STD or anxiety?

[kelvint]

Hi Doctors,

I am 29 year old male that had unprotected oral and vaginal sex with a stranger 7 weeks ago. It was the first time I done this outside of a 6 year relationship. Extremely guilty.

Since this time I have not had intercourse with my partner. I had three seperate tests carried out after 10 days 14 days and 28 days all negative for chlamydia gonnerhea and bloods were negative. The second test at 14 days included a swab and urine test. For the swab test the doctor looked under the microscope then and there and said there was nothing abnormal.

The reason I had the third test after 28 days was because around day 25 post exposure I began to feel some irritation in my urethra at the tip of my penis. The doctor took urine sample and also gave me 1000g Zithromax to take orally in one go. After one week results again were negative but I still had the irritation which I can only describe as a flare up at different times. Some days I feel nothing other days it is quite irritable. When I went back she gave me doxy for 7 days along with flagyl to rule out trichmoniasis. I have finished that course over a week ago and still I have irritation flare ups at different times. I have noticed some clear sticky discharge usually after a bowel movement but on one occasion I did notice a stain in my underwear. Again it was clear.

My questions are:

1. Is this a form of ngu that have been missed on all the tests I have done? Or Herpes?
2. Would the swab at 14 days have picked up on this if it was ngu?
3. Should the antibiotics I have already taken cured ngu or is there something else I should get?
4. Is it safe to have unprotected sex with my partner again?
5. am I causing this pain by constantly squeezing my penis?

Regards,
KT

[H. Hunter Handsfield, M.D.]

Evaluation of prostatitis is a tricky business, and the tests aren't very accurate. If the evaulation you had were undertaken on 100 entirely healthy, asymptomatic men, probably at least 20 of them would have the findings you did.  In other words, your diagnosis of prostatitis may be right, but it doesn't necessarily explain anything.  Assuming the diagnosis is accurate, it doesn't change my opinions or advice above.

I don't know what sources you have read about prostatitis resulting from STDs.  There is speculation along these lines, but absolutely no research that shows this to be true; all studies (of good scientific quality) that have attempted to document such a relationship came up empty.

Most prostatitis is apparently not due to infection of any kind -- at least in most cases no abnormal bacteria can be found, and antibiotic treatment generally makes no difference in symptoms. Most urologists give antibiotics a try, and perhaps that was done for you. But probably under half of all patients have improvement, and therefore you shouldn't expect it to make much difference.

Finally, I will add -- importantly -- that no adverse effects have ever been reported from men with prostatitis continuing their normal sexual activities. No harm to the affected men, nor to their sex partners.  If you have a regular partner, you should be continuing your normal sexual practices with no fear it will harm either of you.

That definitely ends this thread.  Good luck and best wishes.

[kelvint]

Hi Doctor,

Thanks again for your previous comments and I know this is a bit dated but I had one more question for you I will gladly pay the fee again if I need to.

Since our last conversation I have been to a urologist who did a swab test first and then massaged my prostate to analyse the secretions. There was nothing in the swab but he said that my prostate fluid was infected and diagnosed me with prostatitis. As this is surely not a coincidence straight after a risky sexual exposure I was wondering if this diagnoses puts my partner at any risk?

I've read so many conflicting arguments about prostatitis resulting from STD's and whether or not it is infectious?

Thanks again,
KT.

[H. Hunter Handsfield, M.D.]

I see no reason for such testing.  Even if positive, I would conclude you are an asymptomatic carrier of M genitalium, i.e. it would have nothing to do with your symptoms.  But if you insist, there is no reason to delay on account of your antibiotic treatment.

That will end this thread.  Do your best to accept the reasoned, science based reassurance I have tried to give and move forward without worry.

[kelvint]

Hi Doctor,

Just wanted to say I have found a clinic that will test for M Genitalium which I think would put my mind at ease. Can I just ask how long after taking medication would it be possible to get an accurate result?

Thanks,
KT.

[kelvint]

Thank you for your quick response your service is much appreciated and this will be my last post as I do not want to take up anymore time.

I would completely put the pain down to anxiety but the clear discharge and forked urine are what has gotten me so uptight. If not NGU what could be causing these symtoms?

I will visit a clinic and get reevalued but I just wanted to know at what stage would antibiotics be out of my system so that I could have a full evaluation that is not compromised?

Thank you for your great service there will be no more questions from me but I will post any update at a later stage should there be any.

Thanks again,
KT.

[H. Hunter Handsfield, M.D.]

Normally we try to not seem critical of users' doctors.  But I think you (and your doctor) are barking up the wrong tree.  Although he has examined you and I have not, I strongly doubt you have NGU.  Perhaps your doctor is trying to "do something" to relieve your obsession with all this.  E coli doesn't cause NGU and ciprofloxacin is the wrong drug for NGU.  Perhaps he suspects you have a non-sexually acquired urinary tract or prostate infection, of which E coli is a common cause -- but these are rare at your age (29 according to your profile page) and are not triggered by STDs or by sexual contact with new partners.

1) Already answered -- see my orignal reply.  (Yes.)

2) That's exactly what it means:  lack of improved symptoms is itself strong evidence against any infection of any kind.  They also would have cured an E coli UTI or prostate problem.  

3) I already advised you to resume your normal sexual practices with your wife.  Assuming that includes unprotected intercourse, that's what you should do.

4) I am confident the ciprofloxacin will have no effect on your symptoms.  You have no infection, and therefore no antibiotic will make a difference.

5) Sometimes men complain of urethral discomfort after swabbing for STD diagnosis. But any discomfort more than 3-4 days duration cannot be due to continuing injury or irritation.  This is an emotional/psychological issue.

I would advise you to discuss this again with your doctor -- or, better yet, an STD specialist (if you're in Ireland, a GUM doctor or clinic).  When you do, consider printing out this thread as a framework for discussion.  Your current doctor won't take it personally -- I'm being understanding of the difficult position you may have put him in, but not critical of his management.

[kelvint]

Sorry one last question, the swab test I had at two weeks is the most reliable as I had not taken any medication and nothing was found. I also had one more done a week after I finished the 7 days of doxy and again nothing was found unusual under the microscope. How long would I need to wait after taking antibiotics in order to have a conclusive result of this kind?

Sorry for taking up so much of your time.

All the best,
KT.

[kelvint]

Hi Doctor, thank you for responding to my question and please if could just ask some follow up questions also.

The problems have continued for me unfortunately and in many ways have gotten slightly worse. Iam still experiencing a pinching feeling in my urethra near the top of the penis on and off and have now noticed some discharge that now occurs throughout the day sporadically. It is always clear in colour. One other thing to note is that I have forked urine almost all of the time.

I am confident that I do not of chlamydia or Gonn as my test results are conclusive(3 tests) however I am worried that this is M Genitalium which I have not been tested for and is not available in my country. Also I had protected sex with my partner which I am now extremely nervous about.

I went back to my doctor yesterday and he said that I most likely have NSU/NGU caused by ecoli that would be harmless. He prescribed me with 3 weeks of Cipro which I have taken 2 days so far.

My questions:
1. Should the Zithromax 1000g and then 7 days of Doxy have cleared M genitalium if it were present. Is there anything else I should have taken?
2. Throughout all the drugs I have had there has never been an improvement in symtoms in fact they have gotten worse. Does this mean there is another underlying issue?
3. Do you think I should not have protected sex with my partner or once there is no condom malfunction is this safe?
4. Will the cipro I take for 3 weeks be useful at all considering I have not responded to anything.
5. I had two swab tests taken throughout this experience is it possible that they can cause forked urine or damage.

Thank you in advance,
KT.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I think I can help.

I'm quite confident that your guilt and regret are the only problems here.

We can unequivocally put gonorrhea, chlamydia, NGU, trichomonad, and herpes aside.  The tests you had, including the urine and microscopic tests by your doctor, are definitive for these STDs.  And if somehow you had any of these, the treatments you had would have eradicated them for sure.  And even trichomonas has been covered with metronidazole.  Genital herpes doesn't behave anything like.  On top of all this, your symptoms don't match those of any STD.  Urethral or urinary discomfort, without visible discharge (and especially without inflammation on the micrscopic test) simply cannot be caused by these infections.

Those comments cover questions 1-3.  You could have safely resumed unprotected sex with your regular partner once you knew your first gonorrhea and chlamydia test results were negative, and you certainly should do so now.

Repeated penile/urethral squeezing (e.g., trying to be sure there is no discharge) can indeed cause symptoms like yours.  It can even create discharge which doesn't mean anything but confuses the issue.  Emotions like anxiety and guilt also can inflate trivial symptoms or normal body sensations to a point of discomfort or pain, and can influence judgment about things like urethral redness.

So my advice is to stop worrying, resume your normal sexual relationship, and keep your hands off and entirely stop examining yourself.  Deal with your guilt and regret as you need to, but don't confuse this with STD risk.  They aren't the same.

Best wishes--  HHH, MD