[Question #4186] Discharge or Urine?

31 months ago
Hello. I'm a sexually active male and I was diagnosed with inflamed prostate recently. Sometimes, I see stuff on my underwear and see (little) dribbles of clear liquid on the opening but I don't feel it (flowing) or coming out of my penis. 
* How can I know if this is urine leaking or std discharge? Is the STD discharge normally thicker milky and would be seen and felt flowing out that one would know for sure?  Also, sometimes, my penis head (and near opening) becomes red after I ejaculate, but no pain and redness goes away after a little while. I guess that's related to the prostatitis?  
* What is the herpes virus type normally acquired by unprotected oral sex (fallatio), if the one giving the blowjob is the infected one? 
* How likely to get hsv thru unprotected oral sex with prostitute? And what about when there are no visible sores on her lips? Less likely when this is this case? This was a month ago, I don't have sores.
* Is ejaculation in the mouth more risky in terms of getting infected?
*Would sharing drinks or dry kissing transmit, in general?
* Should I test for hpv and what do I do about the genital wart I already froze off? Ask my female partner to do a pap test at this point, or there's no need for this as this is likely non cancerous?  
Thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome to the forum. Thanks for your question.

First, prostatitis ("inflamed prostate") is not an STD, so we can't advise you in any detail about it. However, some doctors don't understand the difference between prostatitis and nongonococcal urethritis (NGU), an STD. Prostatitis doesn't cause discharge from the penis, but NGU does. Urine is entirely clear (of course can be yellow); abnormal dsicharge is thicker, often not entirely clear. Urine won't appear as "stuff" on your underwear. So I'm concerned you have a discharge because of NGU, or perhaps even gonorrhea. You should discuss this with your doctor and should be tested for STDs. If you aren't certain your doctor is an expert in this area, visit a sexual health clinic, such as your local health department STD clinic.

Herpes simplex virus type 1 (HSV1) is the cause of almost all oral herpes, and of genital herpes that can be acquired by oral sex. However, herpes does not cause prostatitis or symptoms like yours. It's not a likely explanation of your problem.

Ejaculation in the mouth may increase the risk that the oral partner acquires an STD, if the penile partner has an STD. But it probably makes no difference in the penile partner's risk of any infection.

Sharing drinking glasses or cups is zero risk for all STDs. It's primarily a risk for common colds, nothing more.

HPV and genital warts is a different story, and it's a complex one. HPV and warts have nothing to do with your symptoms. Warts rarely are cancerous. All women should get pap smear from time to time -- the recommended frequency depends on age, but not on exposure to warts. She should follow her doctor's advice about it; your past genital wart makes no difference. Lots of information is available online about HPV and warts. Look up information provided by the American Sexual Health Association (the sponsor of this forum, http://www.ashasexualhealth.org/stdsstis/hpv/) and/or CDC (www.cdc.gov/std).

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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31 months ago
Ok thanks doctor.  How accurate is an IGG test for herpes compared to Herpes by PCR for asymptomatic people?  PCR was done 4 weeks after receiving blowjob and IGG was done almost 6 weeks after that exposure.  If IGG was positive for HSV1 in this case but PCR was negative which is more accurate?  Should PCR be repeated or IGG should be repeated? There have never been sores or lesions on penis and it's been 6 weeks from last oral sex (fellatio).   

If IGG is more accurate,  what is recommend to do in terms of treatment when there are no lesions or sores?  Get anti-viral meds?  Or no treatment to be done? If nothing to be done, what bigger complications may occur, mengitits? Is there a possibility of sores appearing later?

Also what's the risk of transmission to others in the case of confirmed HSV1 and how can it be reduced especially when planning to have a kid? Will HSV1 be transmitted to baby?

What sharable things and activities should be avoided to reduce transmission?  Thanks. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
You shouldn't have herpes testing. But if done:  PCR and IgG testing have entirely different purposes. If there is an outbreaks (blister, sore, etc), PCR can be used to determine whether herpes is the cause. The IgG blood test tells if there has ever been an infection in the past (acquired a few weeks earlier). Half of all adults in the US have positive HSV1 blood tests, so that positive result is meaningless. The negative PCR tests shows that HSV was not present in the sample at the time of testing. But it was obvious your symptosm aren't due to herpes, even before you were tested.

Genital HSV1 is usually never transmitted to partners. No prevention steps are necessary unless there is a visible outbreak of herpes.
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31 months ago
Thanks.  When you said acquired a few weeks in the past, meaning  a few weeks before when? 

Test results are confusing because when tested by PCR the results were negative. This was 4 weeks after last exposure.  6 weeks after exposure, igg test showed positive hsv1 and the value was 1.3.  Is this a new infection since this number is low?  How do I know for sure if it a new infection or something I had long time ago? Test igg again later to see if that number increased?  

Could it be that the virus didn't show during the PCR test but within the last two weeks, it was detected by the igg test I just had? If it was an old infection, PCR should have shown it earlier, right?  I haven't had any blisters...etc so I wanted to test again at 6 weeks using IGg and was surprised that it was positive as PCR showed negative. I don't know which test to believe so I know if have herpes or not. Please advise doctor, what's the story here? I never tested for herpes using either of these two months ever before in the past so can't tell how long ago if I had hsv1 back then and didn't know. 

Also, what's the difference if it was genital hsv1 or oral hsv1?  Is the former transmitted via vaginal sex because the infection remains in the penis? And oral herpes transmits from the mouth? How would it matter or differ if hsv1 is genital or oral?

And my most important question, is that regardless genital or oral hsv1, it won't be transmitted to others (without condom) if there's no outbreak? 

In case of no outbreak, are meds needed? I feel neck pain sometimes and my right eye sometimes itches and is watery a bit.  


31 months ago
In other words, if no sores or blisters present, intercourse with no condom is almost never transmitted in the case of hsv1, unlike hsv2 which can be transmitted easily with no condom? 

If I ever develop outbreak later, then I'd need to use meds? But can I still have sex without condom and not transmit it when the outbreak is gone? 

Want to have kids and needed to know if it's safe to start having sex.  I didn't tell my partner anything and I'm afraid if I do , it'll create anxiety and bigger issues.. I don't know if she ever got tested for herpes before and what's her status, but she also haven't had outbreaks..etc.  that said, after my last exposure, we haven't had any sex and I'm concerned to do so now that the igg test showed positive hsv1.  

Thank you so very much doctor. I'd truly appreciate if you can answer all of my questions. Yours truly. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
These are asking more detailed questions about genital herpes and about the differences between HSV1 and HSV2 than are practical on a forum like this. It's also a change in topic from your original concern about symptoms that might have suggested urethritis (NGU, gonorrhea, etc). I would suggest you read up on herpes. Some excellent resources are CDC (www.cdc.gov/std); ASHA, the sponsor of this forum (www.ashasexualhealth.org, follow links to STIs/STDs and look for herpes or HSV); and the Westwood Heights website run by Terri Warren, the moderator for herpes questions on this forum (www.westoverheights.com). If you still don't understand the differences between HSV1 and HSV2, and why genital HSV1 is less likely to be sexually transmitted, you are welcome to ask a new question, which would be answered by Ms. Warren.

I would also urge you to drop the notion that your symptoms are (or were) due to herpes. There is almost no chance they were.

I hope the discussion has been helpful. Best wishes and stay safe.
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