STD or nothing

[mcclaine]

On march 15th I had sex with an escort. She performed unprotected oral and then we had protected intercourse. Even though i was wearing a condom I pulled out before ejaculation and noticed the condom had broken. When asked the escort said she was STD free. Once home I cleaned myself with soap water and witch hazel. About 3-4 days later I developed this strange feeling in my penis. I went to the ER on Saturday for a urinanalysis and a culture test. The urinanalysis test results were good except the urine being cloudy. The culture results came bac ( 2days later) negative for gonerhea and chalymidia. With all that being said they told me I had urethritis but the culture test was negative. I also had an rapid test done a week later which came bac negative. To this day the strange feeling stopped after 2 days of drinking water and pure cranberry juice. My question is what should I do next? Could it be urethritis or something else ? I have been feeling guilty cause I cheated on my girlfriend could this all be in my mind?

[Edward W Hook, MD]

You had unprotected intercourse with a partner of unknown HIV status.  It is statistically unlikely that she had HIV or, even if she did, that it would be transmitted to you.  Therefore your risk of HIV is very low.  The does not mean that it would not be a good idea to have an HIV test.  It would be, just as it is useful for you to have your blood pressure and cholesterol checked.  A test 6-8 weeks after your exposure will provide reliable results that you can have confidence in.  EWH

[mcclaine]

Based on the info I provided should I go for another HIV test?

[Edward W Hook, MD]

Glad to hear it.  Take care.  EWH

[mcclaine]

Jus got bac from the urologist. He said that the treatment I recieved in the ER was sufficent. The 4 blue pills along with the shot I was given was enough to fix the problem. He checked my urine which came bac fine. Examined me again and said everything looks fine.

[mcclaine]

Thx 4 all your help Doc I'll be sure to post any useful info from the visit to the urologist

[Edward W Hook, MD]

no, there does not need to be apathigen detected

EWH

[mcclaine]

Final question, does there have to be a STD virus present to contract urethritis from a person?

[mcclaine]

Your absolutely rite doc, I apologize for my remarks and hope I have not offended you

[Edward W Hook, MD]

RBCs and lack of water arew not relevant.  Nor is that your partner is perceived by you as "dirty" (rather judgemental, don't you think? - what does that say about you and that you had sex with her?)  EWH

[mcclaine]

Thx Doc I have an appt with a urologist in a couple hours I have a couple more questions the rbc was 4 does that reaffirm your advice to seek treatment? Also what about the lack of water intake? And does this mean that the person I was with is " dirty" for lack of a better word?

[Edward W Hook, MD]

8 WBCs is enought to worry about  NGU.  I would seek treatment.  The urine clarity and hyaline casts are not a concern

EWH

[mcclaine]

Thx for the response doc, the sample was collected at the begining of urination as far as the WBC count there were 8 according the test results. As far as my partner I have not had sex with her since my exposure on fear of putting her at risk. As I look at the test results there is also something about hyaline cast being present. About the urine clarity I rarely drink water could that effect the clarity?

[Edward W Hook, MD]

Welcome to our Forum.  The story you tell suggests that you may have gotten non-chlamydial NGU, either from the receipt of oral sex of from the broken condom.  The cloudy urine is supportive of this (BTW, two questions about the  urine specimen- was it taken at the beginning of urination or midstream and are you sure there were no white blood cells present in the urine specimen?)  If WBCs were present, this too supports the diagnosis of NGU.  If there are no WBC is your urinalysis, NGU becomes less of a concern,  

As relate to your questions about whether your concerns might be anxiety-related, my comment is that sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and 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.  

I will comment further once I hear your replies however, the situation and scenario is sufficiently concerning that I would consider treating you for nongonococcal urethritis with either azithromycin or doxycycline.  Of course this also means that if you have had sex with your partner since your exposure, she too would need NGU treatment as well.  

Hope this helps. EWH