Could this be an STD?

[needadvice112]

Hi Doctor,

First off, thank you so much for taking the time to answer important questions such as these.  

Approximately 9 days ago, I had unprotected oral sex, protected sex (but condom fell off as I was pulling out), and mutual masturbation with a girl who I later found out to be a commercial sex worker.  Immediately following the event that night, I started feeling an uncomfortable burning sensation in the tip of my penis.  This burning sensation has been pretty consistent over the past 9 days.  I also notice that my urine and ejaculate flow has decreased as if there is some blockage or something.  I have not noticed any signs of sores or redness however and there is absolutely no pain during urination or discharge.  I was examined by a doctor 5 days after the event, which didn’t lead to any diagnosis.  I gave a urine and blood sample at day 8 and am currently waiting on the results.  I have the following questions.  

1. Do my symptoms point to any particular STD?
2. Did I give my blood and urine sample too early following the event?
3. Regardless of the results, should I be retested once more time has passed?

[H. Hunter Handsfield, M.D.]

You had a low risk exposure.  Simply pulling the penis out of the condom, while the condom is still inside a partner, probably does not significantly increase the risk of infection.  Oral sex is inherently low risk for all STDs, and mutual masturbation isn't an STD risk either.

Perhaps most important, it is impossible for an STD or any other infection to start to cause symptoms less than 2 days after exposure.  Whatever was going on the same night was due to something else.  A burning sensation within a few hours could be due to some sort of physical or chemical irritation, such as a reaction to the latex condom or to lubricant, especially if the the condom was lubricated with a spermicide.  However, that symptom would go away within a couple of days.  No STD causes ongoing burning, and no STD causes decreased amount of semen.

Therefore, the direct answers are:

1) No.

2)  Urine testing for gonorrhea and chlamydia can be done any time starting 1-2 days after exposure, so that test was not too early.  However, no blood test can show any STD before 4-6 weeks.

3) Based on the exposure and your symptoms, you don't need STD testing at all. But discuss it with your doc and follow his or her advice.  Also, talk to him or her about the possibility your symptoms are due primarily to anxiety.  That's probably the most common cause of the sort of problem you describe.  Whatever the cause, you can be sure it isn't an STD or other infection, and probably nothing that can possibly harm you or a future partner.  But as I said, to be really safe, follow your doctor's advice about further evaluation.

Best wishes---  HHH, MD

[needadvice112]

Thank you for your prompt reply.  I do understand that anxiety could possibly cause the symptoms I am experiencing, however, just the fact that they have lasted so long still worries me.  Especially since I have never experienced anything like this before.  Even when my anxiety seems low, the fact that I have discomfort in that area, causes me to get anxious.  Maybe it is a vicious cycle.  I do take some comfort in the fact that I noticed the effects immediately following the event and that could rule out some of the worrying causes.  Maybe I can add an update once I get my urine test results in next week.  I will make sure to get more blood work done in about 5 weeks from now also.  

Just to clear up any confusion, the amount of semen has not changed, but the flow seems to have decreased.  Like if I am having a hard time expelling it.  My semen also seems to be somewhat a little more thick and whiter than before.  

Thanks again for your input.

[H. Hunter Handsfield, M.D.]

The additional information doesn't change my opinion or advice.  None of this suggests any STD.