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What does white tongue and bad taste in mouth 2 years after performing cunninglingus indicate?

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Posted on Mon, 18 May 2015
Question: Hi, i performed oral sex on a prostitute (cunninglingus) in august 2013, its been almost 2 years, and im still suffering from -
symptopms-
1. white tongue
2. bad taste in mouth (metallic taste)
3. split urine streams
4. the stools are extremely lose, and they slip up like grass when they go into water
5. the food is undigested and i can see what i have eaten in my stools clearly
6. always feel tiredness, want to sleep
7. always irritation in my penis and relaxes after i masturbate but returns in 1 hours.
8. always burning and itching in my ass.
9. my lips are sticky, the part where i sucked her vagina, they still feel sticky when i put my tongue on my lips and my tongue is hairy white.

blood tests done -
1. std panel - negative (herpes, hiv, chlamydia, gonorrhea, syphillis)
2. hepatitis panel - negative
3. urine routine and culture - negative
4. stool routine and culture - negative
5. complete blood count - white blood cells were little higher than normal and esr was a little low.

a)whenever i have taken antibiotics, i feel so much better for first 7 days but after that , all the symptoms come back again.

b) i feel so depressed, i dont know what to do, i feel like committing suicide because no one can diagnose my problem

c) after all this , someone told me that it might be allergy to that women's vagina fluid that my body is reacting and cannot accept her fluid and constantly trying to fight, thats why im having mucus in stool and that irritating feeling ...

is it due to allergy to her vaginal fluid or something else? could this be some disease ?
what test should i do now? and what medications should i try.... pls help me
doctor
Answered by Dr. Prasanna Heijebu (2 hours later)
Brief Answer:
Possible fungal infection.

Detailed Answer:
Hi Sir.

I understand your concern.

I have gone through all your mentioned symptoms in detail.

This could possibly be orogenital candidiasis,a fungal infection.

Since STD screen is negative,you need not worry too much.

This is not a form of allergy.

Associated parasitic infection of the gut is also possibility.

I recommend you to take Tab FLUCONAZOLE/diflucan 200 mg PO on Day 1, THEN 100 mg once a Day.

Treatment should be continued for at least 2 weeks to decrease likelihood of relapse.

Likewise tab Metronidazole 2gm PO single dose.

Please note these drugs have to be taken only under strict medical prescription.

Post your further queries if any.
Thank you.
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Prasanna Heijebu (2 hours later)
Already taken flucanazole 150 mg for 4 weeks,
and already taken metronidazole (flagyl) 400 mg for 15 days ,
6 months ago...
should i take them again...?

and yeah, if it was parasitic infection, im taking albendazole once every 2 weels///


and how it is related to irritation in urine...? like if i masturbate then i feel relaxed for 1 hour and again that irritation starts... why is that...?

and why it is not an allergy...?

i forgot to tell u.. that after that incident... i had worms in my stomach as well.... red thin worms..... but i dont see them now in my stools....
doctor
Answered by Dr. Prasanna Heijebu (19 hours later)
Brief Answer:
Possible nematode gut infection.Can lead to allergy as well

Detailed Answer:
Hi Sir.

I understand your concern.

In case if you have not responded to fluconazole,its wise to prefer higher antifungal like Voriconazole. This drug is taken as 200 mg PO twice a day for 14 days.

Likewise tab Pyrantel pamoate 11 mg (base)/kg PO once a day for 3 days; not to exceed 1 g/dose .Red thin worms could be nematode infection

I have one more suggestion, that is to get a stool test for microscopy for ova and parasites, and culture to check for any infection. You have mentioned about worms in your stomach, how did you see them? During an endoscopy? Also since you have already tried taking fluconazole and it hasn't receded, I think taking a scrapings of tongue and observing under microscopy and culturing too will give an idea of which organism it is and will also tell us a specific antibiotic to use. Similar for urine culture and microscopy too. So I know it may be an ordeal, but if you can visit a lab and request them for all these tests, with your GP's prescription for these tests, it will be very helpful.

Please note these drugs have to be taken only under strict medical prescription.

Since now you have mentioned worms in your gut,there is high possibility of allergic/hypersensitivity reactions affecting your anal and penile area.This might certainly contribute to irritation and itch in those areas.

Masturbation can cause relief by central action through brain exerting a sense of relief.Its not related to elimination of allergy.

Thank you.
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Prasanna Heijebu (1 hour later)
Thnx doctor for ur suggestion,
i have already done stool routine and culture and stool routine and culture but all came back negative

I saw red thin worms in my toilet stuck to my stools...i saw them with naked eye, but doctor gave me some medicine i think albendazole, i dont remember the name, but it got fine after that and i never saw them again, and also im taking albendazole once every 2 weeks from so many months,,,,

i took (ofloxacin 200mg + ornidazole 500mg) tablet , and i feel much better,

and i bought 14 flucanazole tabs as well,

and that earlier doctor told me, to complete this ofloxacin + ornidazole for 10 days and then diloxanide fluorate 500 mg for 10 days, that will clear any amoebiasis u have....

now doctor, u tellme , after completing these medications....
(ofloxacin 200 mg + ornidazole 500 mg ) , flucanazole (150mg)
and then diloxanide for 10 days....

then after that, what medications should i take..?
Pyrantel pamoate , Voriconazole... both to be taken for how many days?...and in how much quantity...?
doctor
Answered by Dr. Prasanna Heijebu (21 hours later)
Brief Answer:
Need to start higher drugs as described in detail below.

Detailed Answer:
Hi Sir,

Welcome again.

Since there is recurrence in your case,you need to take higher antifungals.

So I would stringly suggest that you take Tab.Voriconazole 200 mg PO twice a day for 14 days. Likewise tab Pyrantel pamoate 11 mg (base)/kg PO once a day for 3 days; not to exceed 1 g/dose.

Please remember that any change in the dosage or use of your existing medications needs to be discussed with your prescribing doctor first, before making those changes. Likewise, starting new prescription medication will require a discussion face to face with your doc and a prescription.

Red thin worms could be nematode infection. The Pyrantel Pamoate is an antihelminthic agent (de-worming) that can help with that.

Post your further queries if any,
Thank you.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Prasanna Heijebu (4 hours later)
Hey doctor,

im already taking albendazole... how is pyrantel different from albendazole..?
i think they both are deworming tablets....
im taking albendazole 400 mg once every 14 days for so many months and even taking them now...

and regarding voriconazole, i did a blood test earlier which showed that i dont have candida infection... do i still have to take voriconazole...? im already taking flucanazole.... why do i need fungicide..?
and also, when i took flucanazole earlier, there was no improvement at all about the white tongue in my mouth...so i dont think it was a recurrence....
should i do a medical test before i start fungicide treatment with voricanazole, because voriconazole are extremely expensive, 4 tabs cost 1000 rupees, 14 days , 2 times would be 28 tabs, that it 7000 rupees.... should i do a blood test first to know that it is a fungus problem?
and i have heard that voriconazole is given to patients who are immunocompromised (hiv), what do u suggest...?

but when i take antibiotics , i feel much better but when i stop taking them, the problem starts again....

as of now, im taking (ornidazole 500 mg + ofloxacin 200mg) , and my stools are normal , there is much relief in the itching and irritation in anal and penile area, but when i will stop taking this medication, the problem will start again... so i want to know why is that...?
doctor
Answered by Dr. Prasanna Heijebu (23 hours later)
Brief Answer:
Get culture sensitivity for both stool and throat swab.

Detailed Answer:
Hi Sir.

I understand your concern.

Pyrantel is extremely effective against helmith infections.

Its superior to albendazole.

Instead of blood test I advise you to get a KOH test for thoat smear.

This along will culture in SDA medium will help to isolate candida if any.

Blood tests for candida are not conclusive.

Fluconazole is ineffective against certain species of candida.

These resistant strains are covered by voriconazole.

Voriconazole indication does not always imply immunocompromised state.

You need not worry of this fact since you already mentioned that your STD panel is negative.

I also recommend stool culture and sensitivity since you seem have relapsing symptoms while stopping ofloxacin and ornidazole.

Culture sensitivity has 100% accuracy in isolating pathogens and formulating therapy.

Post your further queries if any.
Thank you.


Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Prasanna Heijebu (1 hour later)
Thnx doctor ....

i visited a doctor and told him the entire thing to him and also about voriconazole....

he said to use 3 sets to get rid of worms....

set -1 -------------- use pyrantel pamaote 1g/day once for 3 days,

then, gap for 10 days

set - 2 -------------

nitazoxanide 500 mg twice for 3 days,
wait 3 days
and then Praziquantel 600 mg 3 days and albendazole 400 mg for 7 days
together.

then gap of 10 days,

set 3 ------------------

ivermectin - 12 mg once orally.


he said, that if u follow these 3 sets, all the worms in your gut will be finished, if u feel that the infection is coming back...
repeat these 3 sets in 4 weeks.

even if after these... your symptoms dont improve, then go for voriconazole 200 mg twice for 10 days.....

i want to know doctor,... are these tablets safe...? and are the sets are safe..?
and should i start taking voriconazole...if all these sets fail..?
doctor
Answered by Dr. Prasanna Heijebu (2 hours later)
Brief Answer:
Start Voriconazole only after culture sensitivity.

Detailed Answer:
Hi Sir.

I understand your concern.

Yes you have the 3 sets as prescribed by your doctor.

It will eliminate all the concerned parasites.

These tablets are relatively safe.

These are well tolerated by most individuals.

I advise you to start voriconazole after you get throat swab for culture and sensitivity for candida or other related organisms.

Post your further queries if any.
Thank you.


Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Prasanna Heijebu (14 hours later)
Hey doctor,

1. Are u sure that if i follow these 3 sets, then all the worms in my gut will be finished...? like flukes, tapeworms etc...

2. Do the above 3 sets cover every kind of parasitic infection...?

3. How much gap should I have in between each set...? the doctor told me to wait 10 after every set to rest the liver...

4. Is there any drug left for the treatment of parasites that is no included in the above 3 sets...?
doctor
Answered by Dr. Prasanna Heijebu (16 hours later)
Brief Answer:
Ten days time is allowed between each set.

Detailed Answer:
Hi.

You have been prescribed all kinds of necessary medications required to expel all the parasites from your gut including flukes and tapoeworms.

A minimum of ten days is allowed between courses to provide rest to liver.

No drug is left untouched to treat you gut infestation.
I totally agree with your doctors prescription.

Thank you
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Dr. Prasanna Heijebu

General & Family Physician

Practicing since :2010

Answered : 1422 Questions

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What does white tongue and bad taste in mouth 2 years after performing cunninglingus indicate?

Brief Answer: Possible fungal infection. Detailed Answer: Hi Sir. I understand your concern. I have gone through all your mentioned symptoms in detail. This could possibly be orogenital candidiasis,a fungal infection. Since STD screen is negative,you need not worry too much. This is not a form of allergy. Associated parasitic infection of the gut is also possibility. I recommend you to take Tab FLUCONAZOLE/diflucan 200 mg PO on Day 1, THEN 100 mg once a Day. Treatment should be continued for at least 2 weeks to decrease likelihood of relapse. Likewise tab Metronidazole 2gm PO single dose. Please note these drugs have to be taken only under strict medical prescription. Post your further queries if any. Thank you.