[Question #1598] Unprotected Sex - Possible Herpetic Urethritis?

45 months ago

Hello,

On December 16th I had unprotected sex with a stripper. I am starting to think that this was the biggest mistake of my life. About 3 days later I started to have mild burning/pain while urinating and then pain after urination that would be dull at times and then more strong in other instances. It has been going on for about 2 weeks now and is finally starting to fade. I was tested for Chlamydia and Gonorrhea at 3 days post exposure and also at 6 days post exposure. Both of the tests came back negative but at the 6 day mark I was given 1000mg of Azithromycin as a precautionary measure. I haven’t had any “obvious” lesions until about January 2nd a small red patch of skin on the side of my penis appeared and already seems to be going away a 12 hours later (no blisters). I also have some itching in the creases of my groin area, scrotum and general groin area.  This has been going on for over 2 weeks now. On December 30th I went and got tested again, (results have not come back yet) and was treated with another 1000mg of Azithromycin and a shot of something in the butt cheek, which they said was to treat Gonorrhea as a precautionary measure.

The pain is never “extremely” strong during urination it is more after the fact. I feel like there is also an increased “dribble” after urination. Also under the head of my penis just near the opening of my urethra seems to be very sensitive which gives off some pain/burning after urination, other than that the pain in my penis seems to be internal. It seems as if there is something inside my penis. (I know there is not) however it just “feels” that way.

I am mostly worried about what I have read on the internet about Herpetic Urethritis. Does this sound anything like Herpetic Urethritis without any obvious patches of blistering lesions besides small red patch 2 weeks later? As I said the only thing that I could say that looks anything like a “lesion” would be the small red abrasion on the shaft which is already healing 12 hours after it appearing, (no blister).

Side Note: Does the ASHA send anything in the mail after I ask a question? I hope not.

45 months ago
Addition to Question #1598 - I am experiencing some swelling on one side of the opening of my penis. Also my encounter experienced unprotected Oral and Vaginal Sex which did not last more than 10 minutes and the vaginal intercourse was rather dry.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Good morning,

I think herpetic urethritis without any external lesions (and the red patch you describe does not seem consistent with herpes) would be highly unusual indeed.  A herpes lesion would be more than a red abrasion that lasts 12 hours, normally.  Is that the area that is swollen as well?  And when you say abrasion, can you tell me more what it looks like?  Also, two weeks after the encounter would be a most unusually long time after the encounter to show up as a new infection.  Also, most people who have herpetic urethritis, in my experience, have pain during urination, as acidic urine passes over open sores.  You are describing more pain after urination, correct? 

The symptoms that you had do sound more like a bacterial infection of some kind - perhaps not chlamydia or gonorrhea but there are other kinds of bacterial infections you could acquire through unprotected intercourse.  Thankfully, you've been adequately treated for those two infections. 

You should be on the lookout for any other abnormal skin changes when thinking about herpes as a possibility.  And if you get more "abrasions", I would strongly suggest that you have a clinician visit to evaluate anything that comes up that is not usual for you. 

I'm going to ask Dr. Hook or Handsfield to look at your question as well since I seriously doubt that herpes is the issue here. 

Terri
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45 months ago
Thank you so much for the quick response and thank you for all that you do. The area is about the size of a small pea, no blisters and is not really "raised" or anything, just slightly red and is decreasing in redness since last night. When I stretch the skin in that area it does not seem raised. Also this area first showed up over 2 weeks after exposure.

The swollen area is at the tip of my penis on the "lips" where the opening of my penis is located.

It was slight to moderate pain during urination (nothing serious) and moderate to high moderate after to about an hour after. At this point there is almost no pain during urination, if there is it is slight. Before it was a slight burn/pain during urination and a pain after urination which varied in intensity which seemingly got worse as the day went on and climaxed at night.

Other symtoms: Dry/Itchy creases in groin area, area between anus and scrotum, and scrotum itself. I have examined the anus, and all around area religiously for sores/lesions and nothing seems to be out of the ordinary.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Greetings. Terri asked me to comment.

I happen to know of a new, high quality research paper to be published soon in a medical journal that describes the largest series of patients (80 of them) with herpetic NGU. From that research, previously published work, and my own clinical experience, it seems unlikely you have herpetic urethritis. It usually causes more severe symptoms than you have described; I would expect the urinary pain to be worst when actually voiding, not afterward; and usually there are typical external penile lesions; and usually would be improving by now. That said, external lesions were absent in many of the 80 cases in the soon to be published report, and swelling of the urethral opening might favor herpes or other viral cause.

Some NGU is caused by adenovirus, normally a respiratory virus causing common cold symptoms and often conjunctivitis (pink eye). The symptoms are pretty much the same as herpetic NGU, without external blisters or sores. This might be favored if you've also had cold or eye sympotms.

Did your sexual exposure 3 weeks ago include oral sex? Both herpetic and adenoviral NGU usually are acquired by oral sex (HSV1 accounted for two thirds of the 80 cases in the new report, HSV2 only one third.)

It would be helpful to know more about the findings when you were examined, and the expertise of the doctor(s) you have seen. STD clinic? Urgent care? Did they look for (or find) elevated white blood cells in a urethral swab or urine? Other urinalysis results? Culture test for bacteria that cause UTI or prostatitis?

Finally, I would say that your description of skin prolbems in the groin etc are not consistent with herpes or any STD and probably are unrelated to the main problem. I don't know what to make of the pea sized swelling you describe.

As sort of implied above, if you haven't seen an expert with lots of experience in herpes or other STDs, that probably would be helpful. But all in all, my guess is that nothing serious is going on; that some (most? all?) your symptoms might be the result of anxiety over all this. I'm not a believer in anxiety creating symptoms on their own. But it certainly can magnify trivial symptoms or even normal body sensations that you otherwise might disregard or not even notice. But you're a better judge of this possibility than Terri or I can be.

I hope these comments have helped.  HHH, MD
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45 months ago
SPECIMEN TYPEurm   
COLORyellow   
APPEARANCEclear   
GLUCOSE(URINE)negative   
BILIRUBINnegative   
KETONESnegative   
SPECIFIC GRAVITY1.030   
BLOODnegative   
pH6.0   
PROTEIN(URINE)negative   
UROBILINOGEN0.2   
NITRITEnegative   
LEUKOCYTE ESTERASEnegative   
Here is the results of the UA Dipstick from a urine sample 13 days after exposure.

The exposure was both Oral and Vaginal Unprotected Sex. Like I stated earlier the swelling of the opening of the urethra is red and slightly swollen.

I have seen a university clinic twice once 3 days after exposure and  six days after exposure. 13 days after exposure I was seen by Urgent Care and was seen by a NP.

Just to recap, Three days after exposure I was seen at university clinic for slight pain during urination and slight pain after. There was some chaffing on the sides of the penis and a small cut at the tip of my penis that the doctor noticed when he examined me but believed that it was a mechanical injury since it showed up immediately after the sex occured (it was dry sex, chaffing and minor skin peeling occured about a day after.). He said that the pain during urination was most likely urine hitting that small cut. He swabbed the chaffing/peeling skin on the shaft as well as the small cut for herpes and came back negative a few days later (this was 3 days after exposure). I was also tested for Chlamydia and Gono at that time which also came back negative. 6 days after exposure I was still experiencing symptoms so I went back in to the university clinic, with burning/pain (minor) while urinating and pain (moderate after) was tested again for Chlamydia and Gono which came back negative. Finally, I went into Urgent Care 13 days after exposure to get looked at again. Same symptoms, mild burning while urinating, pain/burning after. Still waiting for Gono, Chlamydia, and Trichomonaisis tests. 

I honestly have never been so worried in my life and am most worried about Urethral Herpes.

Also, you said that burning underneath the scrotum is not a sign of Herpes which in my eyes is a good thing.

Thank you so much doctor for your expertise.



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Given all of this additional information, Dr. Handsfield and I both agree that herpes is even more unlikely as a cause for your symptoms.  Really. 
If the cut showed up immediately after sex, that would not have anything to do with herpes, and would likely account for the burning with urination as your doctor indicated. 
If you happened to have NGU, which we really don't know from what you've said, it is pretty normal for it to take a while to feel better.  The cells inside the urethra may have been disrupted and because you use your penis for sex and peeing, the healing cells take a while to get better - the urine may just keep disrupting them for a little while.  When I was seeing patients in my practice, and they complained of their urethra feeling "off" even after treatment, I always asked them to wait two weeks before deciding that treatment was unsuccessful, allowing the tissues to really heal and get back to normal.  This could be happening with you. 

The urinalysis that you posted looks completely normal, which is a good thing.
I would suggest that you give this a bit of time and try to not focus so much on your penis for a bit.  It will likely get better and go away.  And if you encounter any more strippers, please put a condom in your pocket and use it as needed.
Best
Terri
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45 months ago
Thank you for the response, This will be my final post.

The small cut seemed to only cause pain the first couple days. What I am most worried about is the slight pain/burning during and after urination which started to occur what seemed to be separate from the small cut the first couple days. Since the main pain that has been occurring for the last 2 weeks have been during and after urination and it seems like it is deeper in the urethra which caused me to worry about herpes.

I did not mean to be confusing about the different instances of pain.

I just got back from the clinic again at about 2 p.m. and the doctor said that the small abrasion I talked about looked nothing like herpes, and she did swab the inside of my urethra about 3/4 inch down to test for herpes just in case.

So in your professional opinion my symptoms do no sound like herpes? (burning/pain during (slight), pain after (moderate throughout the day)

I am obviously very worried about herpes mostly.

Thanks again and this is my last post.

 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I understand that you main worry is herpes and I seriously doubt that's what is going on here.  Glad you had the swab done for herpes from the urethra - was that just today?  I'm guessing that it will be negative.  You can always renew here if you have new information.  All the best

Terri
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