Uneasy

[Helpquest78]

Dear Doctors:

Several weeks ago, after a long night out with friends (the majority of which I don't remember), I woke up to find a condom wrapper in my pant pocket.  To be honest, I do not even know if I had sex.  Nevertheless, I am extremely nervous that I may have contracted an STD.  As such, I have taken the following steps:  

(1) completed a course each of Zithromax, Ciproflexin and Doxycycline (obtained by my physician without a Gonorrhea/Chlymidia test); (2) approximately 14-days post exposure tested for Gonorrhea, Chlymidia and HIV (using DNA-PCR and antibody test) - results of all 3 were negative; (3) nervous the HIV results were inconclusive due to time of testing, was retested, again using DNA-PCR and antibody, at 31 days exposure - again, results were negative; (4) my mind continuing to race, I was tested for Syphilis approximately 45-days post exposure - results were negative.  

Despite my test results, I still worry that I may still have either Gonorrhea, Chlymidia, HIV or Syphilis (I remain symptom free of all).  The mind is a powerful thing and once the wheels start spinning, it is tough to slow them down.  I have refrained from sexual contact with my wife, as I would not want to infect her if I am infected.  

Any assurances/suggestions/advice is welcomed and appreciated.

Thanks.  

My question is, how sure can I be that I am in the clear with respect to these 4 STDs, based upon my results and symptom free status?  

[H. Hunter Handsfield, M.D.]

No STD causes such symptoms; and none of this sounds particularly abnormal or disturbing.  That your own doctor(s) find nothing wrong also should be reassuring.  However, this forum doesn't get into non-STD genital or urinary problems, so I don't have anything more to say except to encourage you to continue to work with your doctors if you remain concerned.

[Helpquest78]

Dr. Hansfield,

I have a follow-up question for you.

I've been scouring the internet for a solution to this problem I'm having for the last several years.  

Basically the tip of my penis (around the bottom side of the opening of my urethra) is red and looks irritated. The lips on both sides of the opening appear somewhat swollen as well. It seems to get more irritated at times and seems to alleviate the next day. Just back and forth but never really gets better. It's been about 5 or 6 years. Other symptoms seem to be...

-Might be my imagination, but more frequent urination.
-Urine usually dark

Okay so here's where it gets frustrating. It seems that doctors don't know what is wrong with me. I have been tested for STD's and infections but everything has come up negative. I almost wish I had herpes or something just so I could know what the hell is wrong with me at this point. The best advice a doctor has given me thus far is to apply cortisone on my penis. Didn't help at all.

So I started looking online and realized that SO MANY men are having this same problem. Many are using tea tree oil on the affected area, which seemed to help the redness and irritation.

Really at a loss for what to do. All forums talk about this problem, but there is never a solution.

According to forums, could be anything from ballantis, Prostatitis, HPV wart inside urethra.

Doctors tests have found nothing wrong. What should I do?

Thanks.

[H. Hunter Handsfield, M.D.]

My reply above answers your question about the chlamydia/gonorrhea tests.  The antibiotics to not "interfere" with the test except by curing the infection.  Your negative results mean that at the time you were tested, you were not infected.  Most likely you were never infected, but it is possible you had been infected and then cured.  Which it is can never be known.

[Helpquest78]

Thank you for the response.

My doctor agreed to prescribe the antibiotics sans testing, as I was in the process of moving out of state and couldn't get in for testing.  I figured it was a good idea to get on a course of meds, just in case.  As a follow-up, is there any potential the results of the Gonorrhea or Chlamydia test were affected by the antibiotics (I was still taking Doxy at the tie of testing)?  Or, is it inconsequential, as the antibiotics would have cured both?

Thanks again.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

Turning first to your concluding question:  you are definitely "in the clear with respect to these 4 STDs".  You do not need any further testing and can safely continue or resume unprotected sex with your wife, with no fear of transmitting anything.

You're obviously a better judge than I can be about whether or not you had sex that night.  However, my bet is that you didn't.  Regardless of how drunk or high someone is, it is rare to forget a sexual contact!  Further, given the evidnece of the open condom package, it seems fair to assume tha if sex took place, it probably was condom protected.

I'm a litle surprised your doctor treated you with those drugs.  Perhaps you talked him or her into it, and s/he found it easier to relent (against better clinical judgment) than to argue with you.  Is that what happened?

Further, it was a mistake not to test you for gonorrhea and chlamydia BEFORE treatment.  However, those antibiotics would have cured either infection.  The results of the tests 2 weeks later you were not infected at that time.  At this point, you'll never know for sure.  Those drugs also would abort syphilis if you had been exposed, so here too there was no point in testing afterward.  Here too, it will never be possible to know for sure whether you weren't infected, or were but cured.  However, heterosexually transmitted syphilis is really rare these days -- so you can safely assume you were not.

Which leaves HIV.  The combination of negative antibody plus DNA at 1 month is 100% proof you weren't infected.

So at this point, my advice is to cease all worry, continue sex with your wife, and don't have any more testing.

Good luck--  HHH, MD