[Question #523] HSV1 Urethritis

44 months ago
This is a follow up to previous question:

I had unprotected oral sex 3 weeks ago.  Within 24 hours I noticed my meatus was red around the tip and slightly inflamed.  Same day tested.  Had no leukocytes in urine, but did show some blood in the test.  Treated with Rocephin (1g IM) and azithromycin (2g oral).  The next day the red meatus was improved, but still redder than normal for the next ~14 days.  Test for CT and G negative. Urine clean no growth. I had minor discomfort on urination for ~14 days, some urethral itching in first inch of urethra and outside on undershaft of penis, and often waxing and waning aching in penis.  I have not had any sores, ulcers, or rashes or discharge.  At 7 days visited a urologist who did a DRE and found Yeast in prostate fluid (Urine clean).  Prescribed Diflucan, but also said he did not believe yeast caused prostatitis. Took Diflucan for 7 days along with Doxy (100mg BID).  Did not change symptoms materially.  Switched to Augmentin for 7 days (500mg BID).Had full STD panel done at 10 days.  Everything negative accept HSV1 Igg was 8.0.  I actually have a negative HSV1 Igg 15 months ago. I requested Valtrex even though still never had any lesions, blisters, ulcers or discharge.  I have taken Valtrex for 5 days.  My Urethritis symptoms have subsided mostly, however, felt like that improvement started a day or two before I began Valtrex on day 17.  Now day 22 and still having burning sensation in groin, perineum, testicals, and inside of thighs.  The sensation comes and goes and sometimes have milid itching.

1. Would the current HSV1 test have been positive only 10 days after exposure, or is that too short of a time period?
2. Does this sound like it was herpetic urethritis caused by HSV1?
3. Is it possible that Igg negative HSV1 test 15 months ago was false negative and I have had antibodies for longer?
4. Are slight burning in groin, perineum, testicals, inside thighs symptoms of HSV genitally after 3 weeks?

Thank you
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I don't believe that a person would go from negative to 8.0 in 10 days normally, but I recently saw another patient who had a similar increase in a short time for HSV 1.  I'm not clear that it isn't something with the test rather than with the person, in these situations.  Have you ever in your life had a cold sore on your lip or in your nose?  So in answer to #3, yes, I think it is possible that you had it before and the first test missed it.  The soonest I have seen seroconversion is 10 days and that was from 0.2 to 1.2.  In your case, your baseline was 15 months before your most recent test, so we really have no idea when in there you might have seroconverted, right?
I would be very surprised if HSV 1 genital infection (and we really have no idea WHERE the infection is, do we?) was causing all these symptoms as HSV 1 genitally is normally  an infrequently recurring problem.  From your list of medications, it doesn't sound like anyone thought you might have a prostate problem, was that evaluated?
Also, in my experience, new herpes infections that cause urethritis are also accompanied by external lesions as well.

Terri

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44 months ago
I do have a past history of Prostatitis.  This is what initially had me have STD workup 15 months ago (where Igg's were negative).  At that time, I was diagnosed with Chronic Bacterial Prostatitis, and did have e Coli grow in a urine culture which was confirmation.  That prostatitis eventually subsided over 3-4 months and I took months of cipro and bactrim (which I am not sure actually did anything).  I believe the prostatitis resolved on its own.

I have not had cold sores to my knowledge or recollection the past.  Nor have i ever had any genital lesion, blister, etc.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
It's possible that you current issues are once again related to prostate problems and it would good, I think, to have that evaluated at this time. 
If you've never had a cold sore on your lip or in your nose, we can't know where your HSV 1 infection is, specifically if you've received oral sex in your lifetime.  If you get an outbreak in either location, please have it swab tested to know if it's your HSV 1, flaring up.

Terri
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