Oral sex and STD risk

[skymass14]

I am 33/M and happily married.
Unfortunately I received oral sex twice in 2 days about 2~3 weeks ago without a condom from sex workers who probably have many oral sex clients. No vaginal sex.
3 days later I was worried and took doxycycline (leftover from friend) 2 pills per day for 1 day, and 1 pills per day for 2 days (total 4 100 mg pills for 3 days).
1 week ago I started to get a slight burning/itching sensation at the tip of my penis. I did not notice any discharge or redness and there is *no* pain during urination, but the tip of penis near the inner distal urethra seemed to be of continuous discomfort and hypersensitivity.
I had sex with my wife yesterday.
Today I went to a local urologist and under a microscope he said there was a small number of WBC (only a little more than normal) and there was a possibility of STD because of the oral sex.
He ordered a PCR test (8 types of STD) and are waiting for results.
He prescribed doxycycline 100 mg and levofloacin twice per day for 3 days and told me to come back 3 days later for test results and would further prescribe according to results.
He recommended that I have not sex with my wife, but I already had sex with my wife.

1. How much protection do you think that the prior leftover doxycycline self-administered would have given me for gonococcal and NGU? Do my symptoms sound like NGU?
2. If the PCR results are negative, would it be okay to just take the antibiotics and not tell my wife? If not, what is the risk?
3. If the PCR results are positive for non-gonococcal and non-chlamydia infection, would it be okay to just take the antibiotics and not tell my wife?
If not, what is risk?
4. If I take antibiotics 1~2 days and have sex with my wife, is it high risk? Due to fertility cycle she is asking for sex.
5. What is the real risk of already have infected my wife (single exposure)?

Some risks no one may know, but maybe a indication of something like 1 in 10 or 1 in 1000 etc… would be helpful.

[Edward W Hook, MD]

This will be my final answer.  As I said above, this is something for you and your doctor to consider. There are not formal, well established guidelines for management of positve tests for M. genitalium.  The infection is difficult to treat and as I already mentioned, whether or not all cases need to be treated is debatable as well.  EWH

[skymass14]

We are taking the antibiotics as prescribed.
A lot of papers seem to mention much antibiotic resistance and recurrence.

How long should we wait to be retested (our physician did not mention this), and should we again retest a few months later?

Thanks.

[Edward W Hook, MD]

The role of Mycoplasma genitalium is the subject of much research at the present time.  The infection is associated with urethral infection in men but it is unclear that the infection leads to complications.  Your partner should also be tested for Mycoplasma genitalium.  At the present time, azithromycin is widely used to treat the infection.

You should work with your doctor on the management of this infection.  EWH

[skymass14]

I called my local clinic.
They said it was "Mycoplasma genitalium"

How should we proceed?

[Edward W Hook, MD]

I am not precisely sure what your test was positve for.  It sounds like either Mycoplasma or Ureaplasma, both of which are NORMALLY found inthe genital tract and do not warrant treatment.  There is one species of Mycoplasma, called Mycoplasma genitalium which may be a pathogen and is soetimes treated.  Please find out what the test was positve for and I will comment further but my guess is that what you have is not something that we would normaally treat.  Once I know what you have I can also comment on treatment of your wife, if you wish.  EWH

[skymass14]

I didn't fully the prescription above:
My current prescription (excluding shot) is
An additional 4 days (total 7 days) of doxycycline 100mg and levofloxacin twice per day followed by
Azythromycin 250mg twice per day for 7 days

[skymass14]

I told my wife (which turned out to be a very good choice).
Unfortunately the PCR results came positive for
Mycoplasma urea (I think the test is combined, not sure)
And candidiasis

I have been prescribed
An additional 4 days of doxycycline 100mg and levofloxacin twice per day followed by
Azythromycin 250mg twice per day.
I got a shot of antibiotics too, not sure if I heard right but it sounded like levofloxacin or something similar.

He told me to ignore the candidiasis results and keep myself dry/proper hygiene.

My wife has been also prescribed the same drugs (excluding shot).

My questions are, since my wife has a very slim but still notable chance of becoming pregnant.
1. Should she wait until her period to start treatment? If she waits, will it decrease the possible effectiveness of the antibiotics?
2. Would it be feasible for my wife to NOT take antibiotics and just have a PCR test now, and a PCR test 2 week or 1 month later?
3. What are the odds of recurrence or failure of treatment?

Thanks.

[Edward W Hook, MD]

You can't let this go, can you.  The discomfort of NGU is mild, present primarily on urination and does not occur at the distal penis.  In fact no part of what you describe raises any concern for NGU whatsoever.  

I have nothing more to say,.  You may post your test results, if you wish.  EWH

[skymass14]

Could you kindly explain:
> You symptoms do not sound like gonorrhea or NGU
I had somewhat more definite pain for 1 day and then more mild burning sensation for 5 days.
This is only at the inner distal tip of penis.
No pain during urination.
Would that be atypical for NGU? Or, would that be more typical for allergic reaction or trauma? (I don't think the sensation itself is psychological)

The discomfort is decreasing recently, but haven't yet received results of exam.
One thing I'm slightly worried about is that the clinic did not tell me to hold my urine and I had urinated about 30~40 minutes before my urine collection, and that it may affect the sensitivity of the PCR analysis.
As I am now taking antibiotics, I don't think I retest would be useful.

Thanks.

[skymass14]

This is definitely my first post.
I read a lot of posts in the recent week before posting and phrased my post similar to my search results (including the 1 in 100 type of questioning as I saw that in another post).

Could you kindly explain:
> You symptoms do not sound like gonorrhea or NGU
I had somewhat more definite pain for 1 day and then more mild burning sensation for 5 days.
This is only at the inner distal tip of penis.
No pain during urination.
Would that be atypical for NGU? Or, would that be more typical for allergic reaction or trauma? (I don't think the sensation itself is psychological)

> Your taking antibiotics and then having sex with your wife was a mistake.
Actually I was reading your recent replies which made me think I was low risk and was not looking for diagnosis/treatment until today.

I thought my pain was due to allergic reaction or trauma because I tried a very old underwear recently for one day, then got scared today after I realized the pain had not subsided and that I had sex yesterday. I would not take antibiotics thinking I had an infection and have sex with my wife unless I could avoid it.

[Edward W Hook, MD]

Welcome to the Forum.  Have you asked this question before using a different name?  The question is quite similar to one asked here recently.

Receiving oral sex is a relatively low risk event.  Most commercial sex workers do not have STDs and most exposures to infected partners do not lead to infection.  The doxycycline you took may have reduced your risk for many common STDs somewhat but there are no data to determine how much.  I agree with the plans the doctor has made for you.  If the tests are negative no further therapy is needed.

1.  You symptoms do not sound like gonorrhea or NGU.  As I said above, I cannot tell you how much the doxycycline would reduce your risk.

2.  Your taking antibiotics makes not telling your wife a risk.  The risk is low (hard to say how much) but not zero.  

3.  Same answer as for 2 above. Your taking antibiotics and then having sex with your wife was a mistake.

4.  The risk is no zero but it is low.

5.  No answer.  See above

Your overall risk for infection is less than 1 in 100, I would guess but not zero.  In the future, do not make the mistake if taking antibiotics.  EWH

[skymass14]

Of note, this exposure and treatment is currently in South Korea.