Hi Doctors,

Just wanted to say thanks for what you’re doing on this site. I’ve reviewed many of your prior posts and have found them to be very helpful.

My situation:

-          May 12^th: Unprotected sex (condom broke, unsure how long) with woman who was in a relationship

o   This is the second person I’ve had unprotected sex with, 3 weeks after she confirmed she feels completed normal

-          May 14^th: Two days after unprotected sex, I began having a strong tingling and leaking sensation at the tip of my penis constantly throughout the day, however, whenever I would check there would be nothing there. Redness and inflammation started a week or two later. No other symptoms, as I checked vigorously over the last few months

-          May 14^th: went into doctor, STD tested administered for HIV, HSV1/2, G+C, Syphilis, all negative

-          May 16^th: STD tests come back negative, treated anyway with Z-Pack (1 dose) and ceftriaxone shot

-          May 21^st: no improvement, go to doctor and tested for Mycoplasma hominis & Ureaplasma, negative. treated with Ciprofloxacin (7 day course), metronidazole (1 dose), and doxycycline (7 day dose)

-          May 31^st: still no improvement, see a urologist who prescribes Uribel and says give it some time (uribel seems to have made it worse?), as he thinks I show no signs of further infection except for a little bit of blood in urine

-          June 7^th, urine analysis still considered normal, tested for HIV, HSV ½, G+C, Syphillis, Myco Hominis / Genitalium, Ureaplasmas, all negative

-          June 19^th: stop taking uribel

-          June 26^th: retested for everything including HIV, HSV ½ (igG), G+C, Syphillis, Myco Hominis / Genitalium, Ureaplasmas, again all negative

-          July 18^th: retested for HSV 1 and 2 IgG (10 weeks after exposure), still negative.

I am now at a spot where my symptoms feel as though they may not be as intense as they originally were, and are possibly slowly getting better. However, I still have some redness / inflammation at the tip of my urethra, as well as a sensation that urine is leaking out of my penis. I’ve avoided sexual contact during this period.

With this in mind, the way I see it is:

1)      I had NGU, and still have some sort of resistant strain that wasn’t showing up on testing due to the antibiotics

2)      I have persistent inflammation without infection, and just need to give it time

3)      I have Herpes 1 or 2, and this is an atypical showing of the virus (I have had no blisters, sores, etc. out of the ordinary)

Please let me know your thoughts on what you think might be causing this!

Dr. Hook,

Thanks for your quick response. It was along the lines of what I was expecting. Overall, it is tough for me to chalk it up to “heightened awareness” given the physical inflammation and constant sensation that urine is leaking out of my penis / tingling, as well as “cold” feeling of the penis tip that I have never felt before. It just seems odd that this would start occurring 2/3 days after the unprotected sexual exposure.

To your comment about persisting NGU symptoms, this definitely makes sense. I have made a point to stop with the religious inspections a few weeks ago, hoping that it will bring the inflammation down. Also, I went in today to get one more round of tests for likely causations(MC, UP), using a first catch sample first thing in the morning, which is something I have not done for other tests.

In terms of HSV concerns, the only reason this is still in play is that I have read (through online forums, I know are not always trustworthy), cases of people who have had similar urethral tip discomfort (i.e. constant dribbling sensation, inflammation of the urethral opening, etc.) that have later found it to be HSV causing the infection. These were noted with no signs of outbreaks, even with inspection.

With the above concerns in mind, is there anything else that you recommend I can do to get to the bottom of what might be causing this, or at least put my mind to rest? Would you recommend continuing to test for herpes at 12 or 16 weeks to be conclusive? Or maybe trying antiviral medication for some time?

Please let me know your thoughts based on the specifics above!