What Can It Be

[lorfig]

I'm a 35 year old divorced male, who has been in monogamous relationship with a good womanWomen's way for 4 years.  She has been hinting lately she would like to marry.  I've only been with her and my ex-wife for the past 18 years, so my history is just that.

Five weeks ago I did something quite stupid; I met another man my age on line in (NJ area) he gave me unprotected oral  for 2-3 minutes and I then ejaculated into a towel, not his mouth.  I was stunned, disgusted and quickly left the place we were and immediately washed my privates vigorously with hot water and soap. After twelve days I saw no symptoms whatsoever and believe me I checked myself several times each day.  Then the next, I noticed the tip of my penis felt raw and swollen around the urethra lips, but no burning or discharge.  No fever, blotches, redness visible either.  Two days later (two weeks after encounter) , I spent $200, visited a clinic for a blood and urine analysis.  My test were for chlamydia, gonnorreah and syphillis; that was what the counselor at the Quest lab recommended and all came back negative.

In the three weeks since, my situation has not improved and actually gotten a little worse.  There is a small ring of swelling around the opening of my uretha; it is a little swollen and has become quite irritated.  There is not much discoloration, but one side is swelled up more than the other. One week ago I went to my urologist, took urine test (negative) and upon examining he prescribed an anti fungal, cortisone cream to apply threeX a day.  He said if it does not improve to come back and get full std panel.  Cream only irritates it more.  Front page of today's paper talks about explosion of syphillis outbreak.  I'm now terrified and want to get another test asap.  What are the chances I caught this and how much longer should I wait to test.  Also, what other tests should I have?

I'm avoiding sex with my gf, but can't put her off much longer...please help asap.

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[lorfig]

Test called back in negative.  My paranoia has subsided and I feel confident moving forward and putting this incident behind me.  I hope someone else in a similar sitation reads this and it helps them.

[lorfig]

Thank you for putting those statistics up; it puts the odds in clear perspecitve.  As this encounter was anonymous, the "what ifs" are the concern.   I understand the CDC and other sites will error on the side of caution, given the seriousness of syphillis.  News reports as recent as yesterday are saying there is an "explosion" of new cases even "epidemic" was used in Monday's newspaper article.  The timing of the sore, it's severity and timely news reports have raised great concern here.

Yesterday was five week period from the encounter and I had a second blood test.  Many periodicals report RPR test will often not show antibodies until 5-6 weeks.  Once results are back, I'll have piece of mind to move forward.  Thank you for your feedback.  This site is of great service to those who have genuine concerns.

[Edward W Hook, MD]

You are clearly concerned and that is driving you in the non-productive realm of "what if" questions.  Both my statement and the CDC's statement are correct.  Direct contact with  a syphilis lesion is highly infectious.  did you see your partner's mouth?  If so and there is no lesion you have little to worry about.  While syphilis has been transmitted on occasion by oral sex, it is enough of a medical oddity to warrant publication when it occurs.  Just to further put things into perspective, this year there will be fewer than 10,000 cases of syphilis in our country of 350,000,000.    that's one case for every 35,000 Americans and over 98 % of those infections will be acquired through genital-genital contact.  You can keep testing. the results will continue to be negative.

Regarding your penile soreness- yes, NGU is a possibility. That is why I said it.  As I also said however, the more likely casue is over examination.  Over examination is does not require antibiotics to heal, just for you to leave yourself alone.  EWH

[lorfig]

Your posts state "only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny unless your partner had a sore on his mouth".  The CDC and other sites report syphilis is highly contagious and can spread through oral sex, even kissking.  I have no idea if this person had any lesion in their mouth; I need to be certain I do not have syphilis.  I'm not worried about HIV.  First test was 2 weeks (neg) and it has now been 5 weeks.  I want to be certain; is this long enough to show up?  If this sore on my urethra is a chancre, would its presence indicate enough bacteria is present to show up on blood test?

Finally, there is no discharge whatsoever; if this is NGU can it be passed to my gf?  I have left this sore area alone but it has become contstantly painful and stings all day.  After I shower it's really profound, red and swollen.  Ibuprofen helps.  Could this be a non STD caused by over examination and if so, will some antibotic clear this up?

[Edward W Hook, MD]

Welcome to our Forum.  Following receipt of unprotected oral sex, of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny unless your partner had a sore on his mouth.  If you had gotten gonorrhea you would have most likely developed symptoms of urethritis (penile infection).  It is not clear to me that you were tested for NGU which is detected not with tests for specific bacteria but by looking for signs or irrigation of the urethra on either a swab or in the first part of a urines specimen collected just as a person starts to urinate, not once they have started.  Even if your partner had an STD (any STD and it is likely he did not), most exposures do not lead to infection.

There is virtually NO risk of HIV form this exposure.  

In addition, I worry that repeated self-examination may also be causing irritation.  The skin at the opening of the urethra is VERY sensitive and repeated self examination frequently causes the area to become sore.  My advice would be to try your best to stop repeatedly examining yourself and, if it has not been done, to see if you can be evaluated for NGU.

Hope this helps.  EWH