Dear Dr: I posted before about intense pain when urinating, redness and swelling of the urethra and swollen lymph nodes (bilateral) in the groin after a protected (with condom) both oral and vaginal sex with an escort. I was diagnosed an NG urethritis, but it become worse with the course of antibiotics with more pain and mucus discharge, so dr HHH who kindly responded my post (so much thanks to him) suggested treatment with antivirals, and a urethral swab test: as I had oral herpes, dr concluded high probability of adenovirus, so I started acyclovir 400 each 8 hours and didn't get the swab test, but got blood tests: chlamydia igm and urine negative, gonnorhea urine negative, thricomona negative, hsv 1 dna real time quantitative pcr <100 copies/ml (negative), hsv1 dna real time quantitative pcr <100 copies/ ml (negative), both in whole blood, hsv 1 igG high (positive) and hsv 2 igg negative.  So far the pain urinating is way less, I don't have discharge, lymph nodes are way smaller, but I started with very small, tiny white ulcers in the meatus (not painful except when urinating), that occasionally bleed, and the meautus is still red and swollen. I also started with left pink eye, with congestion, without discharge, pain or any ulcers. With this said, does this support an adenovirus or other respiratory virus urethritis and exclude the possibility of a new herpes infection, or do I still need an swab test of the urethra because the virus could be only confined there and not in the blood? Do these other virus produce confined tiny ulcers or sores? Thank you for your time and response.

Welcome back and thanks for the follow-up. I'm sorry you didn't mention your cold symptoms and especially conjunctivitis (pink eye) in your original question! As I said in my reply there, "The other [cause of viral NGU] is adenovirus -- primarily a respiratory virus and a common cause of colds and/or conjunctivitis ("pink eye")." So this indeed supports adenovirus and not herpes as the cause of your urethriitis.  And yes, it could be associated with small ulcerations ("tiny sores"). In contrast, ulcerations caused by herpes typically are at least 1-3 mm in diameter. The combination of conjunctivitis plus urethritis (especially with meatitits) is classical for adenovirus -- I could use your case in my teaching of residents and medical students (and probably will).---

By the way, I'm curious where you are, if you're OK letting me know the country and city; or even the particular clinic where you have been getting care for the problem. But of course understand if you'd prefer not.---

"...it seems the medical literature is scarce about this condition [adenovirus urethritis}...."  Actually not all that scarce. Go to PubMed, the main portal to world medical literature (or ask your ophthalmologist to do so):  https://www.ncbi.nlm.nih.gov/pubmed  In the main search window, enter "adenovirus AND urethritis". You'll see it identifies 30 scientific papers starting as early as 1967. If you further refine the search by limiting it to words that appear in the titles (adenovirus [ti] AND urethritis [ti]), you'll see 8 papers, mostly in the past 15 years.---