Is this Urethritis - Chemical, Bacterial, Viral?

[JustaGuywithaQuestion]

40 yr male.  Received condom-protected oral and had vaginal sex with a sex worker (massage parlor).  She put condom on me with her mouth and had penis in mouth for a few minutes before it was on.  Condom appeared to be intact after sex (3-5 mins).  Warm cloth wipe after, and I applied an ethyl-alcohol-based hand sanitizer to my penis just to be sure. I may have gotten some in my urethra - not my first mistake here.

10-11 days later, I had a tingling in my penis/urge to urinate frequently.  No other exposure after the one above.  No burning sensations.  Overall body heat but no fever registered.  General malaise, and a few instances of chills.  Along with tingling, for one evening testicles felt swollen/sore.  No discharge.  No lesions/sores suggesting HSV (I have never had - all past tests neg).  Doctor could not see me for 3 days (I live in a small town).  Due to concern about untreated STD (seemed like urethritis/chlymidia), I started a regimen of doxycycline (100mg 2x daily).  I know it is not smart to self-treat, but benefit of early intervention seemed to outweigh risk of later treatment.

I had taken 3-4 days of doxy by time of doctor's appointment.  I was feeling better but still a sensation of something being "off" in penis.  Blood and urine tests all came back next day within normal ranges (negative for leukocytes, WBC normal, etc).  I am completing 10 days of doxy total just to be sure.

Questions:  1)  does urethritis caused by a chemical irritant take the same time period to appear (several weeks) as bacterial or viral, or is it more immediate  -- and are symptoms typically the same?  2) Anything here that suggests something other than NGU -- like HSV-2?  3) If this was bacterial, would 2-3 days of doxy result in completely clean blood/urine tests so quickly? 4) I plan on getting a complete STD test panel (including HIV, since I have not had a test for over a year) -- would 6 weeks post exposure be the right time?

[JustaGuywithaQuestion]

Thank you for the very helpful information, Dr. Hook.  Much appreciated.

[Edward W Hook, MD]

1.  Recommended duration of therapy with doxycycline is 7 days.  Azithromycin stays in the body a long time so repeat dosing is not needed, just a single 1.0 gram dose

2.  I am not aware of any data that suggest that 14 days is significantly better than 7 (or 7 for that matter) days.  You can only kill the bacteria once.

3.  Sorry, I didn't mean to sound glib.  You had a lesion related to sex and, subsequently, burning on urination.  Having started treatment, your symptoms improved.  This all certainly is consistent with a bacterial infection.  At this point however, any further symptoms you are noting may be more due to overly close genital inspection and observation than disease.

Hope this helps EWH

[JustaGuywithaQuestion]

Thanks for your thoughtful and helpful response, Dr. Hook.  A few brief follow-ups based on your answers (and I'll be glad to pay for another response if that is necessary):  1)  In #3, "Cure however takes longer."  What is a typical cure time if this was urethritis (or other bacterial infection)?   2) In #3 - re: continued therapy - does 14 days of doxy produce any more significant benefit vs 10 days?  Seems from my review of STD information that the standard course in the US is 7 days, UK 14.  So, I'm just trying to determine whether to stop at 10 or go to 14.  

Finally, just a note - if by "bacterial, if anything" in #2 you meant that the symptoms may have been related to genitally-focused anxiety (as your colleague calls it), I am entirely open to that possibility and will continue to relax.  Your answers have helped me in that regard, so thank you.

Again, glad to pay for another answer if I'm using up too much advice.  Thanks again for your help, and sorry about the LSU game.  Roll Tide.

[bobwall]

Dear sir how soon after antibiotic therapy can you get a re-test for bacterial infections (test for cure) is between 3-5 days ok or does certain factors influence this i.e antibiotic half lives and type of re-tests.

regards BOb

[Edward W Hook, MD]

Good questions.  In order:
1.  Chemical agents can certainly cause genital irritation upon direct contact.  The hand sanitizer would qualify for this.  In general, the reactions they cause appear soon after exposure, sometimes occurring right away or taking as long as a few hours.  For symptoms to occur after a delay of several days or longer would be unusual for a chemical irritation.

2.  Nothing here to suggest HSV.  In fact, your response to antibiotics suggests that the problem was bacterial, if anything.

3.  Antibiotic therapy typically brings about a rapid symptomatic response.  Cure however takes longer.  It is not suprising that your syptoms and findings were negative after three days of doxycycline.  I am glad you continued therapy nonetheless - that was the right thing to do.

4.  I would think if you want a re-test (I doubt you need it), they could be performed at 6 weeks.  Sooner for the bacterial tests but for the HIV or other viral STDs at least six weeks if preferable.

Hope this helps.   EWH