Unprotected Oral

[uhoh999]

I had unprotected oral sex about 48 hours ago with an escort (a girl gave me oral sex, I am male) and very brief protected vaginal sex. The next morning, maybe 12 hours later, I felt a frequent need to urinate and a weird feeling in my bladder, maybe a tingling or a feeling of having to urinate. I have no problems urinating, nothing weird with my urine, nothing physical on my genitals, etc.

I don't really have any pain urinating and my urine doesn't smell weird or look cloudy.

I masturbated several times that same day before the sexual encounter, and during the oral sex, I came close to orgasm and held back a couple times before actually orgasming. I've read online that between the excessive masturbation and the holding back, it can cause these symptoms and irritation.

Should I be worried? It wouldn't be an STI if the symptoms were that quick, could it? Probably all in my head?

If I go get tested tomorrow, maybe 60 hours after the encounter, would that be too soon? What should I do?

I am in a long term relationship, and obviously, I don't want to transfer any STIs.

[H. Hunter Handsfield, M.D.]

Sorry, we don't examine clinical photos on this forum.  Based on all the other information, I doubt there's a problem.  But if you remain concerned, you'll need to be re-examined professionally.

That will end this thread.  I won't have any further comments or advice.

[uhoh999]

Here's an update. Want to know my next step or if I'm good. The symptoms have cleared up for the most part. Still feeling the need to urinate frequently (moreso when I am anxious) and feeling a slight sensation in the urethra that comes and goes. Don't notice anything when I'm occupied or busy.

My urethra opening is still sticking a bit now and again. The only way I notice it is if I look directly at it and spread the sides apart and it is very slight. Doesn't always do this, either.

Here are links to two pictures:

http://s30.postimg.org/robzivuep/first.jpg
http://s16.postimg.org/445iuwmv9/second.jpg


I've noticed a little bit of redness on the top of the head of my penis, as well as below the urethral opening. The redness on top is slight. There is pigmentation as well on the sides of the head and maybe a bit below the urethra that you can see, next to the slight redness. I don't know if this is normal or not.

Thoughts on my next step or am I all good and just need to stop worrying?

[H. Hunter Handsfield, M.D.]

If the urethral discharge or stickiness, or any other symptoms, have cleared up and don't recur in the next week, I would consider you clear and safe to resume sex with your wife or regular partner.

[uhoh999]

I did not see your message until it was too late. There aren't many options in my area for this type of care, unfortunately. In any case, my test results came back negative. Would you assume I'm good to go and all clear now? Or, with the lack of a swab, would you still be suspicious?

[H. Hunter Handsfield, M.D.]

Congratulaions for seeking care.  But I'm disappointed you were not properly examined.  That's bad medicine.  You should have had a direct examination of your urethra, and a urethral swab inserted into the urethra to examine for white blood cells (this also is a quick way to check preliminarily for gonorrhea).  These are standard, routine, and should be automatic in evaluating any man with symptoms that suggest urethritis.  Presumably the urine test is for gonorrhea and chlamydia, which is fine -- but half of all nongonococcal urethritis (NGU), which is what you may have, will not show up.  So you'll likely end up never knowing whether or not you had NGU or other STD.  There is also a chance that azithromcyin would transiently suppress but not cure some infections, especially if you happen to have gonorrhea; azithromycin in the standard 1 gram dose will cure only around 80% of gonorrhea.

I recommend you return to the clinic, perhaps with this thread printed out as a framework for discussion; or find another clinic with more experience with STDs (e.g. a public health STD clinic, Planned Parenthood, etc). Do it today if possible and no later than tomorrow, before the azithromycin has time to clear up your possible urethritis. Most likely the exam will be normal and no urethral WBC found -- but as I said earlier, better safe than sorry!

1,2) I suggest you hold off on unprotected sex with your wife until this is sorted out-- or at least until you know your gonorrhea/chlamydia tests are negative.

3) See above about a proper evaluation for urethritis.  If anything shows up (gonorrhea, chlamydia, NGU) then you should also have blood tests for HIV and syphilis -- routine whenever any STD is suspected.  Based on what is known so far, I would recommend against any other testing (herpes, hepatitis, etc).

[uhoh999]

I went to a local walk in care clinic (we have no specific STD clinic here and I have no primary care doctor). They took a urine sample. Said results will come probably Monday.

I explained everything to the doctor and she didn't even do a physical examination of my penis because she said it doesn't sound like too much is going on, which agrees with what you had to say. She didn't really comment on the sticking of the urethra.

She gave me 1g of azithromycin saying that it will take care of anything if something is present.

What are your thoughts on this? It brings up a couple questions:

1. I just took the dose. How long until I'm not contagious to my wife on the chance I have something?

2. At what point would it be safe to resume unprotected sex with my wife? (This hasn't happened since the original incident so she is not at risk)

3. Should I have gotten any other testing? I can easily go back and request more. They have a lab right on site. My chances for any major STD are extremely low as you said (HSV, HPV, Syphilis, HIV).

Looking forward to your thoughts on my treatment. As always, I appreciate the help.

Hopefully our back and forth has helped or will help others.

[H. Hunter Handsfield, M.D.]

This could be from slight discharge dries and casues the sticking.  It would be wise to get professionally evaluated by a provider with STD experience.  Nothing may show up, but better safe than sorry.  Don't test yourself via an online service or lab, and don't take any antibiotics before you have been seen.  If possible, see the doctor or clinic when you haven't urinated for a few hours, for more accurate evaluation of possible discharge.  I'll be interested to hear what is found, if anything.

[uhoh999]

Just a follow up with a new symptom. The opening to my urethra seems to stick together slightly now. This started yesterday morning. The weird feeling in my bladder is basically gone. The sensation in the tip of my penis has subsided a bit.

Does this new symptom cause any concerns or change your opinion?

[uhoh999]

Thank you. I can definitely understand that being the case. I appreciate all the help.

[H. Hunter Handsfield, M.D.]

Another typical symptom of genitally focused anxiety, causing increased tension in the bladder muscles.  This results from the same mechanism by which stress causes tension headaches, but applied to the genital tract.  Such symptoms are common in men who are worried about STD or who feel shame, guilt, or anxiety over a sexual choice they regret.

Of course get medical care if this or other symptoms persist or you otherwise remain concerned.  If you do, you can definitely expect no STD will turn up.

[uhoh999]

Doc, I'm still having a feeling of constant urge to urinate. No noteworthy pain/burning, really, but feels as if my bladder is full constantly, and almost as if something is in the tip of my urethra. I've had that feeling since the morning after, and it hasn't really gotten any better. It's been close to 3 days since the encounter now. Just wanted to know your thoughts. Will this eventually go away, or could it be STI related or could it be related to something else entirely?

[uhoh999]

Thank you very much. You have helped me more than you know.

[H. Hunter Handsfield, M.D.]

Extremely low -- as a guess, no more than one chance in a few thousand for any STD you can think of.  Oral sex is low risk of all STDs (gonorrhea, syphilis, herpes, HPV, NGU) and zero risk for some, such as HIV, chlamydia, and hepatitis B and C.  I never recommend any STD testing after a single oral sex exposure, unless there are typical symptoms.  If I were in your situation, I would not be tested for anything and would continue unprotected sex with my wife without concern.

[uhoh999]

Thanks, Doc. I really appreciate the help.

What are the odds of catching something more serious than those two STIs from oral sex as I described?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Your symptoms for sure are not due to any STD from the event described, for several reasons.  First, no STD (or any other infection) can start to cause symptoms 12 hours later.  36-48 hours is the minimum.  Second, STDs generaly do not cause the symptoms you describe.

These symptoms are typical for genitally focused anxiety, probably because you regret or are otherwise worried about a sexual decision you regret.  I doubt the symptoms are due to sexual arousal without release, but I cannot say for sure that has not contributed.  But the important thing is that the symptoms truly are not suggestive of STD.

Finally, your statement "Probably all in my head?" is an important clue.  Whenever someone suggests his or her own symptoms have a psychological origin, usually that is exactly the case.

So testing for STDs is optional.  But if you decide to do it, 60 hours is not too soon at all.  By that time, gonorrhea and chlamydia tests both would be valid.  So if you would find the negative results reassuring (and I stress that I definitely would expect them to be negative), by all means go ahead and do it.

I hope this has helped.  Best wishes--  HHH, MD