Aa
Worried about mystery
I have been diagnosed with epididymitis and would like some help and input as to the possibility of STD.
Until last weekend, I was monogamous with the same woman for three years and neither of us have/had ever been symptomatic of any STD. Prior to last weekend, I had not had sex for about two months.
A couple of months ago, I had some very minor itching at the base of my urethra. No pain or burning or discharge - just a bit of an itch. It resolved in a couple of days and I haven't had any such symptoms since.
Last weekend, I had unprotected oral sex (she gave me head) and then had protected vaginal sex with a woman I had not had sex with before. Probably irrelevant, but she was completing treatment for strep throat at the time (at the end of a course of penicillin; she'd not been symptomatic for several days). We used a condom throughout the vaginal sex and the condom remained intact.
About 2-3 days after that sexual encounter (early to middle of this week) I began to feel a fullness behind my left testicle. I had (and have) NO other symptoms - no discharge, no urethritis, no pain or burning when urinating; nothing. Everything seems totally normal except the swelling epididymis. I sought medical treatment this weekend and, after an ultrasound to rule out torsion, was diagnosed with epididymitis.
The doctor was fairly aggressive about the possibility of STD. They have taken samples to test for gonorrhea and chlamydia. I do not yet have these results but of course am worried sick that I somehow contracted something, despite its unusual presentation and the use of a condom... I realize there are a lot of other things that can cause epididymitis, but it just seems like too much of a coincidence to be unrelated to my sexual encounter.
I was given Cipro 500mg 2x day for 10 days. I started the Cipro late yesterday, but (perhaps due to an optimistic imagination) the swelling does seem to be subsiding a bit.
Thank you.
Until last weekend, I was monogamous with the same woman for three years and neither of us have/had ever been symptomatic of any STD. Prior to last weekend, I had not had sex for about two months.
A couple of months ago, I had some very minor itching at the base of my urethra. No pain or burning or discharge - just a bit of an itch. It resolved in a couple of days and I haven't had any such symptoms since.
Last weekend, I had unprotected oral sex (she gave me head) and then had protected vaginal sex with a woman I had not had sex with before. Probably irrelevant, but she was completing treatment for strep throat at the time (at the end of a course of penicillin; she'd not been symptomatic for several days). We used a condom throughout the vaginal sex and the condom remained intact.
About 2-3 days after that sexual encounter (early to middle of this week) I began to feel a fullness behind my left testicle. I had (and have) NO other symptoms - no discharge, no urethritis, no pain or burning when urinating; nothing. Everything seems totally normal except the swelling epididymis. I sought medical treatment this weekend and, after an ultrasound to rule out torsion, was diagnosed with epididymitis.
The doctor was fairly aggressive about the possibility of STD. They have taken samples to test for gonorrhea and chlamydia. I do not yet have these results but of course am worried sick that I somehow contracted something, despite its unusual presentation and the use of a condom... I realize there are a lot of other things that can cause epididymitis, but it just seems like too much of a coincidence to be unrelated to my sexual encounter.
I was given Cipro 500mg 2x day for 10 days. I started the Cipro late yesterday, but (perhaps due to an optimistic imagination) the swelling does seem to be subsiding a bit.
Thank you.
MEDICAL PROFESSIONAL
Chlamydia is rarely if ever acquired by oral sex. Contrary to popular assumptions, chlamydia rarely infects the mouth or throat, so there is nothing to transmit to a partner's genitals. (The most recent research on this was done by my colleague on this forum, Dr. Hook.) For vaginal exposure, a condom should be virtually 100% protective. The incubation period of chlamydial epididymitis has not been studied, and maybe onset in 2-3 days is possible, but it seems unlikely.
Statistically, therefore, it seems unlikely the most recent exposure is the source of your infection. However, it might be possible. But my best guess is that your former partner was infected toward the end of your relationship. You imply but don't state directly that that relationship is over.
A very common sexual behavior -- only recently coming under investigation -- is called "concurrency". It means that new sexual relationships often begin before previous ones end. If you think about it, this makes sense, and the evolving research shows that it is responsible for lots of STDs. However, whether this makes sense in your situation -- i.e., whether it is likely your partner started seeing someone else before your relationship ended -- is not something I can judge, only you can do that.
Usually it isn't worth the emotional energy to try to figure out for sure who was infected first. Just make sure your former partner is treated for chlamydia. She should receive treatment even if she is tested and found to be negative.
Statistically, therefore, it seems unlikely the most recent exposure is the source of your infection. However, it might be possible. But my best guess is that your former partner was infected toward the end of your relationship. You imply but don't state directly that that relationship is over.
A very common sexual behavior -- only recently coming under investigation -- is called "concurrency". It means that new sexual relationships often begin before previous ones end. If you think about it, this makes sense, and the evolving research shows that it is responsible for lots of STDs. However, whether this makes sense in your situation -- i.e., whether it is likely your partner started seeing someone else before your relationship ended -- is not something I can judge, only you can do that.
Usually it isn't worth the emotional energy to try to figure out for sure who was infected first. Just make sure your former partner is treated for chlamydia. She should receive treatment even if she is tested and found to be negative.
MEDICAL PROFESSIONAL
If your doc is experienced in recognizing and treating epididymitis, I have to respect his diagnosis. However, you don't describe a typical case. Epididymitis usually causes more dramatic pain, swelling, and tenderness than you describe. Also, sexually acquired epididymitis always has urethritis (urethral infection), with some combination of abnormal discharge, white blood cells in urethral secretions or urine, and/or positive tests for gonorrhea or chlamydia. There are nonsexually transmitted cases; they tend to occur in men over age 35 or those with underlying urinary tract problems (e.g., someone who recently had urinary tract surgery, congenital anomalies like urethral stricture, and so on). It also can occur as a side effect of certain medications (most classically amiodarone, sometime used for heart rhythm disorders).
If indeed you have sexually acquired epididymitis, most likely it goes back to an exposure before the exposures last weekend. Receiving fellatio can result in nongonococcal urethritis (NGU), perhaps sometimes due to normal oral bacteria. If orall acquired NGU leads to epididymitis, it is rare; no such case has been reported in the medical liturature and I have never seen such a case. Chlamydia (by far the most common cause of sexually acquired epididymitis) isn't caught through oral sex; gonorrhea can be, but almost always causes overt urethritis, with discharge etc. Perhaps the pending tests will prove me wrong, but I'm betting they will be negative.
I can't make much of your past itching at the base of the urethra. However, itching IN the urethra, usually felt at the tip, can be a symptom of urethritis.
Also hard to make much of the apparent improvement in your symptoms in the past few hours. No antibiotic is likely to work that fast; most epididymitis requires 2-3 days before symptoms start to subside.
Final comment: Interesting that your doc chose ciprofloxacin. It usually would work, but is not completely reliable against either gonorrhea or chlamydia. However, it is commonly used for nonsexually acquired infections.
Bottom lines: 1) If the gonorrhea and chlamydia tests are negative, which is what I predict, you will then be confident that whatever you have--epididymitis or some other cause of testicular pain--wasn't sexually acquired. 2) Continue to follow up with your provider and follow his advice.
I hope this helps. Best wishes-- HHH, MD
If indeed you have sexually acquired epididymitis, most likely it goes back to an exposure before the exposures last weekend. Receiving fellatio can result in nongonococcal urethritis (NGU), perhaps sometimes due to normal oral bacteria. If orall acquired NGU leads to epididymitis, it is rare; no such case has been reported in the medical liturature and I have never seen such a case. Chlamydia (by far the most common cause of sexually acquired epididymitis) isn't caught through oral sex; gonorrhea can be, but almost always causes overt urethritis, with discharge etc. Perhaps the pending tests will prove me wrong, but I'm betting they will be negative.
I can't make much of your past itching at the base of the urethra. However, itching IN the urethra, usually felt at the tip, can be a symptom of urethritis.
Also hard to make much of the apparent improvement in your symptoms in the past few hours. No antibiotic is likely to work that fast; most epididymitis requires 2-3 days before symptoms start to subside.
Final comment: Interesting that your doc chose ciprofloxacin. It usually would work, but is not completely reliable against either gonorrhea or chlamydia. However, it is commonly used for nonsexually acquired infections.
Bottom lines: 1) If the gonorrhea and chlamydia tests are negative, which is what I predict, you will then be confident that whatever you have--epididymitis or some other cause of testicular pain--wasn't sexually acquired. 2) Continue to follow up with your provider and follow his advice.
I hope this helps. Best wishes-- HHH, MD
Yes, the prior relationship ended at the end of last year and she moved to another state. I will get in touch with her straight away so she can get tested and treated. I'm gratefull for all of your help and advice. It was good to have you here.
MEDICAL PROFESSIONAL
The more detailed description indeed suggests epididymitis. In men your age, most cases are due to nonsexually transmitted urinary tract infections. Most likely your urine culture will be positive for E. coli or other typical UTI organism.
Thanks so much, Dr. HHH.
A couple follow-ups.. I should have been more descriptive in my testicular narrative (but was running out of space) - it definitely became very full and tender posterior to the left testicle. I can feel the tubing behind it very swollen and tender, almost as if I'd grown a third, mushy testicle back there (sorry!). While only slightly painful, there's a considerable amount of fullness and tenderness. I'm not a urologist but it sure seems like epididymitis to me, too. So, while confident in the epididymitis diagnosis, I was confused on the STD front because while on one hand it seemed so unlikely to be sexually transmitted (since I am otherwise showing no symptoms of an STD such as urethritis discharge or the like), the coincident sexual experience seemed too timely to be ignored.
Also - assuming tests come back negative, the epididymitis has subsided, and I've completed the course of Cipro fully, is sexual activity OK again?
Thanks again for your help and advice. I appreciate it, and as you mention, certainly plan to follow up with the Dr. per Dr's instructions in a few days.
A couple follow-ups.. I should have been more descriptive in my testicular narrative (but was running out of space) - it definitely became very full and tender posterior to the left testicle. I can feel the tubing behind it very swollen and tender, almost as if I'd grown a third, mushy testicle back there (sorry!). While only slightly painful, there's a considerable amount of fullness and tenderness. I'm not a urologist but it sure seems like epididymitis to me, too. So, while confident in the epididymitis diagnosis, I was confused on the STD front because while on one hand it seemed so unlikely to be sexually transmitted (since I am otherwise showing no symptoms of an STD such as urethritis discharge or the like), the coincident sexual experience seemed too timely to be ignored.
Also - assuming tests come back negative, the epididymitis has subsided, and I've completed the course of Cipro fully, is sexual activity OK again?
Thanks again for your help and advice. I appreciate it, and as you mention, certainly plan to follow up with the Dr. per Dr's instructions in a few days.
Sorry, Dr. H I realise you are busy but I wanted to clarify my post - my big question is: with epididymitis showing up only a few days after the most recent sexual encounter, what are the chances that the chlamydia was contracted on that recent sexual encounter? I thank you for your help.
Well Dr. H, much to my surprise I received a phone call from the doctor tonight that said the test came back positive for chlamydia. He is prescribing a single dose of azithromycin. I'm quite stunned and trying to figure out the source. How likely is it that it was the recent contact? It just seems so atypical a presentation, I'm trying to do as much homework as I can. Thanks.
BTW, you mention age, and I did not.. I am 42.
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