[Question #13737] Herpetic urethritis or something else?
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1 months ago
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Hello! Thanks again for offering this service.
I had unprotected vaginal and oral sex with a trusted, regular partner on 1/10. I had protected vaginal sex with another partner on 1/12. The unprotected partner has since been tested and all was negative and she's noted no symptoms.
On 1/17, I noticed some very slight urinary discomfort but shrugged it off. On 1/18, it became more painful when urinating and slightly after.
I went to urgent care on 1/18 and described the symptoms to the NP. They did a urine dip, which was normal and sent off a sample for testing. They suspected cystitis and prescribed cephalexin.
On 1/19, I woke up and noticed some whitish discharge coming from my penis and more painful urination. I called urgent care again and they said given the discharge they suspected an STI and would go ahead and prescribe doxy while I wait for test results. I discontinued the cephalexin and started the doxy.
I received test results late on 1/19 and was negative for Chlamydia, Gonorrhea, trichomoniasis, ureaplasma, and mycoplasma. The urine culture was also normal. They indicated the urine herpes test was positive though. The NP said she still doesn't think herpes is likely though because that's an unreliable test and I don't have any external lesions. She said she'd add BV to the testing as that could have entered my urethra and caused this irritation. No other potential causes for irritation are noted. As of this morning (1/20), the discharge seems less but the painful urination continues and I've felt some pain/pressure in my lower abdomen and back.
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1 months ago
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What are your thoughts on my situation? Is herpes likely? Do I need herpes blood or swab testing? Other testing? I am continuing to take the doxy thus far and figure by tomorrow (after 48 hours), whether my symptoms are responding to that will be informative. Does that make sense or should I consider stopping the doxy?
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Terri Warren, RN, Nurse Practitioner
1 months ago
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Wow. are you in the US? Urine testing for herpes is highly unusual and I'm wondering what lab would do that? and how they would do that? It might be useful to obtain a herpes IgG test, yes.
I think taking the doxy is the best thing, yes, and I hope that is useful in clearing up your urethritis. While you tested for a great many things, there are still some things that could have caused this situation. I assume your regular partner was also tested for everything? The thing is, if she has an untreated infection of some kind, you could get this again.
This isn't a simple situation because of 1) herpes positive from a urine test and 2) you were negative for some of the usual suspects that cause urethritis.
How are your symptoms now that you've been taking doxy?
Terri
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1 months ago
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Hi Terri - Thanks for your help here.
I just started the doxy about 27 hours ago (around noon on 1/19) - three doses total now. The last time I went pee may have been slightly less painful than this morning but it's hard to say. So maybe it is too soon to really know? I figure by a full 48 hours in, it'll be obvious that it's either working or not. Does that seem reasonable?
My partner had STI testing done as part of a routine check up that happened to fall within this period. She indicated she was negative for everything though she didn't go through a list of what all her testing included. I shared the detail of what I was tested for though. She was not tested for herpes nor has she had any lesions or other symptoms. She's actually a doctor herself and also remarked how unreliable urine herpes testing would be.
I guess I'll monitor my symptoms, keep taking the doxy, and seek out herpes blood testing based upon your commentary. Let me know if you have further thoughts with the additional information.
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Terri Warren, RN, Nurse Practitioner
1 months ago
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If this is bacterial and something the doxy will treat, you might feel better in 48 hours, yes.
I think your plan is a good one - and if you notice any abnormal skin lesions on the penis, be sure to have them evaluated and swab tested, though I doubt that this is herpes.
I'm going to find out more about this urine test for herpes. Do you recall the name of the urgent care clinic? I could call and just ask what lab they use
Terri
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1 months ago
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Sounds good. Thank you.
I just gave them a call to check on the BV result anyway (not back yet) but I asked and they said they use Quest. I am going to try to see if I can get a copy of the lab results sent to me when they call back. I can let you know if I find more about what that herpes test is.
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Terri Warren, RN, Nurse Practitioner
1 months ago
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Interesting! I can look that up
Terri
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29 days ago
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As an update here, my symptoms are definitely becoming more mild. I haven't noticed appreciable discharge since starting the doxy and while it still burns when I pee, the pain has definitely decreased. Although, I have noticed the pain still varies a bit (maybe depending on dilution level of my urine?). I still don't see any lesions. Presumably the improvement can be attributed to the doxy, right? If so, that would be strong evidence that this is not herpes, right? Given that, would you still suggest herpes blood testing? I'm a bit confused given that I apparently had a positive herpes urine test. Is there risk to doing the blood test, such as a potential false positive there to cause further alarm? And if it were negative, would that be conclusive anyway?
All of that said, I'm curious if you've learned anything about the herpes urine test and what your advice would be given that and the update on my symptoms.
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Terri Warren, RN, Nurse Practitioner
29 days ago
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I don't see a urine test for HSV on Quest's lab list. Yes, it is likely that the improvement is due to the doxy.
Since we don't really know what's up with the herpes urine test, yes,I still think a herpes antibody test is warranted. The risk with the antibody test is false positive but the new IgG test available from LabCorp, made by Roche is very good with very few false positives. The issue is timing. And what's going on with your regular partner. It does get more complicated since she is the one with whom you had unprotected intercourse. Condoms reduce the risk of transmission by 65% so not perfect, the risk is still low. If your regular partner's test or has tested negative for herpes, that's good to know and you could go do an antibody test now. If you have a new infection, not enough time has passed to be sure you'll get an accurate result. You could just wait 6 weeks and do the Roche test with labCorp and the chances are, if you have herpes, it would be positive by then. This urine test has certainly complicated things. I would be tempted to call them and ask where the urine went to be tested or herpes and then you could find out more about it. You have exceeded the number of posts allowed here so I'm going to shut this down now. You can always pay for more questions if you wish
Terri
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