STDS and oral sex

[Zoob789]

Doctors, thanks for taking this question. In advance, I have spent a bit of time reviewing the boards. I understand many of the risks are low. Your help would be great. 3 weeks and 2 days ago I had unprotected oral sex with a female. She had no signs of infection and is generally clean and level headed. She performed on me. No vaginal sex. 2 days later I had a slight meatus irritation. I have never had any other symptoms. No discharge or sores. Urethral meats irritation and slight redness only. At times it is brought on by rubbing against boxer shorts. The sensation comes and goes. Through the night it seems to be fine. In the morning it is not red. It may seem slightly inflamed. If so, not much. I had a test for gono, it came back negative. What else, if anything should I be concerned about. What should I do next. I am not worried about HIV. Needless to say, anxiety seems to be getting the best of me. HSV1, HSV2, chlamydia, something else.... Thanks!

[Edward W Hook, MD]

Not much.  I suggest you wait for your test results.  The medications your doctor has provided will cure most bacterial STDs if you are infected (which I doubt).  EWH

[Zoob789]

Ok, saw my primary care doctor last night. He did a complete exam. Said symptoms sound more urethritis and/ or yeast due to the localized pain, lack of redness and lack of symptoms typically seen with std's. I gave a urine sample to rule anything out. And I am on 1g of Zithromax and 7 days doxy BID. Additionally he prescribed nystatin cream. At this point, what else can we do? Thanks

[Edward W Hook, MD]

Glad I could help.  EWh

[Zoob789]

Thanks for the answer. I greatly appreciate it. Most of what I read in many of this forums state that chlamydia is not transmitted orally, and you seem to be leaning away from NGU all together. I am going for a swab tomorrow. I now it's yeast...

[Edward W Hook, MD]

Welcome to our Forum.  As you probably know from reading replies to other clients, few STDs are acquired from receipt of oral sex.  Furthermore, irritation of the urethral meatus in sot a common STD symptom.  Gonorrhea has been eliminated as a possibility for you so that leaves nongonococcal urethritis (NGU) as a possibility.  NGU is best diagnosed with a swab specimen taken from the penis at least an hour after last urination. On occasion microscopic evaluation of urine collected just as a person begins to urinate can serve the same purpose but the swab is the preferred  approach.  With either method, one is not looking for bacteria but for white blood cells which are a sign of inflammation.  It is the signs of inflammation, manifest as increased numbers of white blood cells, which are the basis for the diagnosis of NGU.   Much NGU acquired through unprotected genital/genital sex is caused by bacteria of which the association with chlamydia is most certain.  Other microorganisms cause it less often (trichomonas, some ureaplasmas, Mycoplasma genitalium, oral bacteria  introduced into the urethra during receipt of oral sex, etc) but are not typically tested for and despite optimal microbiological evaluation, in about 30% or more of cases there is no clear cause.

The other possibility is that your meatal irritation is due to a fungal infection.  If this has not gotten better in over 3 weeks, it would be best to have a trained clinician take a look.  I would not worry about herpes or STDs other than NGU however and as I said, I think NGU is unlikely as well.  EWH