[Question #3229] Possible STI- worried

91 months ago

Hi Drs.,

I am a 30 yo hetero male.I have been dealing with a plethora of symptoms since past 4 months:

1. Had protected oral and vaginal sex with a CSW 4 months ago-incidentally had a fungal infection a few days later, which had me convinced that I had acquired Herpes. I had headache, cold sweats, constipation, etc. Tests were negative for Herpes (NAAT swab). All other STI tests were negative- HSv1 oral +

2. Had rough masturbation and non-genital rubbing + very brief accidental genital contact (unprotected for 2-3 seconds) with a new partner 3 months ago--Developed meatisis on urethral opening and also had a bruise or wound around my penis head which hasn't healed fully till today. I developed burning pains throughout my body and felt fatigue for more than a month. I also felt random pain in my penis for few seconds which would then go away. I lost 15 pounds in 6 weeks.

3. Had protected oral sex one month ago-- no new symptoms. Tested for GC, Chmalydia, Trich - negative

4. Tested negative for all STIs including HSv2 IGG, HIV 4th Gen

5. Had unprotected oral sex couple weeks ago- observed few bumps on my penis shaft which has again led me to believe that I have Herpes. NAAT swab again came back negative. A week later, I have pain in my butt and foot and my groin lymph nodes are enlarged (and hurt a little when pressed). Last couple of times I have also observed that I get a burning sensation when I pee right after ejaculation (masturbation). Also, my urethra gets inflamed post masturbation(meatisis which flares up). Today I felt like there was a razor inside my urethra for a few seconds. I have also been having itching in my groin area and random pins and needles on my penis and testicles (happened 2-3 times today).

I have learnt about the power of stress in past 4 months, but my latest symptoms after last exposure seem worrisome to me. Do they sound like Herpes or another STI to you? Which tests should I go for?

Thanks!

91 months ago

Sorry- also wanted to mention that I have been feeling slight burning sensation on my penis head since yesterday.

Edward W. Hook M.D.

91 months ago

Welcome to the Forum. The sorts of exposures that you have described are virtually no risk events. STIs are not spread through receipt of masturbation and STIs are uncommon following receipt of oral sex. While I would suggest testing for gonorrhea and chlamydia for the sake of completeness what you are describing does not sound like an STI. Were your discomfort due to herpes, lesions (small blisters or open ulcers) would have formed within a few hours (certainly less than 8-12) of the onset of discomfort. The trauma you describe could certainly cause the sort of discomfort you describe. Similarly itching and "pins and needles" sensations are not suggestive of an STI.

As for the swollen lymph node you describe, these may be normal or could be related to the irritation you are describing. Most people have lymph nodes in their groin which can be felt. Repeated examination and pressure can make lymph nodes tender. the lymph nodes that I speak of are non-specific and do not suggest STI.

My advice. An STI is most unlikely. Despite that I would seek screening for routine STIs as noted above. A urinalysis looking for signs of inflammation may also be helpful. More importantly, I think you should be examined by a trained clinician who can comment on the origin of your discomfort.

I hope this assessment and suggestions are helpful. EWH

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91 months ago

Thanks so much for the help, Dr. Hook.

I had seen my PCP couple days back but now am feeling more discomfort in my urethra. (happened 3 times today). I have a lab order from my PCP for Male STI Urine Profile. Will this include the inflammation test as well? Or should I discuss for this test with the PCP?

I am always able to feel my lymph nodes, but right now, one lymph node on each side seems to be enlarged more than the others and is tender. I have had a pilonidal cyst issue for many years, and it had flared up a bit few days ago. Could that be the source of tender lymph nodes?

I will go back to the PCP and use your inputs as framework for further discussion.

Thanks!

Edward W. Hook M.D.

91 months ago

Thank you for the additional information. The fact that the discomfort has happened intermittently makes it still less likely that your symptoms are due to an STI. Typically discomfort associated with STIs is continuous and often progressive.

I suspect the Urine Profile your PCP has ordered includes a urinalysis looking for white blood cells as signs of inflammation but also think it is worth verifying this in order to be most efficient.

As I mentioned above, lymph node swelling and/or tenderness is a non-specific finding. While this can occur with some STIs, tenderness of the sort you describe is also seen regularly with infections of the leg or even problems in the lower gastrointestinal tract so that your lymph node is tend, while a clue to what might be going on, does not by any means indicate that this is an STI.

I'm pleases that your PCP is open to discussion and that you are working through things with him/her. If the PCP does not have a good idea of what might be going on, given that the symptoms do involve your urinary tract, you might ask if he things there is any benefit to seeing a urologist. EWH

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91 months ago

Thanks so much, Dr. Hook.

I submitted the urine sample today and will talk to my doctor to refer me to a urologist.

I observed what seems like a oral herpes outbreak on my lips- really small bumps which are only visible when I zoom in on them. I never knew I had oral Herpes until recently and have never observed an oral outbreak for as long as I can remember.

I am concerned- can a new genital HSV1 or HSV2 infection activate an old Oral HSV1 infection, either directly or indirectly (by bringing down my immune system) ? Have you seen this kind of scenario in your experience ?

91 months ago

Dr. Hook,

I just again observed a razor like feeling in my urethra for around 5-10 seconds today, thankfully no pain while urination shortly afterwards. I am still afraid that I am going to feel pain while urination right after ejaculation.

Since the NAAT swab for 'bumps' on my penis had come back negative for HSV 1 & 2 last week, can I ask the doctor to take urethral swab for Herpes NAAT test? It's been 2 weeks since oral sex exposure.

I am concerned if this is urethritis caused by HSV ? I am awaiting the urine test results for Chlamydia and Gonnorhea.

Edward W. Hook M.D.

91 months ago

I'm glad you were tested and plan to talk with your PCP - I think it will help to re-inforce that this is not an STI. My sense is that you are feeling guilt or anxiety over STI risk that, from a realistic perspective, is just not there. if you really need to look hard for bumps/lesions/vesicles/blisters then they are most likely normal and you are being hyper-sensitive. If you really think this is HSV, I would suggest you get the lesions tested and suspect that they will prove that what you have observed is not herpes. There is no data to even suggest that a new HSV infection will lead to reactivation of old HSV-1 infection. Again, to use an old saying, you are adding 2+2 and assuming that the answer is 7.

Similarly, there is no reason, other than cost and the fact that it is unlikely that the test will be positive, to not test for HSV of the urethra. If you choose to do so, please seek a PCR test, not a routine culture. no matter how you test however, I am confident that your test will be negative and that you are over-reacting to your perceived risk for STI.

this is my third response to your questions. Thus this will end this thread, as per Forum guidelines. I really do not think your symptoms are in any way suggestive of getting an STI from your exposure of concern. this thread will be closed later this evening. EWH

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