[Question #3193] To Dr. Hunter Handsfield with regards to my possibly STI scenario.

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91 months ago

I had my first ever two unprotected vaginal sex with a new partner with bacterial vaginosis (because I can tell from the fishy odor and was diagnosed by an OB) exactly 24 to 25 days ago (it was 2 days) on Dec 17-18. Sessions last 3 minutes each. I got a sore throat on the Dec 24. Then I experienced near constant tingling throughout the day on the right side of my urethra, near the base of the penis on Dec 26 that I experience until today but has lessened in duration and intensity. I developed cough and colds on Dec 28 which is almost gone as of today. I have gotten 2 IGM herpes blood test for hsv-1 and hsv-2 on Dec 30. The test came back negative. I do not have hsv-1 or hsv-2 prior to this occasion and I never had any other sexual partners. On Jan 5, I went to a urologist and explained the same symptoms I presented here. He let me get a urinalysis and he said there was nothing to see, but I am only assuming this tests for chlamydia and gonorrhea, but not another major STD which is syphilis. He then told me to go back March for an HIV test. 

I only had common colds and the tingling on the right side of my urethra near the base of my penis (and sometimes I believe radiates to the testicular area but very mild and brief) as symptoms. I never had any flu symptoms of fever, headaches, extreme fatigue, rashes, and etc. I never had any discharge or discomfort when urinating, I never had lesions appear on my penis, but I have one small pimple like object on the glans of the penis. I believe it was already there even before the exposure.

I wouldn't be worried about STD's anymore if it wasn't for the constant tingling in my urethra. Could it still be very mild dormant herpes? Could it be HIV? The IGM test should have theoretically picked it up by then, but I don’t know if it can be a false negative. Please do advice.


1,483 words

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91 months ago
In the initial instructions written during the payment I did not notice that the 1,500 character limit was including spaces.. I cannot edit the question sadly. 
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Edward W. Hook M.D.
91 months ago

Welcome to the Forum.  As you probably know but are trying to work around, 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.

The encounter you describe is low risk for STI.  Most people do not have STIs, most exposures to infected partners do not lead to infection and it sounds like your recent partner has been recently checked for STIs (if she was checked for bacterial vaginosis, she was likely checked for  other STIs as well)  all of which combine to make STI quite unlikely.  Urethral tingling of the sort you describe is not at all suggestive of herpes and is not a concern.  while urethral herpes does occur rarely, the duration of your symptoms is incompatible with herpes and to have isolated urethral herpes without external lesions is quite unusual.  Should you have future concerns, I urge you not to test with the IgM test.  These tests are renown for their high false positive rates and misleading results.  You got lucky with your negative results. 

Urethral symptoms are sometimes difficult to characterize.  The most reliable symptoms of urethral/penile infection are abnormal penile discharge or burning on urination, neither of which appear to be present for you.  From all that you have described, it is unlikely that this is an STI however several comments and a suggestion or two:

1.  If the urologist did only a urinalysis, then to be absolutely sure you did not acquire and STI such as chlamydia, it would be advisable to have a urine test for gonorrhea and chlamydia.  This is a different test than a urinalysis which looks for the presence of white blood cells and a variety of chemical abnormalities in the urine which can lead to the diagnosis of a lot of different problems. If your urinalysis did not show WBCs STIs are unlikely but to be 100% sure, testing for chlamydia and gonorrhea would be a good idea and provide you with assurance (these infections can rarely occur without the presence of WBCs).

2.  It is not clear that you had a blood test.  while your symptoms do not suggest HIV or syphilis in any way, if you did not have a blood test, you were not tested for these STIs.  If you choose to test for these unlikely possibilities, the proper time to have a blood test would be 4-6 weeks after your encounter.

3.  Is it possible that you are looking for symptoms and, as a result, becoming aware of normal sensations which normally go unnoticed.  Anxiety focused self awareness can cause the sort of sensations you describe. 

I hope these comments are helpful.  It is unlikely that you have an STI from the encounter you describe.  EWH




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91 months ago
I stopped seeing my partner just recently because she was the type to lie a LOT. We only dated for 1 month so I do not know her well. This was what really scares me even if she did go to an OB, I cannot say 100% that she notified me of everything they talked about. She had several sexual partners prior to me which not all were protected as well. By the time I noticed the throbbing/tinglings and sore throat, we were already in bad terms. Just wanted to clarify because I know BV increases transmission rates by several times.

Regarding your numbered answers:
1. He just did a normal urinalysis and he said to get the first moment of urine and not the usual mid-stream. The only thing that was traced in my urinalysis was a red blood cell value of 1 but it appears to be in the normal range. The urologist I talked to seemed to not explain much and just concluded I did not have any other STD's and just go back for an HIV test later, not even suggesting syphilis. 

2. I have not taken blood tests for syphilis and HIV due to the time frame since my exposure. I was due to take it around january 15 (28 days after exposure if ever). I have never experienced any ARS symptoms for HIV and although I read some symptoms may not appear on some cases, the majority of the cases would. 

3. I also read a lot on the posts by you and Dr. HH that anxiety can cause "imaginary" symptoms. However, I believe that i'm not as anxious many times of the day and I feel my urethra more of throbbing rather than tingling it's slightly painful, but bearable. My attention is redirected to it whenever i'm eating or for instance focused on my computer game, and even now while typing this post. I do not know if that is a normal sensation at all because it is always on "radiating" on the same area, right side of the urethra near the base of the penis. I am honestly more annoyed by it than anxious basically it's like any other recurrent mild pain one experiences and eventually you'll at some point feel fed up of feeling it.

My one and only follow up question is (due to the length): I really want to know what I can do and when would I be 100% sure that I do not have any STI's at all. As you mentioned, my herpes IGM tests were not conclusive at all, which I only took to ease my mind back then. Some people, including a post I remember by Dr. HH, say that herpes may take possibly days, weeks, months to years to show up, if so, if it does take years to show up, will an IGG test pick it up 3 months after the primary exposure (this is something I never got to read in the many posts i've read) I read a forum with a guy having the same urethral sensations for many months before he had a herpes outbreak and I am wondering if that may be my case as well. I read that HIV will be detected mostly within 3-4 weeks, but outliers will be present after that range, so is 3 months conclusive to say I do not have HIV? Same goes for the bacterial STD's. I am curious because I know a lot of the STD's may not present symptoms and create havoc and notice a bit too late. Because it is only then that I am totally surely free of STI's is when I can completely ignore this throbbing i'm feeling that I cannot get rid of. I apologize for the length, but I believe given my limited knowledge, you are the experts that can aggregate all your experiences to give the best advice possible. I appreciate the help a lot.
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Edward W. Hook M.D.
91 months ago
Thanks for the additional clarification.  This additional information however does not change my assessment of your situation. 
1.  I would call the office and specifically ask if your urine was tested for gonorrhea and chlamydia.  As I said above, a urinalysis, while helpful, is not sufficient to completely rule out STIs.  In addition, urine can also be tested for trichamonas which could theoretically cause penile symptoms (but again, woul dmost probably also have an abnormal urinalysis). 
2.  Your exposure was rather low risk for HIV and I would not be overly concerned.  OTOH, if you want to be completely assured, the blood tests I suggested will help to accomplish that.
3.  Thanks for the additional information  This does not change that symptoms such as these are not suggestive of STI.  Perhaps your urologist has another explanation.

Regarding your follow-up.  Your risk for herpes is very low.  My sense is that you are worrying about this more than you need to be and nothing you have written suggests herpes.  In fact, what you have described (no lesions, the symptoms you do have, your test results) all argue that you do not have HSV.  Again, if you were tested for gonorrhea, chlamydia and trichamonas and your tests are negative, I would urge you to be confident that you did not acquire an STI from the exposure you have described.   

I hope this additional information helps.  EWH
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91 months ago
Thank you Dr. EWH. Perhaps even the slightest anxiety give one "imaginary" sensations. Best wishes 
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Edward W. Hook M.D.
91 months ago
Certainly anything that causes persons to worry, even a little, and heightens their awareness or vigilance can make normal sensations more apparent and worrisome.  EWH
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91 months ago
Sorry doctor Hook, but I just noticed now. The head of the area on my penis have about 30-50 very very small dots it is a bit rough to the touch, but is not red or itchy. I don't know if this is normal? The sides of the head of the penis as well as the back side are smooth to the touch and do not have dots.
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Edward W. Hook M.D.
91 months ago
It is not unusual for persons to have small "bumps" or dots present on the head of the penis.  These can vary in size and appearance.  I suspect this is normal but if you have continuing concern or they begin to change, please have an experienced clinician take a look. 

This is my third response to your questions.  thus as per forum guidelines, this thread will be closed in a few hours.  Take care.  EWH
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91 months ago
Perhaps it was there before I just haven't really paid attention to them until recently. Thank you that's all I need. I Appreciate all the help given. 
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Edward W. Hook M.D.
91 months ago
That would not be unusual.  The closer you look the more you see.  EWH
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