[Question #3669] 9 weeks after oral sex, urethral symptoms continue to pain me

36 months ago
Hi Doctors,I regret that I am here again so soon to lean on you again, so first I apologize, but no doctor can provide an answer that seems to solve my condition, and all I am left with is a large amount of Google results of men w/ almost identical symptoms to mine after oral sex without anyone ever seeming to have an answer.I'm sure you'll read my previous posts, but to cut right to it. I got unprotected oral 9 weeks ago for approx. 15 minutes from CSW. Thats the only action, though I'm sure she saw people before me that day. Within 2 weeks, I had a very strong burning discomfort in my penis but not during urination. In a panic I got STD testing at 2 weeks which was neg for everything BUT HSV1 at 3.67, which I'd never had before. I have re-tested myself twice and the titers have not moved. Terri seems confident that its extremely unlikely that my HSV1 is from this event considering my high number @ 14 days, and my unchanging titers after 8 weeks of consistent testing. My uro diagnosed prostatitis. I've been on Bactrim, Doxy, and now 2 weeks of Cipro. I went back today and he did an exam and said my prostate feels fine now, but my symptoms stay. I am left with a strange burning sensation on my penis that waxes and wanes. After masturbation, my urethra gets noticeably redder on the inside, and I recently noticed a small patch of skin on my shaft right below the glans that is very raw and hurts when touched, but is only visible when erect (circumcised), while masturbating last night I felt a bump on my shaft which I've not felt before. The uro said it didn't look herpetic but to keep an eye out. It's very tiny and right near the end of a vein in my shaft. My penis feels raw, I feel it when it touches my underwear. prescription fungal/steroid cream burned like hell, so did lotion. I have no answers. afraid to have sex. I read that HPV can cause burning, could I have HPV? Could this tiny bump be a wart? I'm 29 and not vaccinated. Syphilis?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
I too am sorry to see you back. The previous replies from both Dr. Hook and Ms. Warren were meant to be conclusively reassuring and it's unfortunate you did not (could not?) take them that way. I agree with all they said.

Look at it this way:  Half of all adults in the US have positive HSV1 blood tests; most of those, especially in people without symptoms, are from distant past oral HSV1 infection, not genital; the average risk of genital HSV1 from any single episode of receiving oral sex, by a partner not known to have oral herpes, is under 1 chance in several thousand; and most people with new genital herpes, whether HSV1 or 2, have typical symptoms, which you have not had. Thinking objectively, how to you add up those facts?

In addition the unchanging HSV1 result after several weeks proves the infection was not acquired 2 weeks before the first test but a long time before that. Finally, examination by a highly experienced urologist has reassured you that your penile "bump" isn't herpes. (And herpes never causes such a bump anyway.)

A genital wart could appear as a "bump" on the penile skin, but genital warts rarely present with only a single wart, and 2 months is too soon:  warts typically don't appear until 2-6 months, often a year, after exposure. And oral sex rarely is the source of genital warts. HPV does not cause urethral redness, "raw" feeling, or increased sensitivity against underwear.

There also is no possibility of syphilis. This was a low risk event in regard to syphilis, and if you had been exposed, syphilis would have been aborted or cured by the doxycycline you received.

In summary, you don't have herpes and almost certainly not a genital wart. Clearly the main problem here is anxiety magnifying your awareness of your genitals, including skin texture or "bumps", and magnifying trivial symptoms or normal body sensations that otherwise would be ignored. All evidence is that you have no STD or any other infection from the oral sex exposure 9 weeks ago. Except for the possible anxiety/emotional connection, I have no doubt your symptoms have nothing at all to do with that event.

HHH, MD
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36 months ago
Hi Dr. Handsfield, thank you for your response.

While I understand the odds are in my favor, I can't shake the fact that there is something wrong with me down there and I don't know what it is. While I feel pretty confident now that I've eliminated HSV1 since my titers have remained nearly static, I am still awaiting a 9 week HSV2 test, just to be safe. I know HSV2 is incredibly rare via Oral sex apparently, but you never know I guess when dealing with a CSW.

However, I do have some follow-up questions regarding HPV, which is still a bit of a concern to me. I have some additional questions regarding HPV that I hope you can address for me (p.s., I am seeing a dermatologist tomorrow for a professional evaluation of my bump, which appears to have a white spot on it, possibly dead skin, and a very very tiny scab, but that may be from me scratching/picking at it like a moron).

1. You said that 2 months (9 weeks) is relatively too soon for HPV, but then said HPV typically shows between 2-6 months, sometimes 1 year. Was that typo? Because 2-6 months would mean that its possible since I'm past 2 months and just noticed the bump recently? I know it wasn't there before because I'd have felt it during masturbation.
2. I've been reading about HPV, and I see that some of the symptoms may be burning and itching, even without the presence of warts. Is this accurate? I have had a burning sensation on and off in my shaft (which I originally thought was in my urethra) for nearly the entire time since the encounter. Is burning a possible symptom of HPV, and if so, would it burn as early as 3 weeks after exposure?
3. I got a magnifying glass to further inspect the bump, and upon looking closer I saw it has a bit of what I believe may be dead skin on top (white flap), but I am avoiding pulling at it or trying to remove it so that a derm can take a closer look... I also noticed that there is another small discolored spot right next to this one, about 1mm away from it. Both of them are, for the most part, flat spots, they are not pink or red, and they are a slightly darker pigment color than my normal flesh color (I am Caucasian). The burning seems to originate from this area. Does this change your assessment at all?
4. Is there really no way for me to get tested for HPV? If I do have it from this encounter, I'd really like to find out if I have a "high risk" strain or not. I cannot in good conscience go forward with my partner without knowing if I am putting her at unnecessary risk.
5. Is there any new information in the fight for a cure for HPV?

Thank you kindly for your time and patience.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
1. You're over-interpreting my comments. Only a few percent of new HPV infections would show up by 9 weeks. But HPV doens't cause itching or irritation at all, so this is irrelevant.

2. You are misunderstanding whatever information you found, or the sources are unreliable. Genital warts may become irritated and then may itch. But itching and irritation is never the main or only symptom of HPV.

3. Self exam with magnification is probably the worst thing someone worried about STDs can do. There are many normal skin irregularities that may seem atypical or unusual. I'm betting the "spot" you are seeing is normal.

4. Lots of labs offer HPV testing through websites. None of these tests have regulatory approval in the US and none can be considered conclusive. Since you are a sexually active person probably between the ages of 20 and 50, there is a 25-50% chance a genital HPV test would be positive. And there is no treatment or anything else to do for HPV if such a test is positive, unless there are visible warts or other lesions. In the event you have a genital HPV test that is positive, it will mean you have an asymptomatic infection with that HPV type plus some other explanation for your symptoms and whatever skin anomalies you are seeing. As for "not going forward" with a high risk strain, why not?  All sexually active people encounter partners with high risk HPV types (they're actually more common than the low risk ones); sex with any particular partner does not raise theiir risks of having an HPV problem someday.

5. New HPV research is coming out all the time. This and your other threads have already discussed some of the main information. My overriding advice is that you try to understand that having genital HPV is a normal, expected, unavoidable consequence of being sexually active, even with a single monogamous partner. Vaccination prevents infection with the 9 most important types and is recommended for everybody; and women should follow pap smear guidelines; and anybody should see a doctor if they develop warts or other genital lesions they are concerned about. Those steps successfully prevent all cancer before it becomes a health threat. Aside from those steps, you and other sexually active persons should just disregard HPV.

Think carefully before you ask any further follow-up questions in this thread. Because repeated anxiety driven threads are deleted without reply, this will be your last chance on this forum.
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35 months ago
Hi Doctor,

I appreciate your stern enforcement of your forums policy, and I have taken what you said very much to heart about thinking very carefully before making any follow up comment to your latest message.

It has now been a little over 12 weeks since this all started happening to me. I learned that the lab that tested me for HSV in 2016/2017 appears to report false negatives for my HSV1 results. I've come to this conclusion because they reported me as a 0.4 in 2016, a 0.5 in 2017, and then after this event I tested with LabCorp and Quest (new labs) and they both reported 3.6+ positives. At 12 weeks I went back to the original lab for my final HSV test, and they reported me AGAIN as a 0.4 negative for HSV1, and a <0.20 for HSV2. I am perusing a western blot with Terri to find out once and for all what my ultimate status is since enough time has passed for it to be accurate, but the fact that my symptoms have continued for 3 months consistently now makes me more confident every day that it isn't HSV and that I likely have a asymptomatic older infection.

However, at 12+ weeks, this dull pain continues. My Urologist says everything is fine. I just started Pelvic PT where they confirmed I have a tense pelvic floor. I'm starting TENS therapy... but I have some follow-up questions specific to mycoplasma and trichomoniasis. It is my understanding that these two less common STIs can lead to my symptoms and must be treated with very specific antibiotics, azythromycin/moxifloxacin and flagyn (respectively) both of which I have not been prescribed. From the research I've done, it seems like testing for these two can be very hit or miss, with the bacteria sometimes taking 5+ days to grow which is longer than most online labs culture for. Even if you do not believe I have these, I want to rule out all options, can you recommend the best way to approach being accurately tested for these two bacterium?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the follow-up. I agree an HSV WB is the best way to sort out your conflicting HSV1 antibody test results. I'm glad you understand that symptoms like yours are not attributable to HSV. If WB confirms you have HSV1, it will mean you have an asymptomatic infection plus some other explanation for your symptoms.

The sexual exposure that you associate with these symptoms was oral sex. Neither trichomonas nor M. genitalium is carried in the mouth or throat (both have been carefully studied), hence there is no possibility of either one from oral sex. In addition, neither has been reliably reported to cause symptoms like yours; there have been suspicions over the years about both organisms and prostatitis, but no good evidence for it. That said, if at sometime in the future your urologist concludes you (still? again?) have prostatitis, or decides to try another round of antibiotic therapy, I would understand if s/he wanted to use antibiotics that would cover them, i.e. metronidazole (Flagyl) or tinidazole (Tindamax, which may be somewhat more effective); plus moxifloxacin, which would be effective against most other causes of prostatitis, in addition to M. genitalium. Azithromycin is no longer recommended by experts for M gen. But don't get your hopes up; I am confident such treatment would make no difference in your symptoms. Neither of these organisms has anything to do with any of your symptoms, and I'm also confident you have no infection of any kind from the oral sex event. All your symptoms have a psychological origin, which also goes along with the finding of a tense pelvic floor.

That completes this discussion. As you are aware, there will be no replies to future questions about this exposure and your symptoms (and no refund of a posting fee).
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