.

I'm pretty confident you have been suffering from the chronic pelvic pain syndrome, which often is the result of genitally focused anxiety after a regretted sexual choice.  For more information, google CPPS (spell it out) and start your reading with the excellent Wikipedia article and the information you can find from the Stanford University dept of Urology.  If I'm right, this is good news, because it would mean you have nothing that will ever harm you or a future sex partner.

If your symptoms continue, you should follow through with the referral to a urologist.  However, you should expect that nothing serious will be found and that no more treatment will be necessary.  In the meantime, I definitely feel you should not abstain from sex.  If you have been doing that, I recommend you resume sex with your partner.  In fact, sexual release is felt to often be beneficial for symptoms like yours, and you have nothing that will harm your partner.

I hope these comments are helpful.  Best wishes--  HHH, MD
8 Comments
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Avatar_m_tn
Do you think having the swap test done at 3 weeks and only 4 days after completing Cipro is conclusive, or could the test have been skewed due to all the antibiotics?

Neither Suprax, Cipro, or Doxycycline are listed as recommended treatments for gonorrhea based on the CDC website. Yet you (and my GP) seem so confident that it's not gonorrhea. I want to trust medical science but the onset of my symptoms after this encounter just won't let me believe it's not related.

What about NGU (mycoplasma or ureaplasma), or Trich? I wasn't tested for  these.

The epididymitis i experienced was much like the first time which was of non sexual causes. The pain and swelling have subsided but the dull ache persist after treatment with the Cipro.

I have occasional staining pain in my shaft, testies, and glands. There is just a dull ache/warm burning to my genitals (like i experienced trauma, but didn't). Seems to occur more after urination. I haven't had much of a sex drive since this. In fact I haven't had an erection to even have sex.  I also have developed an anal itch and swelling/redness and burning over the past few days. Could these be hemorrhoids? Would CPPS cause this?

I read up on CPPS and that may be a possibility. I will be following up with the the Urologist and will share the results.
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Avatar_m_tn
I think the wet hypersensitive feeling on the tip of my penis is being caused by an inflamed meatus. The wetness is from not voiding all of the urine from my urethra. I masturbated without any reduction in my symptoms. If fact, the semen in my urethra seemed to irritate it more.

I've read this could be a HSV sign as well as the Anal itching. I haven't had any visual lesions. Do you think this could be HSV?  

During the swab I was billed for a test for candida and vaginal infection so I assume it's not either of those. When they called my resutls back they said it was negative for gonorrhea and chlamydia. No mention of anything else...

What else would cause an inflamed meatus? The first urine test did show 250 glucose in urine but the blood test and following urine test ruled out diabetes.

Do you think having the swap test done at 3 weeks and only 4 days after completing Cipro is conclusive, or could the test have been skewed due to all the antibiotics?

What about NGU (mycoplasma or ureaplasma), or Trich? I wasn't tested for  these.
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239123_tn?1267651214
Based on all the information you have provided, including the additional info in these follow-up comments, I remain reasonably confident you have no STD.

The swab test results for gonorrhea and chlamydia are conclusive.  Antibiotics generally do not simply suppress a positive test result.  The make tests negative by curing the infection.  Since cipro is usually effective against chlamydia and gonorrhea, the negative result shows you were definitely not infected at the time you were tested.  There is no way to know for certain whether you were never infected or had been infected and cured.

HSV causes symptoms only at the infected site.  Anal itching is not a herpes symptom if the anus wasn't exposed.

I'm reasonably confident you have no urethritis or meatitis, in which case NGU is not an issue and trich rarely causes symptoms in men -- and can't be acquired by oral sex.  Probably neither can the mycoplasmas or ureaplasma.  As for herpes, when it causes urethritis/meatitis, it is generally more severe than you describe, and would always clear up within a week or two; persisting symptoms this long can't be herpes.

Follow through on your planned visit to the urologist.  My guess is that the evaluation will confirm no objective evidence of urethral inflammation.  In any case, follow his or her advice about further evaluation or treatment.  There's nothing more this forum can do.
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Avatar_m_tn
Thank you for your comments Dr. I appreciate your input.

Urologist diagnosed me with prostatitis and wrote a script for month long antibiotic and alpha blocker. I realize the the symptoms of CPPS and prostatitis can overlap and may even be the same.

They are also testing for ureaplasma should have the results latter this week. He said they are fairly common and could have been acquired years ago and can just flare up and cause issues like i'm having.

I've also read your comments about an Australian study (in 2006) about NGU which seems contradictory to your comments in this thread.

The user forum suggested a fungal issue but two different Dr.'s haven't seen anything abnormal when doing a visual inspection.

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239123_tn?1267651214
I'm inclined to doubt I have contradicted myself and suspect you misinterpreted something either in that editorial or in my comments here.
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Avatar_m_tn
Dr. One more question I have hoping you could answer, please!

Is it likely that my symptoms are related to HPV/ genital warts? I haven't had any improvements going on 8 weeks now. I have a follow up with the urologist next week would contacting a dermitogist be a better choice in you expert opinion?
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239123_tn?1267651214
HPV and warts don't cause such symptoms.  I suggest you stick the the urologist; I don't think a dermatologist would have anything useful to offer.

That wil end this thread.  I won't have any more comments or advice.
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