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STDs (Expert Forum)
Worried about mystery
Answered by
University of Washington
Seattle - WA
This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection.
IMPORTANT
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
Worried about mystery
by SumGuy, Jan 27, 2008 03:44PM
I have been diagnosed with epididymitis and would like some help and input as to the possibility of STD.
Until last weekend, I was monogamous with the same woman for three years and neither of us have/had ever been symptomatic of any STD. Prior to last weekend, I had not had sex for about two months.
A couple of months ago, I had some very minor itching at the base of my urethra. No pain or burning or discharge - just a bit of an itch. It resolved in a couple of days and I haven't had any such symptoms since.
Last weekend, I had unprotected oral sex (she gave me head) and then had protected vaginal sex with a woman I had not had sex with before. Probably irrelevant, but she was completing treatment for strep throat at the time (at the end of a course of penicillin; she'd not been symptomatic for several days). We used a condom throughout the vaginal sex and the condom remained intact.
About 2-3 days after that sexual encounter (early to middle of this week) I began to feel a fullness behind my left testicle. I had (and have) NO other symptoms - no discharge, no urethritis, no pain or burning when urinating; nothing. Everything seems totally normal except the swelling epididymis. I sought medical treatment this weekend and, after an ultrasound to rule out torsion, was diagnosed with epididymitis.
The doctor was fairly aggressive about the possibility of STD. They have taken samples to test for gonorrhea and chlamydia. I do not yet have these results but of course am worried sick that I somehow contracted something, despite its unusual presentation and the use of a condom... I realize there are a lot of other things that can cause epididymitis, but it just seems like too much of a coincidence to be unrelated to my sexual encounter.
I was given Cipro 500mg 2x day for 10 days. I started the Cipro late yesterday, but (perhaps due to an optimistic imagination) the swelling does seem to be subsiding a bit.
Thank you.
Until last weekend, I was monogamous with the same woman for three years and neither of us have/had ever been symptomatic of any STD. Prior to last weekend, I had not had sex for about two months.
A couple of months ago, I had some very minor itching at the base of my urethra. No pain or burning or discharge - just a bit of an itch. It resolved in a couple of days and I haven't had any such symptoms since.
Last weekend, I had unprotected oral sex (she gave me head) and then had protected vaginal sex with a woman I had not had sex with before. Probably irrelevant, but she was completing treatment for strep throat at the time (at the end of a course of penicillin; she'd not been symptomatic for several days). We used a condom throughout the vaginal sex and the condom remained intact.
About 2-3 days after that sexual encounter (early to middle of this week) I began to feel a fullness behind my left testicle. I had (and have) NO other symptoms - no discharge, no urethritis, no pain or burning when urinating; nothing. Everything seems totally normal except the swelling epididymis. I sought medical treatment this weekend and, after an ultrasound to rule out torsion, was diagnosed with epididymitis.
The doctor was fairly aggressive about the possibility of STD. They have taken samples to test for gonorrhea and chlamydia. I do not yet have these results but of course am worried sick that I somehow contracted something, despite its unusual presentation and the use of a condom... I realize there are a lot of other things that can cause epididymitis, but it just seems like too much of a coincidence to be unrelated to my sexual encounter.
I was given Cipro 500mg 2x day for 10 days. I started the Cipro late yesterday, but (perhaps due to an optimistic imagination) the swelling does seem to be subsiding a bit.
Thank you.
Doctor's Answer
by H. Hunter Handsfield, M.D., Jan 27, 2008 05:45PM
, Jan 27, 2008 05:45PM
If your doc is experienced in recognizing and treating epididymitis, I have to respect his diagnosis. However, you don't describe a typical case. Epididymitis usually causes more dramatic pain, swelling, and tenderness than you describe. Also, sexually acquired epididymitis always has urethritis (urethral infection), with some combination of abnormal discharge, white blood cells in urethral secretions or urine, and/or positive tests for gonorrhea or chlamydia. There are nonsexually transmitted cases; they tend to occur in men over age 35 or those with underlying urinary tract problems (e.g., someone who recently had urinary tract surgery, congenital anomalies like urethral stricture, and so on). It also can occur as a side effect of certain medications (most classically amiodarone, sometime used for heart rhythm disorders).
If indeed you have sexually acquired epididymitis, most likely it goes back to an exposure before the exposures last weekend. Receiving fellatio can result in nongonococcal urethritis (NGU), perhaps sometimes due to normal oral bacteria. If orall acquired NGU leads to epididymitis, it is rare; no such case has been reported in the medical liturature and I have never seen such a case. Chlamydia (by far the most common cause of sexually acquired epididymitis) isn't caught through oral sex; gonorrhea can be, but almost always causes overt urethritis, with discharge etc. Perhaps the pending tests will prove me wrong, but I'm betting they will be negative.
I can't make much of your past itching at the base of the urethra. However, itching IN the urethra, usually felt at the tip, can be a symptom of urethritis.
Also hard to make much of the apparent improvement in your symptoms in the past few hours. No antibiotic is likely to work that fast; most epididymitis requires 2-3 days before symptoms start to subside.
Final comment: Interesting that your doc chose ciprofloxacin. It usually would work, but is not completely reliable against either gonorrhea or chlamydia. However, it is commonly used for nonsexually acquired infections.
Bottom lines: 1) If the gonorrhea and chlamydia tests are negative, which is what I predict, you will then be confident that whatever you have--epididymitis or some other cause of testicular pain--wasn't sexually acquired. 2) Continue to follow up with your provider and follow his advice.
I hope this helps. Best wishes-- HHH, MD
If indeed you have sexually acquired epididymitis, most likely it goes back to an exposure before the exposures last weekend. Receiving fellatio can result in nongonococcal urethritis (NGU), perhaps sometimes due to normal oral bacteria. If orall acquired NGU leads to epididymitis, it is rare; no such case has been reported in the medical liturature and I have never seen such a case. Chlamydia (by far the most common cause of sexually acquired epididymitis) isn't caught through oral sex; gonorrhea can be, but almost always causes overt urethritis, with discharge etc. Perhaps the pending tests will prove me wrong, but I'm betting they will be negative.
I can't make much of your past itching at the base of the urethra. However, itching IN the urethra, usually felt at the tip, can be a symptom of urethritis.
Also hard to make much of the apparent improvement in your symptoms in the past few hours. No antibiotic is likely to work that fast; most epididymitis requires 2-3 days before symptoms start to subside.
Final comment: Interesting that your doc chose ciprofloxacin. It usually would work, but is not completely reliable against either gonorrhea or chlamydia. However, it is commonly used for nonsexually acquired infections.
Bottom lines: 1) If the gonorrhea and chlamydia tests are negative, which is what I predict, you will then be confident that whatever you have--epididymitis or some other cause of testicular pain--wasn't sexually acquired. 2) Continue to follow up with your provider and follow his advice.
I hope this helps. Best wishes-- HHH, MD
A couple follow-ups.. I should have been more descriptive in my testicular narrative (but was running out of space) - it definitely became very full and tender posterior to the left testicle. I can feel the tubing behind it very swollen and tender, almost as if I'd grown a third, mushy testicle back there (sorry!). While only slightly painful, there's a considerable amount of fullness and tenderness. I'm not a urologist but it sure seems like epididymitis to me, too. So, while confident in the epididymitis diagnosis, I was confused on the STD front because while on one hand it seemed so unlikely to be sexually transmitted (since I am otherwise showing no symptoms of an STD such as urethritis discharge or the like), the coincident sexual experience seemed too timely to be ignored.
Also - assuming tests come back negative, the epididymitis has subsided, and I've completed the course of Cipro fully, is sexual activity OK again?
Thanks again for your help and advice. I appreciate it, and as you mention, certainly plan to follow up with the Dr. per Dr's instructions in a few days.