DGI

[GLarson]

Doctor,

I am a 49 year old male with the following exposures:

1) Received unprotected hand masturbation with some oral contact on penis shaft from CSW 11 months ago.
2)  Received protected oral sex from CSW 7 months ago.
3) Performed protected insertive vaginal sex 6 months ago.

I've had no other sexual encounters since then.

I had negative tests for all the following after the last sexual encounter:

1)2 weeks - Gonorrhea & Chlamydia Dna amplification urine, HIV rapid, RPR, and HSV2 igg.
2) 6 weeks  - same - all negative
3) 12 weeks - same - all negative
4) 17 weeks - Hep A, Hep B (ag & ab), Hep c
And HIV ICMA, Hsv 1& 2- all negative

3 months after last exposure, experienced testicular pain and swelling.  Diagnosed as epydidmitis. Prescribed Cipro 10 days follows by Doxycycline for 10 days. Reduced pain & swelling, but still has not completely resolved. Had urethra swan for NGU & gonorrhea/ chlamydia urine tests. All still negative.

In past week, experienced soreness in wrists and elbows. Petachiae (now gone) and acne like bump on hand present. Could this be disseminated gonorrhea infection?  Is there any way gonorrhea would have been missed and spread to epididymis, prostate, or blood & joints now?

Thanks.

[H. Hunter Handsfield, M.D.]

That treatment could have cured either gonorrhea or chlamydia.  Or it could have suppressed the infection, but only briefly.  Either way, for sure you were not infected at the time you were tested and remain free of both these STDs at this time.  But this is all pretty much irrelevant stince there is essentially no chance you were infected with either of these STDs at any time.

That will wind of this thread.  Time to move on.  Do your best to stop worrying about it.

[GLarson]

One follow up question. 3 weeks prior to my first gonorrhea/chlamydia NAAT, my dentist prescribed a 7 day corse of amoxicillin for a tooth infection. Could that have interfered with the detection of either STD in the subsequent NAAT or urethral swab tests? I know the sexual encounters posed low risk, but just want to cover all the bases.

[H. Hunter Handsfield, M.D.]

Thanks for your kind words about the forum.  I'm glad to have helped.

Even if your symptoms seem typical for CPPS, ideally you should see a doctor (perhaps a different and more sensitive urologist) to confirm it  But in the meantime, or if you decide to hold off on reevaluation for a while, the Stanford protocal might help and certainly can't hurt, so it seems worth a try.

Happy holidays.

[GLarson]

Thank you for your insight and reassurance. I just perused the resources you mentioned and they do fit for me. I've been under treatment by a psychologist for anxiety disorder and am just starting to see improvement of my GERD (omeprazole 40 mg, now down to 20 mg). Did have a scrotal ultrasound, but only found a couple of hydroceles and small cyst. Urologist was brusque and of no help. Maybe I cam manage the sporadic pain with the Stanford protocol?

Thanks for the care and happy holidays!

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

I'm afraid your online research has mislead you -- probably you read information about disseminated gonococcal infection (DGI) out of context.  DGI doesn't behave at all like the symptoms you describe.  In any case, your negative test results showed you did not acquire gonorrhea (or any other STD); and if you had and it disseminated, it would not cause these symptoms.  On top of all that, if you had acquired gonorrhea, either the cipro or doxy (and for sure the combination of them) would have cleared it and prevented DGI, epididymitis, or any other complication.

As for your genital area symptoms, I'm also skeptical you had true epididymitis.  Sexually acquired epididymitis is due only to chlamydia or gonorrhea, which you did not have and really could not have acquired, if your description of the sexual exposures is accurate.  Your symptoms sound more like the chronic pelvic pain syndrome.  CPPS and prostatitis are not sexually acquired and most cases are not due to any known infection (which is why your symptoms haven't cleared entirely with the antibiotics).  For more information, google CPPS -- spell it out -- and start your reading with the excellent information you can find both on Wikipedia and from the Stanford University dept of Urology.

If your symptoms continue or you otherwise remain concerned, continue to work with your doctor(s).  But for sure neither DGI nor any other STD is the cause.

Best wishes and happy holidays--  HHH, MD