Really worried now

[worredsick345]

First of all, thank you in advance for your time and service on this website.

I am a 32 y/o WM with no prior history of STDs, and have been in a committed, monogamous relationship for 3 years.  Eleven days ago, while out at a bar, I met a girl who it turned out was actually transsexual.  As we were both more than a little tipsy, we went back to her place.  We kissed, she gave me unprotected oral sex, there was significant genital-to-genital contact, and we had protected anal sex (me to her). There was also a brief period where I rubbed my penis against hr anus unprotected -- probably no longer than 20 seconds.  She said she was negative for STDs when I asked her (twice -- that night and again a few days ago).

Four days later, I developed a bad sore throat followed by flu-like symptoms, which included bodyache, dehydration, a bad cough and stuffy/runny nose.  Fearing I got strep from the encounter, I used a leftover Zithromax prescription (1.5 g) to treat it.  The sore throat and achiness have since largely resolved, although I am still coughing a little and slightly congested.  However, about 4 days ago, I started feeling a tingling in my penis, generalized heightened penile awareness which borders on mild urethral discomfort (not specific to when I urinate, however), as well as needing to urinate excessively (approx once every 60-90 min, including at least one time at night).  This is all rather unusual for me, although I do pee frequently, and I have no history of UTI.

So, I am now extremely worried about STDs, especially herpes.  I have not seen any "classic" herpes sores or lesions yet on my penis, despite constant monitoring (believe me), but I know many people are asymptomic for sores and/or the sores can appear to look like small cuts, etc.  (Which I simply can't tell if I have.)  Any advice you have to offer will be sincerely appreciated.  Thanks again.

[Edward W Hook, MD]

Yes, the discomfort is typically followed very quickly by lesions.  EWH

[Edward W Hook, MD]

Your major risk ifs from receipt of oral sex and that risk is not great.  Your active but protected rectal sex and your genital to genital contact without penetration do not put you at risk for STD.  As for your receipt of oral sex, this puts you at risk for gonorrhea and nongonococcal urethritis (NGU) primarily.  There is a modest chance that you might have acquired herpes but that determination should be made on the appearance of presence of lesions (typically small vesicles or "water blisters" with or without accompanying discomfort).

Your symptoms of urinary frequency and discomfort suggest the presence of a urethral infection.  At the same time, if you did have a urethral infection, the azithromycin (zithromax) you took should have taken care of it.  To address this concern once and for all, I would suggest that you see a clinician or visit your local STD clinic. You need a swab or urine test looking for white blood cells (if they are increased, you could have NGU) and to test for gonorrhea.  If those tests are negative, then you need not be concerned.

As for your other symptoms, these complaints are not consistent with STD.  Sometimes we are queried as to whether or not persons with the sorts of symptoms you describe could have the acute retroviral syndrome (HIV) and our answer if uniformly NO, that symptoms are a poor indicator of HIV.  My guess is that you may have caught a cold or some other community acquired viral infection at around the same time as your exposure.  Your symptoms however are not suggestive of an STD

Hope this helps.  EWH

[worredsick345]

Thank you so much, Dr.  This is very helpful, and I will get tested as you sugget.  A brief follow-up -- if the UTI symptomology I've described is the result of herpes (as opposed to gonorrhea/NGU), would I have likely seen the herpetic lesions you describe by now?  When are they most likely to develop?  Again, thanks for your expertise.