[Question #4544] Tests negative but something going on

27 months ago
My abridged story- 8 months ago i, a man, had unprotected vaginal sex with a new woman, one night. 3 days later began having distal urethral burning, persistent, unrelated to urination or ejaculation, no discharge. This was treated with cefuroxime and azithromycin, later doxycycline, ceftriaxone and flagyl, with no change. The following week I began to have a red rash on the left scrotum, with left testicular and left peroneal soreness, as well as hemmorhoid irritation on the same side. I never developed blisters or ulcerative lesions,  i did note a small skin tag like lesion on the left scrotum that is easily irritated and has peraisted. About 2 weeks in I had my first full STD panel and have done them monthly, as well as 1 western blot for hsv, all have been negative. 
After 4-5 months the urethritis began to wane but occasionally returns for a day or 2, and while i occasionally feel a sting with ejaculation or a strong urine stream it is usually just there. I frequently have a burning pain along the ridge and side of the glans penis. I also often note the glans as discolored, purplish, with patches of pink that appear like irritation, seemingly worse with sitting or at night. In addition there can be pain along the sides of the penis, and sometimes getting an erection can be mildly painful. 
I have seen a derm and urologist and am being treated w doxycycline for possible prostatitis. My concern is that I am worried this is an STD, particularly hsv, and have abstained from sex lest I share. I was looking to get your impression and see if any ideas as to cause. Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome to the Forum.  I'll be glad to comment and hope my comments will prove helpful.  Before I address your symptoms and their lack of response to therapy, let me point out that while the timing of the onset of symptoms is consistent with common STIs such as non-gonococcal urethritis, the numerous antibiotics you have taken would have cured virtually any bacterial STI, or trichamonas, if that had been present.  Your multiple repeat STI test panels serve to verify that no typical bacterial STI is present and I recommend against further bacterial testing for these symptoms.  

The Western blot you took ( and which I presume was done at the University of Washington) was a bit early for detection of recent HSV infection.  OTOH, your symptoms- the lack of lesions and their intermittent nature are not suggestive of HSV either and I am skeptical that this is the problem.  If you chose to repeat the Western blot and it is negative, at this time that would conclusively rule outHSV as well.

My advice at this time is as follows:
1. It is time to stop worrying about STIs, including herpes.  If you have been abstaining from unprotected sex with aregular partner be use of your concerns, you can put those concerns aside.  
2.  I would continue to work with your urologist and dermatologist, completing their suggested therapy.
3.  I would try to move on from here.  We have a number of clients with symptoms such as yours.  The symptoms virtually always resolve over time and there is no evidence that any such person has experienced complications or passed an infection on to a regular sex partner.

I hope this assessment and suggestions is helpful.  EWH
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27 months ago
Thanks so much for your help, and thanks, your answer is very reassuring! I know that it is an unusual annoying combo of symptoms but the timing of onset and nature just make me worry. I will continue to hold the course with my current docs, put it out of my mind and hopefully it will all just clear up. One quick follow up question, i wasn't clear in my original but I took the western blot (yes, through University of Washington) at about 6-7 months post exposure. Is that too soon? When would it be long enough to be a definitive answer? I thought by then I had waited long enough. 
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Thanks for the clarification.  It was my mistaken understanding that your Westerb blot was performed much sooner.  At more than six months the results would be conclusive without a need for repetition.   EWH

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