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STDs (Expert Forum)
Oral Sex - Urethritis
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Oral Sex - Urethritis
by SoVeryWorried, Apr 29, 2006 12:00AM
Hi Doctor, thank you for your helpful forum. I am 24/male. I have had no sexual contact for 2 years until a month ago when I visited a prostitute who gave me unprotected oral sex only for ~10 min and insertion was deep. I released in her mouth and I know that other customers do too. She seems uneducated and knows little about STD¡¦s (though she uses condoms for genital-genital sex).
Symptoms:
2 Weeks: I got a fever (fatigue, back/muscle ache, etc) for a week.
2.5 Weeks: Soreness/pain in my shaft/tip of penis, as well as pressure in my groin/testicles. I got checked for STD¡¦s and all was negative (gonorrhea, Chlamydia, syphilis, HIV). Also, sporadic itching in general groin area (was prescribed Ketoconazole cream for that).
3 Weeks: One night symptoms escalate quickly. My testicles feel incredibly heavy. Constant urination and constipation. Abdominal pains. There is inflammation of the tip of my urethra (opening has become noticeably larger). I go to the Emergency Room and they find nothing in my urine test but they still give me 4 pills of Zithromax and a shot of Rocephin (250mg). I feel immediately better.
4 Weeks: Symptoms are milder but still present.
My questions are:
1. The doctors did not determine what the cause(s) of the symptoms was. I got negatives for gonorrhea, Chlamydia, syphilis. It seems to me that I have NGU. What do you think I might have and should do?
2. I went to ER due to lots of pain in my groin. I was wondering about the chances of Sterility from something like my incident due to NGU or whatever disease I might have gotten. Should I get an ultrasound for epidemitis?
3. I am Most Terrified about contracting genital warts from the prostitute. I did not check her mouth for lesions/warts as I should have. I know that oral warts are rare, but this lady (~30 yr/old) is very promiscuous and has unsafe oral sex. Prostitutes are ¡§supernodes¡¨ of STD transmission. Could she have multiple strains of HPV in her oral cavity and could they be symptomatic due to other infections in her mouth? Please assess my risk of getting infected with HPV from this single exposure. I am also uncircumcised which increases my worries. I don¡¦t think asymptomatic males can get tested right? Could multiple strains of HPV infect my genitalia in a huge cauliflower explosion?
4. I don¡¦t think I have genital herpes because it¡¦s been 4 weeks now and I examine my penis everyday and see no symptoms. Is it safe to say that I am home-free for this STD?
5. Lastly, your forum is very helpful. Your advice seems optimistic and hopeful. I am still a bit concerned. You say that oral warts are very rare, but there seems to be a good amount of information on it on the web. You have said that most infections are due to repeated/frequent exposure (though recently an HIV+ pornstar spread the disease multiple times from single episodes). Does this apply to my case with an unsafe prostitute?
Thank you so very much.
Traumatized,
SoVeryWorried
Symptoms:
2 Weeks: I got a fever (fatigue, back/muscle ache, etc) for a week.
2.5 Weeks: Soreness/pain in my shaft/tip of penis, as well as pressure in my groin/testicles. I got checked for STD¡¦s and all was negative (gonorrhea, Chlamydia, syphilis, HIV). Also, sporadic itching in general groin area (was prescribed Ketoconazole cream for that).
3 Weeks: One night symptoms escalate quickly. My testicles feel incredibly heavy. Constant urination and constipation. Abdominal pains. There is inflammation of the tip of my urethra (opening has become noticeably larger). I go to the Emergency Room and they find nothing in my urine test but they still give me 4 pills of Zithromax and a shot of Rocephin (250mg). I feel immediately better.
4 Weeks: Symptoms are milder but still present.
My questions are:
1. The doctors did not determine what the cause(s) of the symptoms was. I got negatives for gonorrhea, Chlamydia, syphilis. It seems to me that I have NGU. What do you think I might have and should do?
2. I went to ER due to lots of pain in my groin. I was wondering about the chances of Sterility from something like my incident due to NGU or whatever disease I might have gotten. Should I get an ultrasound for epidemitis?
3. I am Most Terrified about contracting genital warts from the prostitute. I did not check her mouth for lesions/warts as I should have. I know that oral warts are rare, but this lady (~30 yr/old) is very promiscuous and has unsafe oral sex. Prostitutes are ¡§supernodes¡¨ of STD transmission. Could she have multiple strains of HPV in her oral cavity and could they be symptomatic due to other infections in her mouth? Please assess my risk of getting infected with HPV from this single exposure. I am also uncircumcised which increases my worries. I don¡¦t think asymptomatic males can get tested right? Could multiple strains of HPV infect my genitalia in a huge cauliflower explosion?
4. I don¡¦t think I have genital herpes because it¡¦s been 4 weeks now and I examine my penis everyday and see no symptoms. Is it safe to say that I am home-free for this STD?
5. Lastly, your forum is very helpful. Your advice seems optimistic and hopeful. I am still a bit concerned. You say that oral warts are very rare, but there seems to be a good amount of information on it on the web. You have said that most infections are due to repeated/frequent exposure (though recently an HIV+ pornstar spread the disease multiple times from single episodes). Does this apply to my case with an unsafe prostitute?
Thank you so very much.
Traumatized,
SoVeryWorried
Doctor's Answer
by H. Hunter Handsfield, M.D., Apr 29, 2006 12:00AM
, Apr 29, 2006 12:00AM
You clearly have no active infection and probably never did. I don't know what you mean by feeling better "immediately" after the antibiotics. If you mean under 24 hours, it suggests your symptoms were mostly emotional. Zithromax and Rocephin require at least 24-48 hours before treatment starts to result in reduced symptoms. Anyway, you can rely on the the negative exam and tests in the emergency department.
1) Most likely you had no infection at all, but some sort of nonspecific inflammation, or just anxiety-related magnification of normal body sensations. In any case, the antibiotics would have cleared up any infection that could have caused your symptoms.
2) Groin pain generally is not a symptom of any STD. Epididymitis causes excrutiating pain and swelling of a testicle, not the groin.
3) HPV is not transmitted to the genitals by oral sex, and condoms are highly protective for genital exposure. Anyway, you probably already have been infected with HPV; almost everybody gets genital HPV somewhere along the line; it's normal. Don't worry about it. (By the way, in the US most prostitutes are not major vectors of STD transmission).
4) It's safe to say you are home free from any and all STDs, including herpes.
5) In 30 years in this business, I have never seen a case of genital warts that appeared to have been acquired by oral sex.
Good luck-- HHH, MD
1) Most likely you had no infection at all, but some sort of nonspecific inflammation, or just anxiety-related magnification of normal body sensations. In any case, the antibiotics would have cleared up any infection that could have caused your symptoms.
2) Groin pain generally is not a symptom of any STD. Epididymitis causes excrutiating pain and swelling of a testicle, not the groin.
3) HPV is not transmitted to the genitals by oral sex, and condoms are highly protective for genital exposure. Anyway, you probably already have been infected with HPV; almost everybody gets genital HPV somewhere along the line; it's normal. Don't worry about it. (By the way, in the US most prostitutes are not major vectors of STD transmission).
4) It's safe to say you are home free from any and all STDs, including herpes.
5) In 30 years in this business, I have never seen a case of genital warts that appeared to have been acquired by oral sex.
Good luck-- HHH, MD
I am a virgin and have only received oral sex before from one girlfriend, the only sexual contact in my life other than the escort. I don't believe I could have HPV, and if I did, it would most certianly be from the escort. When you say that 3 or more lifetime sex partners results in HPV, do you mean that HPV was contracted through unprotected genital sex? I don't see how that can be possible. If oral sex was a vector for HPV transmission, then that would make more sense (with people cheating on each other ie.)
If prostitutes are not major vectors for STD transmission, is that because unprotected oral sex is not a "high-risk" form of sex? My doctor says that it is.
I would be a controlled study to determine if HPV can be contracted via oral sex. When you say that your years in the field have not shown that oral