[Question #2087] 12 months long persist burn/pain symptoms- NSU Risks- Dr Hansfield please

48 months ago


Feb 17, 2016- Oral Sex on Clitoris and Urethra, 10 seconds.
Feb 19 2016, redness (angry inflamed red) on Clitoris; no discharge, no pain when urine, no burning feelings- just occasionally found it when looking at mirror when showering
2 March 2016- gone Waxing- ALL good, no feelings
4 March 2016 Oral Sex; Receiving - This is the only last time I have had sex until now May, 2017
March 05 2016- worked up and found Intensive itching in the groin; lasting or 6 weeks on the public hair areas and inside thighs. NO Burning while urine, No redness, no swollen in the vulvur/Vagina. Only innocent extensive itching feel like scabies.
Life goes on
  • Get tested- Ureaplasma (UU) PCR positive, all others STDs tests negatives (neg on NG CT MG MH UP) (did not have antibiotics as no pain no swollen no redness feelings)
March 05 2016 - 27 April 2016, normal life goes on, only mild itching in public hair area and no burning, no pain and no redness/swollen feelings. 
17 March- still only mild itching; no vaginal pain/no vulvar pain

28 April- Colposcopy
7 May 2016- Intensive extreme burning, redness, inflame red over clitoris & vagina- to a level you wanna cry; ran to Doctor; no blisters/no sores found
pain lasted for 2 weeks then vanished.

June 13 2016- Surgery
Ovarian removal surgery/Regular D&C Check 
Urine Cathertha inserted for a few days; once catheter removed- urine discomfort, burning and pain
Since then; Urethera never been well; always burning when pee, accompany constant on and off pain.

July 14 2016-Feb 2017 intensive vaginal burning and inflamed redness, daily painful symptoms; Daily symptoms lasted until Feb, 2017. The pain is an extreme pain that makes you wanna cry. Antibiotics used during all these time: Doxy (2 weeks), Azithro (2 weeks), Anti-Virals (3 weeks)

STDs retest results: Ureaplasma Negative; HSV-1 Positive (location unspecific); Swab on HSV-1/2 on Vagina- Negatives. 

Symptoms relief since March, 2016, daily burning and discomfort still on Urethra

May 2016- Residual Urethera pain/burning on urine/burning constant all time/ clitoris discomfort, Tried 1G Cefditoren (Injection); Instant relief Clitoris/Ureatha Swollen & Redness within 24 hours, but constant urethera burn and urine burning came back at 5th day until now.

-red and swollen urethera until now, discomfort
-itching at the inner thighs and public hair are also noted
-feeling of occasionally discharge from Urethera Tip (but not frequent)

Questions: Urethera/Clitoris problems- is it due to HSV-1 (unknown location) or Choric UTI/NSU? Any NSU transmission risks to future husband? Vaginal pain 90% gone, now only slight vaginal burning perisists, And Urethera all-time burning still.  
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Welcome to the Forum.  As you probably know, clients on this site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.

Thanks for your detailed summary.  Having now read it twice my sense is that you tend to have recurrences of your urethral/clitoral discomfort following local manipulation, whether this is oral sex, gynecologic surgery, a urinary catheter or something else, all on a backdrop of milder vaginal burnng and itching.  Do I have this correct?  Further it is not clear to me that antibiotic (including antiviral) therapy has been helpful although last may following an injection of cefditoren you did experience improvement.  Cultures have not demonstrated a pathogen (ureaplasma is not a pathogen in most people and can be found, sometimes intermittently in the majority of sexually active adults).  Your direct questions are could this all be due to your HSV-1 infection and does this represent some sort of infection which might be transmitted to your future husband.  I'll provide several initial comments below but would welcome any clarifications if I have misinterpreted your problem or questions.

General comment.  it sounds like the clitoral/urethral inflammatory process you have experienced is different and possibly not related to the vaginal itching/burning you experience.  Is this correct? 

1.  Could this (the recurring urethral/clitoral inflammation) be your HSV-1 infection.  Unlikely (in Medicine we can never say never).  You have never experienced typical genital herpes, cultures have been negative and antiviral therapy have not helped.  Statistically, most (but admittedly not all HSV-1 infections are oral infections acquired during childhood.  Further the recurring clitoral/urethral inflammation you have had should improve with anti-herpes therapy (acyclovir/valacyclovir) within a few days if it were due to HSV recurrences and has not.  The problem sounds like a recurring mucosal, inflammatory process which might be best addressed if it was seen by a dermatologist at the time it occurred.  The complexity and chronicity of the problem suggests that you might need to be evaluated several times and that a certain amount of trial and error approach might be needed.

2.  Does this represent an STI syndrome that you might transmit to others.  No!  You have been extensively tested and the tests are all negative.  There are chronic , recurring non-STI genitourinary syndromes in men (urethritis) and women (vaginitis/cervicitis) which rarely occur and are troublesome to those afflicted.  In persons such as yourself, I would consider either rheumatological or dermatologic problems involving the GU tract. 

I hope these initial thoughts are helpful to you.  In challenging problems such as yours there is no substitute for having a good working relationship with a clinician who will repeatedly examine you and work with you to sort this out.  I'll be pleased to comment further when I hear your response to these initial thoughts.  EWH


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47 months ago
Thanks Dr- yes I love all the comments from you and also other experts.  I found out I made a slight error on timeline- below are the updates, lemme know if it changes your comments/Views:

Symptoms relief since March, 2017 (not 2016), daily burning and discomfort still on Urethra

May 2017 (not 2016)- Residual Urethera pain/burning on urine/burning constant all time/ clitoris discomfort, Tried 1G Cefditoren (Injection); Instant relief Clitoris/Ureatha Swollen & Redness within 24 hours, but constant urethera burn and urine burning came back at 5th day until now.

-red and swollen urethera until now, discomfort
-itching at the inner thighs and public hair are also noted
-feeling of occasionally discharge from Urethera Tip (but not frequent)

Also- tried three weeks anti-viral at September 2016- The symptons even went much more worse- 300% more extreme Pain (less pain when keep walking or moving the legs) and ran to clinican office have it examed- they told me they're not sure if its blister (both sides and like a "Unilateral Snake Sharp Lines" on BOTH SIDE of Vulvar- then swabbed for culture for Variacella-Zoster Virus- Negative,  then they think its just a normal skin since they dont believe people taken Anti-viral could make matter even worse. 
Local MD/Gyn/NYC Gyn/London Gyn - all told me they dont know whats going on with me and ask me to relax and take it day to day.
Its just swollen painful redness everyday (daily basis)- not on and off. 
Could it be some innocent oral bacteria/virus caused this inflammatory response? Could I reasonably assumed it all been killed due to rounds and rounds of antibotics?That guy i used to date he is extremely dirty and like sleeping with tons of gals from different places- he was dangerous. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Thanks for the additional information.  It does not change my assessment other than to make me more confident that this is not a manifestation of herpes.  Further, your description of the rash makes me feel more strongly that this is a Dermatologic or rheumatologic problem and not infectious.

My other comment is to ask if your vigilance looking for clues to what is going on might have led you to notice sensations (the mild ones, NOT the more intense ones) which you might have not noticed otherwise.  We regularly see persons whose focus leads to a sensation of local irritation.  Most often an itch.  EWH
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47 months ago

Thanks- Dr, I understand. It was funny though last time the rash they tested for Varicella-Zoster Virus instead of HSV-1/2 since Doctor insisted that on a 3 weeks of anti-viral could not lead to this kind of skin problems. Do you agree? so they tested for Varicella-Zoster Virus instead.

Anyhow this totally normal oral bacteria/flora has caused the allergic response that lasted for a year? Do you think this is NSU as well? Or just allergy? I dont understand why things started to developed 10 days after my colposcopy....that pain is unbearable. 

You are right- even since when I was a virgin; I occasionally had inflammation on the vulvar as well. And Agree- Vaginal pain is separated from Clitoria/Vulvar Pain

Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
I can't tell you what was being thought regarding varicella vs Herpes simplex except for the fact that typically more acyclovir or valacyclovir is needed to treat Varicella. 

I do not think this is an allergic response to bacteria, including your normal flora.  NSU is primarily a male syndrome so I wouldn't label this that way although what does seem to be going on is recurring urethral/clitoral inflammation.  I still think the next step for you is to talk to a good dermatologist (my suggestion over a rheumatologist) who will take the time to listen to your story and help you work through things (not all will). 

Sorry I don't have more for you on this.  EWH
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Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
There have been three replies to this thread, therefore as per Forum guidelines, the thread will be closed.  EWH
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