epididymitis and std?

[ebro]

Dear Doctor, I am a 21 year old male and in August I had unprotected sex. In late January, I began to experience severe pain in right testicle. I went to a public clinic in NYC, tested negative for everything. Then I went to a urologist, who diagnosed me with epididymitis. He said that the STD tests "miss things" and that I might have chlamydia. He presecribed me Doxycyline which I took twice a day for ten days. The pain subsided, but recently it has returned. I went to another doctor and took a urine test for stds, which came back negative, then  returned to the urologist and he again diagnosed me with epididymitis and gave me levaquin to take for ten days, which i am currently doing. I have a girlfriend and certainly don't wont to infect her. I have read that the most common causes of epidiymitis for someone my age is an STD (CH.,GON.) Do you think its safe to assume that the cause of my condition is not an STD after the negative swab test 2 months ago and the recent urine test? I am very worried and really appreciate the service you do. Thanks for your time.

[H. Hunter Handsfield, M.D.]

The first issue is whether or not you actually had epididymitis.  It usually is associated not only with scrotal pain, but also with overt enlargement of the testicle and pretty severe pain and tenderness.  Also, sexually acquired epididymitis generally includes evidence of urethritis, with discharge and uncomfortable urination.  And sexually acquired epididymitis usually would have shown up far sooner than 5 months after exposure.  So whatever was causing your testicular pain, I'm suspicious it wasn't epididymitis; and if it was, that it wasn't due to an STD.  The negative swab tests for gonorrhea and chlamydia also are reassuring.  On top of all that, if you had one of those infections, the treatment you had would have cured it.

Good luck--  HHH, MD

[ebro]

I should also mention that the Urologist examined my urine under a microscope and could not detect any white blood cells. Does this decrease my chances of having an std?

[trevdog]

I had epididymitis too awhile back.  I was told that it may have been caused by some kind of STD too, Chly, or Gon, but everything was negative.  I had a lot of unprotected sex with my girlfriend at the time and it was caused by some kind of bacterial infection, not an STD specifically.  It takes a long time to subside, and occasionally I still get a reoccurance of it.  Don't sweat it, it will go away eventually.

[H. Hunter Handsfield, M.D.]

Lackof white blood cells in your urine is good evidence against sexually acquired epididymitis, and probably against epididymitis of any cause.

HHH, MD

[ebro]

Dr., Thanks for the quick response. I'm pretty certain it was epidiymitis, as the pain was quite severe and there was considerable swellling. The urologist noted that the pain was centralized in the epididymus. Do you think the swab test is accurate enough for me to forget about it and rule out an std? Can I resume sleeping with my girl without fear of infecting her? The pain is still apparent.
Thank you for everything.

[H. Hunter Handsfield, M.D.]

That sounds like real epididymitis, all right.  Since >90% of epididymitis in young men (under 35) who have not had urinary tract instrumentation or surgery are due to STD--usually chlamydia, less often gonorrhea--it is in fact most likely you acquired it during your sexual encounter last August.  Alternatively, perhpas your regular partner was infected first and you acquired it from her--but you are in a better position by far to judge that possibility than I am.  Your swab test for STDs might have been falsely negative (depending a bit on exactly what test was done).  And there is that 10% of cases that aren't STD, even in young men without predisposing causes.

None of this is a certainty in any way, and I am not making a definitive diagnosis without examining you.  But to be safe, your girlfriend definitely needs to be tested for chlamydia and gonorrhea.

Sorry if my original response misled you; it wasn't so clear to me you actually had epididymitis.

Good luck-- HHH, MD

[ebro]

Doctor, thank you again. I should mention that my girlfriend took a gram of zithromax last week as a precaution. She has had no  symptoms. I also forgot to mention that in early January, I slept with another girl and my condom broke. I was exposed for a maximum of 5 seconds, but this seems more likely to be the cause of my epidiymitis due to the time frame and the onset of my symptoms. She has never slept with anyone else. A few questions if you don't mind?
1.Being that she was treated,and I have tested negative twice (first swab culture, second urine)can we assume that she is okay? .
2.When would PID occur? She has had menstrual cramps her whole life, but they have not been especially bad recently and have sometime been abscent.
3.Does the fact that my epidiymitis seems to be reoccuring any relief that it was not caused by an STD?The pain is less, but swelling still apparent. We have not had any unprotected sex since my diagnosis.

Thank you so much and I really value all of your input.

[mildp]

A related discussion, Epididymitis was started.