[Question #1540] Could my urethritis symptoms be HSV or yeast related?

44 months ago

About 8 weeks ago I had brief unprotected anal sex as the insertive top using a silicone lubricant. I pulled out before ejaculating and cleaned up before returning to bed but don’t remember urinating until morning. About 2 days later I noticed a mild burning sensation after urination. By day 5 it hadn’t gone away so I went to get tested for chlamydia, gonorrhea, HIV and syphilis. Two weeks later those tests came back negative so I met with a doctor who suspected a UTI and prescribed Nitrofurantoin for 7 days.

 

No change in initial symptoms other than added urinary frequency and what felt like difficulty emptying my bladder completely. After day 6 on Nitrofurantoin, I had a urine culture done to retest the STDs as well as bacteria, all which came back negative. Thinking this could have been a false negative, however, since I was still just finishing the Nitrofurantoin.

 

Next doctor put me on Cipro for 10 days. During this time I felt like the urinary frequency and inability to empty my bladder (dribbling at times) completely intensified, mild burning sensation remained unchanged. I made it to day 9 when I broke out in a familiar rash around my anus (I’d previously had an external yeast infection after a similar encounter several years ago which is why yeast is suspected) the doctor immediately recognized was in fact yeast, prescribed me the single dose of fluconazole thinking that would fix everything. The rash did clear up by the end of the next day, but symptoms (seemingly more mild for a couple days) remained unchanged.

 

A week later I was able to see my PCP who diagnosed me with NGU (although he didn’t physically inspect me). He prescribed two more rounds of the fluconazole just in case as well as Flomax to ease up on the urinary issues. I waited another week with no change in symptoms other than slight relief with frequency/flow etc.

 

I then met with another doctor who agreed the possibility of a false negative on the bacteria in my initial urine culture so he prescribed 10 days of Doxycycline to try until I can see a urologist. I’m now on day 6 of the Doxycycline but symptoms persist with no noticeable change other than the return of frequency/trouble emptying/dribbling. I think the Flomax helps, but it seems like the antibiotics make the urinary frequency (even if I don’t have to go) / dribbling worse.

 

The burning sensation is constant, comes and goes a little but it’s still there yet very mild, almost a nagging if that makes sense. I haven’t had any blatant visible symptoms other than the yeast overgrowth after the first two rounds of antibiotics. No back pain, no discharge, no redness around my urethra or any of that. The only symptoms I continue to have are occasional left testicle pain, the mild burning after (not during) urination, the frequency and occasional dribbling/split stream urine. Masturbating seems normal although sperm has been reduced since starting the Flomax (I think this is normal). Energy levels have been normal if not better than normal. I workout about 5-6 days a week with no problems. I did notice a spermatocele around my left testicle and a darker vein (varicocele I think?) down the center of my scrotum but I’ve never really paid that much attention so it could have been there for some time for all I know.

 

I guess my question is whether it’s likely related to HSV1/ HSV2 or if it’s possibly a systematic yeast infection in/around the bladder that’s been resistant to the fluconazole/probiotics possibly being exacerbated by the antibiotics. None of the doctors I’ve seen have suspected HSV even though I did encounter a post-gym eye infection this summer that ended up being viral. I know HSV1 can cause eye infections but I’m not sure how that could/would affect the symptoms I’ve been having. To date I don’t ever remember a “typical” outbreak of any kind in the genital region. I don’t get outward mouth sores or any of that. I hardly ever even have a cold. Occasionally (usually after eat acidic or spicy food) I’ll get a small what I think is a mucocele inside a cheek but usually goes away with a good brushing and mouthwash. My diet is primarily low-carb, low-sugar, high protein. I drink tons of water, very little if any soda and all that. Alcohol habits, maybe 2 on a Saturday. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
You've really had a lot going on down there, unfortunately. 
I'm not suspecting herpes in this situation.  Your symptoms have been pretty constant, rather than the intermittent nature of herpes.  And the lack of lesions is very significant.  Not sure why these antibiotics are making things worse.  You've been tested for STI's - was herpes testing included in that testing?

Terri
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44 months ago
Initially I was tested for the usual suspects.. chlamydia and gonorrhea with routine hiv and syphilis. I didn't have any visible symptoms so they didn't test for hsv. When I had the urine culture done post negative results from that, she just retested for chlamydia and gonorrhea again, plus bacteria (all negative). The only indicator for me and HSV (from what I assume would have been type 1) is the eye infection this past summer. I just wondered if maybe the two were somehow related or if unprotected intercourse could trigger something like that. The Doxycycline seems have some affect (maybe placebo out of sheer hope) but nothing completely noticeable at after 6 days. I've been taking a yeast specific probiotic so no sign of overgrowth reaction to the Doxy yet.  I'm going to see a urologist on my own (can't find one for available for another month). My PCP specializes in geriatrics so he's not super privy with sex related questions (his last attempt was clotrimazole). If you don't suspect HSV, is it possible to still be bacteria related even after three antibiotics? Would I be better to finish the Doxy,  wait for it to clear my system and have a urine culture done again in case the first was a false negative due to the Nitrofurantoin I was on? Would it be worth it to try an antiviral? Idk how specific they can get with testing or if a positive HSV1 test would even prove anything as being the cause. Trying to figure out the best course of action leading up to seeing the urologist so I can don't have to wait even longer for testing after seeing them. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I don't recommend that people take antivirals in your situation because at some point in the near future, you may decide to do more testing and the antiviral can interfere with that testing, so not, not my recommendation.  I don't know what to make of your situation, honestly, I think the visit to the urologist will prove helpful.  Go ahead and finish the doxy - sometimes it takes another week for symptoms to go away after finishing the antibiotics so give it a good chance.  That will also bring you closer to the urology visit.  Another thing you can do is to let the urology office know that you would like to be on a cancellation list - you might get in sooner.

Terri
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