[Question #5027] Unexplained Symptoms

24 months ago

Hello Dr.’s

 Below is a detailed description of my situation. As of 2/25/19, I’ve been living with constant upper thigh, lower back burning/itchiness, lip burning/tingling and redness sunburn/tingling feeling of penis head and urethra burn. Could these symptoms be HSV related even though I haven’t had “classic” lesions or any other STI?

July 28, 2018….. Kissing/Received unprotected oral sex from an unknown promiscuous female.

Within 10 hours, bad urethra penis burn/pain.

July 30, treated for Gonorrhea/Chlamydia at Urgent Care tested for all STI’s   ….results negative Hsv1 IgG (0 .09) Hsv2 IgG (0.06).

Aug 6, Burning persisted, back to UC. Swabbed for Gonorrhea/Chlamydia prescribed Bactrim (Sulfameth) referred to urologist. Test results negative

Throughout week, experienced body itch and random hives that quickly appeared and disappeared, lip burning/tingling and tongue soreness. (Bactrim?) Was on 20 days total.

Aug 10, Urologist diagnosed penis symptoms as Prostatitis.

Aug 21, Saw Dermatologist (Physicians Assistant) for burning lips and itchiness tested HVS IGM and IgG again, prescribed 4 valtex pills just in case…tests negative (no value). Asked about pin head size brown spot on penis shaft, told it was a mole. Prescribed steroid cream to use for lips, didn’t help.

Began experiencing itching/burning soreness of upper thighs/lower buttocks and tailbone area, burning penis persisted. Penis head/scrotum was red like sunburned with small raised dots that would come and go. Also facial twitching

Sept 21, STI retest ……all negative

Oct 15 Back to Urologist, prescribed Levaquin. Told symptoms not STI related

 Oct 29, STI retest (added mycoplasma and HSV Swab)……All negative

Nov 21, ENT appointment for lips/mouth. Full visual exam, nothing found. Referred to Oral Surgeon Pathologist.

Dec 6 retested….all STI tests negative but tested positive for Epstein Barr. Urethra burn reduced but not gone.

Dec 19  New Dermatologist, prescribed “Desonide” to use for lips, didn’t help. Saw no visual issues with thighs or penis head. Prescribed moisturizer. Looked at “mole”, told nothing to worry about.

Jan 29 At follow up, Dermatologist biopsied “mole”, result “Condyloma Acumination with Atypia”

Feb 2 HSV IgG 1-2 and HIV retest. All negative. Hsv1 IgG (0.19) and Hsv2 IgG(0.16)

Feb 19 Oral Surgeon/Pathologist after visual exam diagnosed me as having Burning Mouth Syndrome due to stress related event

Feb 25. Been using Jock itch spray powder (lotramin) on penis head and scrotum. Seems better but not 100%, all other symptoms persist including slight urethra burning.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your confidence in our services.

The brief overview reply is that no STIs cause symptoms of the sort you describe. Although herpes is often tagged as causing burning, tingling, itching, and similar symptoms, the context is all important. Those symptoms can accompany an outbreak (either oral or genital) or precede one by a day or two. Even then, the symptoms are localized to the area at or near where the outbreak is about to occur. Otherwise, these are never symptoms of herpes. You can find claims about such widespread or continuous symptoms and also suich things as back pain on various websites. But there is simply no scientific evidence for it -- and not really even any biological plausibility. Beyond herpes, no other STIs are responsible for such things.

Some comments in response to your symptoms (although you don't actually ask any questions about them):

You describe a sexual exposure that carried little STI risk. No STIs are transmitted by kissing; oral herpes is a potential risk, but oral HSV1 isn't considered an STI. And oral sex is also safe sex:  not completely free of risk, but with far lower risk for all STIs than vaginal or anal sex, and virtually zero risk for some of them.

The one diagnosed STI you have is HPV, which is the only cause of genital warts (condyloma accuminata, with or without "atypia"). But of course almost all persons acquire genital HPV at one time or another, and almost certainly that diagnosis has nothing to do with the sexual exposure described.

Epstein Barr virus (EBV) is often sexually acquired, but it's a nearly universal infection, mostly acquired in childhood or as young adults, and most healthy adults test positive for it. EBV is not a plausible cause of your symptoms. And all your other negative STI tests are highly reliable, showing you have none of those infections.

Finally, I'm intrigued by your comment about "burning mouth syndrome due to stress related event". I have never heard of burning mouth syndrome. But it is clear that the oral surgeon believes your oral symptoms have a psychological/emotional origin. And I have to say almost all your other symptoms suggest the same thing to me. I am confident you have no STI from the sexual exposure described. (That said, if you are emotionally confliced about that exposure -- i.e. a worrisome sexual exposure you regret -- in that sense, your symptoms might be related to that event. But not because of any infection.)

Repeating the bottom line:  I am confident you have no STI other than your genital wart, which probably is now gone, having been treated by removal and bopsy. Certainly neither HPV nor any other STI is responsible for your various symptoms.

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

HHH, MD
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24 months ago
Thank you Dr. for your quick response. Just a couple of more questions if you don't mind. Do you feel that my most recent HSV testing on Feb 2 (6months post exposure)is conclusive?I have read that people may take up to 1 year to test positive. Do you think I should continue to test?In addition to my penile burning in and out, I have experience rectal burning as well over the past 6 months. Do you think the penile burning and rectal burning could be related?All the burning came on right after my oral sex encounter. Any ideas on what may have caused the prostatitis if not an STI?The redness and bumpiness of my penis head is also concerning even though it does change from time to time.. If not HSV or HPV, do have any ideas what this may be?Thank you again Dr.This entire situation has been very difficult that past 6 months and your professional advice is very valuable to me.Im hoping to move on one day soon from this
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
The maximum time required for conclusive antibody testing for HSV2 is 4 months. It can take longer for HSV1, and a few percent never develop positive results. But there is no chance your symptoms are due to HSV of either type, including the mouth burning. No herpes outbreak ever causes symptoms that last more than 2-3 weeks. HPV never causes systemic symptoms, only painless growths (warts etc).

I believe most or all your symptoms are "related" in that they likely have the same psychological origin.

The diagnosis of prostatitis is very imprecise and although some of your symptoms may be compatible with it, they are not typical. My guess is the urologist diagnosed that tentatively, as the only possible urological cause of such symptoms. But that's not the same as a documented diagnosis. You'd have to ask him or her how conficent s/he is of the diagnosis, but I'm skeptical. In any case, no STI causes prostatitis except rare cases of gonorrhea, and that doesn't fit your symptoms or test results.

"do have any ideas what this may be?"  Sorry, but I've already given my best judgment. Psychologically related symptoms, perhaps related to guilt or anxiety over the sexual exposure, and no STI of any kind. Symptoms like this are common in people (mostly men) with sexually related guilt or anxiety. My colleage Dr. Hook sometimes attributes things like this to "post-coital remorse" or PCR -- playing on PCR as a common STI diagnostic method.

This should be viewed as good news. It means that you'll never have any sort of complication or serious physical problem, and have nothing that can be transmitted to sex partners or harm them. Usually symptoms clear up once the affected individual becomes convinced -- emotionally as well as intellectually -- that it isn't serious or harmful. My advice is to entirely cease any further efforts at either diagnosis or medical treatment. If the problelm continues nevertheless, professional counseling should be the next step. Be assured that I suggest this from compassion, not criticism.

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24 months ago
Thank you again , and I will definatley take your advice to try to move on from this.  My last question has to do with the HPV diagnosis. I've been married for 5 years and we have been together for 7 . Both of us have been faithful up to my mistake. Do you think this "wart" could be a result of my oral sex encounter or a prior exposure from years ago on her end or my end?My wife is aware of the diagnosis, when do think it would be safe to resume unprotected sex again (if she will ever allow me too). Take care Dr. Handsfield. Your doing great work and helping many people on this site get through very difficult times in their lives. I for one am very appreciative of that. Be well!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Given your sexual history, almost certainly the wart resulted from delayed recurrence of a distant past HPV infection. I hope you haven't been holding back on unprotected sex with your wife because of this:  by the time the penile lesion was diagnosed, your wife probably had been exposed multiple times already -- perhaps every time you had sex for the 7 years you've been a couple. By that time she was either totally immune or already infected with that HPV strain, so there was no point in stopping sex when it was diagnosed. (There also has been no need to avoid sex on account of your other symptoms, for the reasons already discussed.)

Thank you for the thanks and your kind words. That's why we're here. I'm glad the discussion has been helpful.
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