[Question #487] NGU and Urethritis
105 months ago
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Edward W. Hook M.D.
105 months ago
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105 months ago
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105 months ago
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Edward W. Hook M.D.
105 months ago
|
Unfortunately, the tests for leukocytes in urine are not as sensitive for detection of non-chlamydial NGU as a swab specimen taken from directly inside the urethra at least an hour after last urination so this test does not rule out non-chlamydial NGU. On the other hand, I would point out that there is considerable debate about the pathologic significance of non-chlamydial NGU.
The topic of the health importance of non-chlamydial NGU is debated among experts in the field. In the United Kingdom, when a man is known to have non-chlamydial NGU, clinicians do not recommend treatment of partners and there are no data to suggest health complications or problems related to non-chlamydial NGU. Most patients with NGU are treated because chlamydia test results are typically not available at the time the NGU is diagnosed and because it COULD be chlamydia.
My advice, (sometimes hard to accept) is to do your best to not worry, to cease your intensive self-inspection and try to relax. You have clearly and reliably ruled out the major health consequence of sex with a new partner- chlamydia and gonorrhea. If you cannot do that, I suggest you see if there is a local STD Clinic nearby where you can get a urethral gram stain to completely rule out non-chlamydial NGU. Personally however, I do not believe this is medically necessary. EWH
104 months ago
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Edward W. Hook M.D.
104 months ago
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We hear from many clients who are worried that they may have acquired HSV from a misstep of the sort you describe. Our general stance is to not look. This recommendation comes not from a single study or fact but from a cumulative synthesis of a number of studies and observations. These include:
1. Most exposures to partners with herpes do not lead to transmission of infection. A back of the envelope estimate suggests that in the absence of an obvious lesion exposure, transmission occurs less and possibly far less than once in every 1000 exposures- so, the odds of infection after a single exposure are quite low.
2. While not everyone who acquires HSV develops and outbreak, many and perhaps most people do.
3. As you point out, currently the HerpeSelect IgG appears to miss about 1 in 4 existing HSV-1 infections (taken conversely, it detects 3 out of 4) so the test is not a sure thing and, complicating things further, even in persons with prior negative tests, false positive results DO occur from time to time.
For these reasons, my advice is to not worry about the unlikely possibility that you acquired HSV-1 from the oral exposure you described. If your anxiety cannot be controlled and you want the current "gold standard" test, this would be the Western Blot assay performed at the University of Washington's virology laboratory. Of course if you do this and have a positive test for HSV-1, there is no way to know if your antibodies reflect a longstanding prior infection that was missed by your earlier tests or a more recently acquired infection. Statistically the former possibility is more likely than the latter.
Thus. my recommendation is to stop worrying an move forward. After all, what would you do if the test were positive? EWH