[Question #3882] Persistant, constant urethral irritation/pain

32 months ago
In March I had a  condom protected vaginal and oral sex with a stripper/CSW in Tijuana while on a work trip. After the encounter I have been very regretful, full of anxiety and guilt as I have a truly monogamous regular partner.  3 days after the foolish act I was sitting in a long work conference when I felt a sudden burning coming from my genitals. I rushed to the bathroom to investigate the sensation. I dont remember if urination increased the pain at that time. Since that time there has been a constant urethral irritation/burning that waxes and wanes in intensity. There has never been any discharge. Urination sometimes increases the sensation either before, sometimes during and sometimes after urination. It feels like the inside of the length of the urethra is sunburned or is made of sandpaper.  When I returned home from the trip I had a zpack that I had been prescribed for a separate issue, I took 1 g and then followed with 250mg  x1 the next 2 days, foolish self medication. I spoke to a urologist and described my symptoms without revealing the sex act. he prescribed bactrim 2 times a day for 7 days. Didnt help. Went back to urologist, examined genitals/DRE said mild prostatitis. prescribed cipro for 10 days. Didnt help. he gave me Doxycycline for 8 days. didnt help, then 2 weeks more of bactrim. no relief.  At 6 weeks I had sti test done through quest lab. Negative for hiv, Chl/Gon syph, hep b c, hsv2. this was before taking doxy. At 8 weeks, 5 days after doxy finished, tested again. negative chl/Gon, hsv2 and trich. Neg for M gen. at 10 weeks.  at 12 weeks neg for hiv, hsv2, chl/gon syph trich. Not sure if urologist diagnosis would be same if i disclosed the sex act.
1-does this sound like an sti?
2-does not feel like a referred pain as described by CPPS from wikipedia, I know ive been very worried. what could it be?
3-is my partner in danger from catching anything from me?
Sorry for long, want to move past but the symptoms continue. thnx
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome back to the forum. Thanks for your confidence in our services. FYI, I reviewed your recent discussion with Terri and agree with all she said. I'm also glad you have read up on chronic pelvic pain syndrome (CPPS).

By far the main cause of symptoms like yours, following a very low risk sexual exposure (condom for vaginal, little risk from unprotected oral sex), is genitally focused anxiety magnifying trivial symptoms or even normal body sensations that otherwise would be ignored or not even noticed. No STD or prostatitis causes urethral "irritation" that waxes and wanes and is not associated with discharge. Diagnosing prostatitis by DRE is highly inaccurate, even by the most experienced urologists, and I am confident your doctor has prescribed all this antibiotic treatment in the hope that one or more of them might help, not because of confidence you were infected or that the drugs would help. Any and all STDs that could cause this sort of thing would have responded to one or more of those antibiotics, and your persistence of symptoms despite all them is NOT evidence of a resistant infection, but of no infection at all. So I'm not surprised your various STD tests are negative -- indeed, in my clinic we would not have done some of them except perhaps to further reassure you.

Busy STD experts and clinics deal frequently with patients with complaints like yours. We virtually never find anything wrong, never see any such men turn up later with any complications of any kind, and we never see evidence of health problems in such men's sex partners. Our general advice is to stop further attempts at diagnostic testing and to resume regular sex at home. Usually the symptoms eventually fade -- often when the patient finally comes to understand (and truly believe) that nothing serious is wrong.

CPPS often is associated with discomfort referred primarily to the urethra or penis; it's not just pelvic or bladder area pain. The short term version of CPPS -- what I call genitally focused anxiety -- has not been formally studied. But based on my professional experience, I am convinced it is real and likely shares origins has overlaps with CPPS.

Those comments pretty well address your specific questions. Let me know if anything isn't clear.

HHH, MD
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32 months ago
Thank you for your response Dr. Handsfield.  Before making this post I had read many threads with similar situations as mine on this site and the old medhelp website and guessed what your expert opinion might be. I guess I just  needed to type out my own experience in case you could see anything unique about the way I described my symptoms and perhaps the area of the world I made my bad choice.. This was the first post I have made, I have read many discussions of Ms. Warren’s but have not had any discussion with her.  evidence many of us do similar dumb things if I’ve been mixed up with someone elses post. Some follow up questions: 
1- HSV- I am positive for hsv 1 and have had oral sores on and off for years, if my hsv2  naat test was negative at 12 weeks can I take it as conclusive? I have read that seroconversion can be delayed in hsv1 positive people.  I know I was low risk for acquiring hsv2 and my symptoms aren’t suggestive of hsv 2 anyway but thought I’d ask.
2- HPV-Foolishly I performed brief unprotected oral on the girl (stupid alcohol), she probably has some type of hpv as I understand most of the worlds sexually active people do. can I pretty much assume I now have it orally? This was my only other ever partner. How likely is it that I transmit from my mouth to regular partners genitals if I’m infected? If the csw was vaccinated does that decrease my chance of infection? I know hpv is viewed as an annoyance rather than a big problem but if regular partner has a positive pap down the road the worm can will be opened. 
With all the atb treatments, negative tests and your experienced opinion I feel reassured I don’t have a genital sti. When I palpate a long the length of the urethra on the outside of the penis it is tender to the touch inside.  Any chance I could have some weird urethral fungal infection that isn’t sti related? I know the antibiotics I have taken would probably clear anything bacterial up so maybe fungal?  Of course there were no wbc in urine tests by urologist  2 times  so it probably is genitaly  focused anxiety like you said.  Feels so real/local. Thank you for your work, you and your colleagues are life savers. hope these urethral symptoms  go away soon. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
The main interaction between HSV1 and HSV2 is that having HSV1 modestly reduces the risk of catching HSV2 if exposed; and also makes initial infections milder than they otherwise would be. There is no known effect of either on antibody testing for the other. I don't know where you read that, but I'm not aware of any data that verifies it.

1) The HSV2 test itself isn't really conclusive until 16 weeks, and even then it may miss a few infections. But the test result is only part, and not the most important part, of knowing whether you caught it. The average risk of catching HSV2 from a single vaginal sex with a known infected partner is on the order of 1 chance in 1000. Statistically, it is probable your partner doesn't have it; and your risk was further greatly lowered by condom use. The combination of the very ow risk of your exposure for HSV2 (condom protected vaginal sex), lack of symptoms, HSV1 reducing the chance of infection, and negative antibody test at 12 weeks, taken together, amount to conclusive evidence you don't have it. Don't have any more tests and just forget herpes as a consequence of that event.

2) The chance of catching HPV from any single exposure is low, and is very low for an oral sex exposure. The overall frequency of oral HPV is around 15% of that for genital infection. In fact, the condom protected vaginal sex probably had greater risk of HIV than the unprotected oral. And almost all oral infections cause no symptoms and no disease. The chance of transmission of oral infection to partners clearly isn't zero, but it appears to be very low. This really isn't something to worry about. In any case, the chance a CSW has genital HPV is no higher than for any other sexually active women. And you are wrong that an abnormal pap in your partner will open a "can of worms". It is almost never possible to know when and from whom any particular HPV infection is acquired, and most abnormal paps result from infections acquired many years earlier. If this ever happens to your partner, there is absolutely no basis to assume it came from this particular CSW adventure.

As for your urethral/penile tenderness, I have no further comments other than those above about CPPS and genitally focused anxiety.
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32 months ago
Thank you for your valuable time and expertise. I very much appreciat your insight. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
You're welcome. Take care and stay safe. Let's make this your last question on the exposure 3 months ago and/or your current symptoms, OK?

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