Discomfort after oral sex

[mannishboy]

Hello doctor,

Here's the scenario:

I've been in a monogamous relationship with my wife for 10 years but 11 days ago had a moment of weakness and received unprotected oral sex from a sex worker. Before receiving fellatio, we had protected vaginal sex for about 5 minutes. I regretted my decision and was tested 5 days after exposure for syphilis, gonorrhea, and chlamydia, all of which came back negative. I plan on testing for HIV and Herpes in 3 months just to ease my mind. The sex worker did not have any sores on her mouth or vagina, but did have something that looked like psoriasis on her knees and lower back. .

Three days ago, after being reassured by the results of my tests and many posts on this forum, I had unprotected sex with my wife (who does not know about this incident, but had previously given me permission to sew my wild oats as long as I didn't talk about it...I regret taking advantage of this now). One day after having sex with my wife I began having discomfort in my penile region. At first it manifested itself as a feeling that I constantly needed to urinate and then discomfort from my penis to my bladder. There hasn't been any discharge that I've noticed or sores/bumps of any kind. I'm wondering if this could be indicative of NGU, or, alternatively, a urinary tract infection such as NSU (non-specific urethritis)? Also, is it possible that this could be gonorrhea or some other STD, even though I was tested last week? Should I be retested for all STDs? I'm very concerned now that I passed something on to my wife.

I should mention that I've felt this discomfort in the past, but for (obviously) different reasons. It seems to come and go, but appears to manifest itself most after having sex with my wife after a lengthy cessation period -- or, as another possibility, masturbation. Is it possible that I am some how allergic to my wife's genital flora? Sorry for the lengthy post but I want to be as definitive as possible.

[Edward W Hook, MD]

1.  MEications should help in just a ay or two.  This does not appear to be an STD

2.  No, the tests are very good an you have been tested.  It is time to look for other reasons.  

3.  Yes, IUD strings can be painful but they typically heal in a ay or two.  Unless your are being re-expose, this seems unlikely.  

4.  No, as I sai before, there is no evience that you have NGU.  My advice is to seek other explanations, perhaps with a urologist.  EWH

[mannishboy]

Hello doctor,

I'm not sure if I'm allowed to post again or if I should pay again and start a new thread, but I'll try this first. (My history is contained in the previous posts, so I'll refrain from telling you what you have already heard).

The pain in my urethra (it now feels like someone jammed something sharp into it) has become very overwhelming. Yesterday I went to the doctor and she ran a urine analysis. She stated that my urine "looked clean" -- no abnormal amounts of white blood cells, etc. She also checked me out for noticeable sores/lesions around my urethra and found nothing. She stated that it's possible that I have non-chlamydial NGU and prescribed me azithromycin. It's been more than a day since I took the medication and the pain is still very present.

1. How long should I wait before knowing that this medication is effective/ineffective?

2, Also, should I be tested for STDs again? The doctor seemed to think this it unnecessary, but I'm extremely worried, mainly because I had unprotected sex with my wife and I don't want her infected.

3. The only other thing she posited was that the strings from my wife's IUD could have scratched my urethra. Is this a possibility? Onset of symptoms was really short from sex with her.

4. The pain is substantial, but I get quick relief from taking Aleve. I assume it decreases the inflammation. Is this indicative of NGU?

[Edward W Hook, MD]

No, these symptoms are not suggestive of other STDs.

Your theory about relief following urination is not likely to be due to expelling bacteria however, elimination and soothing of any inflammation present may be part of what is going on.  If there is inflammation there, when your doctor checks for white blood cells, there should be many present. EWH

[mannishboy]

Thanks. I have just two more questions if that's okay. I receive instant relief (i.e. absence of discomfort) after urinating, so I've been drinking a lot of water, tea, cranberry juice, etc. to bring this about. Could this be due to my urine expelling the bacteria from my urethra/bladder? Also, and I hate to belabor this, do any of my symptoms point to an STD (other than NGU, of course)?

[Edward W Hook, MD]

You are correct.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves or be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this is a contributor to your situation.  

If your doctor diagnoses NGU (this woul be by detection of increase white blood cells in urethral secretions, it is easily treated although it can clear up on its own as well.  Treatment hastens improvement.    EWH

[mannishboy]

Doctor Hook,

Thanks for replying! The discomfort is much too salient to ignore -- I do wonder, however, how much of it is arising from psychosomaticisms -- so I am going to see my doctor on Friday for a checkup. I was not tested for NGU and thus plan on asking for that test to be performed. Could you tell me what the usual trajectory (e.g., symptoms, incubation period, etc.) for NGU would be? Is it possible for it to clear up on its own or are antibiotics necessary? I'm glad to hear that it is unlikely anything could be passed to my wife. However, until I get checked out again I might just refrain from sexual activity, or, alternatively, just use a condom.  

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  Your risk for getting any STD following condom protected vaginal sex and receipt of unprotected oral sex is very, very low and your negative tests effectively rule out the possibility that you acquired the most common STDs through your encounter.  The major concern at this time is whether or not you might have acquired non-chlamydial NGU through the encounter that you described.  If so, there are few data that this problem, which is thought to arise from the introduction or the bacterial morally present in the mouth into the urethra, is transmissible to sexual partners.  

My advice is to not worry.  your negative tests and the fact that you have experienced similar sensation in the past both favor the fact that the irritation you experiences is not a threat you your wife's, or your, health.  I would not worry.  EWH

p.s.   Following the exposures you describe there is no need for testing for HIV since this virus is not transmitted through oral sex or condom protected sex.  As for HSV, I would recommend against blood tests for this as well. in the absence of lesions or sores, you are more likely to get a falsely positive test than to find that you acquired HSV from the experience you described.  EWH