[Question #12716] Possible NGU

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5 months ago

Hello Doctors, about a week ago, I asked a question [#12697] about my STD testing experience and symptoms. I'm opening this new thread because I've developed new symptoms. My exposure was on December 30th (unprotected oral, protected vaginal with a sex worker). About two weeks later, I experienced discomfort while urinating, urethral pain (mostly post-urination and randomly), frequent urination, and a sensation of discharge, though none was visible. My chlamydia, gonorrhea, and trich tests were negative at 18 days post-exposure. No blisters or lesions were present. These symptoms lasted two weeks and subsided.

At 45 days post-exposure, I tested negative for all common STDs, including HSV-1/2. However, five days ago, the urethral pain returned—mostly post-urination and at random times. I sometimes feel like there is discharge, but none is visible even when squeezing my penis head. Sometimes it feels like there is something inside my penis hole. The pain is mild to moderate and has been decreasing, it was more present in the first 3 days. Still, no blisters or lesions have appeared.

Could these symptoms be due to NGU? Also, I’ve read about Herpetic Urethritis from Dr. Handsfield when I searched previous questions could that be a possibility?

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5 months ago
Also, I would like the know the accuracy of the HSV1 and 2 igG tests at 45 days post exposure
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Edward W. Hook M.D.
5 months ago
Welcome back to the Forum although I'm sorry you felt the need.  As I said during our prior exchange "Your symptoms are not those typical of ANY STI, including HSV.  Instead your symptoms suggest what we call genitally focused anxiety in which persons concerned about possible STI  are so focused on looking for signs of infection that they notice what are otherwise normal sensations, as well as anxiety symptoms.  Those who then repeatedly examine themselves tend to cause irritation through repeated self-examination adding to their symptoms."  At that time I also suggested you work with your doctor to determine the origin of your prior symptoms.

That remains my recommendation.  The symptoms or NGU as well as herpetic urethritis do not come and go in the nature that you describe.   Nor do they occur post urination.

At 45 days the majority (estimates vary) of persons with newly acquired HSV will have a positive test. 

EWH

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5 months ago
Dr Hook, thank you for your reassurance. One of the main contributors to my anxiety is my recent Urgent Care visit. When I went to Urgent Care and spoke about my recent exposures, I informed the clinician that I was not able to shower directly after my encounter. The clinician informed me that this along with being uncircumcised raises my chances for STD's, particularly HSV. Is that true?  

Furthermore, I spoke in a previous post about how i became sick with a flu-like illness, the day after my exposure. This means that whatever flu that I had was incubating during my sexual encounter right? My questions are: 

 Does this raise the chances of being infected with an std since I assume that the immune system is compromised? 
How common is it to have flu-like symptoms with no noticeable outbreak? 
How common is it to have HSV with no outbreak?
Does a condom really only protect 65% against HSV? 
How often have you seen a test become positive after 6 weeks?

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Edward W. Hook M.D.
5 months ago
Sigh.  The urgent are doctor you spoke with misinformed you.  There are no data to suggest that failing to shower following your encounter is associated with STI risk.  

A flu-like syndrome is a set of symptoms, not a diagnosis.  It can be caused by many different processes including COVID, influenza and a wide variety of community acquired no STI viral infections.  Incubation time vary.

With regard to your specific questions:
 Does this raise the chances of being infected with an std since I assume that the immune system is compromised? 
See above.  you have been misinformed

How common is it to have flu-like symptoms with no noticeable outbreak? 
For herpes?  Quite unusual

How common is it to have HSV with no outbreak?
Les than 25% of persons who have HSV do not report a classical outbreak.  Many of those people have misidentified their initial outbreak

Does a condom really only protect 65% against HSV? 
For persons with multiple exposures to infected partners.  

How often have you seen a test become positive after 6 weeks?
I presume that again you are asking about herpes.  Estimates vary as I said above

You really need to find a way to address your apparent guilt/anxiety and move forward.  If you cannot do so yourself ( and it appears you cannot), I would suggest you seek professional confidential counseling.  You have one follow-up remaining.  After that the thread will be closed and no more of your baseless, anxiety-driven questions will be answered.  EWH

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