[Question #6060] Possible infection

17 months ago
Good morning,
8 weeks ago  I had unprotected oral sex for about 10 second or so twice & protected vaginal sex with my boxers on the whole time and I am almost positive that I never touched her skin during the intercourse. Boxers where completely dry. shortly after I developed penile discomfort (pain and felt like something stuck in my urethra) never had any discharge nor burned while I urinated.  2weeks after the encounter I couldn't handle the discomfort and went to the ER and they ran the whole STD panel and did blood work, everything came back clean and the doctor treated me with one shot and 4 pills he told me that he didn't want to take a chance. the following day I developed some sort of rash on the top of my penis head, i went back to see the doctor and he prescribed an ointment (triamcinocolone.1%)  and took it away in about 2 days.  Since that day I cannot see the light, I've been STD tested 3 times and everything keeps coming back clear this is the reason why i think is probably viral. No lesions, sores or blisters up until this point but 2 doctors prescribed my valtrex and one wanted me to go see an infectious disease dr. I had a 4.8 week hsv test and both came back negative, I have never had a cold sore in my life. Was tested last year and both hsv1/2 were negative. She did not tell me she hsv2 positive and it was confirmed via igg blood test and negative for hsv1. She mentioned that she a bad OB on her face when she was 17 and she was a "virgin" at the time.
1. what are my chances of contracting herpes?
2. how long does it take for first outbreak?
3. should i be concerned of any other std?
4.likelihood of having an outbreak after 8 weeks?
5. should I take the valtrex?
6. Can my urethral symptoms be caused by herpes?
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your confidence in our services.

It is very unlikely herpes or any STD is the cause of  your symptoms. You had a very safe sexual experience, your symptoms don't fit, and all the tests you had are very accurate. Had you been in my hands, I would not have treated you -- but in the very unlikely chance you had gonorrhea or chlamydia, the ceftriaxone shot and azithromycin (4 pills) would have cured it. The only slight possibility could be herpes due to HSV1, from the unprotected oral sex, since up to a third of people with HSV1 do not develop positive blood tests. However, herpes doesn't fit your symptoms and in any case, symptoms from herpes never last 8 weeks. (Please explain "I cannot see the light". I assume you're not blind or having other serious eye symptoms.)

Your story about your partner and her HSV blood test results don't hold together well. Her "bad" oral outbreak isn't likely to have been HSV2, although that's possible if she had recently given oral sex to a partner with genital herpes. But even if that was due to HSV2, it is very rare for HSV2 to be transmitted by oral sex.

Based on your description, the penile rash also was not herpes, and herpes would not have cleared up so rapidly; in fact, the steroid cream would delay healing, not speed it up. No other STD is a likely cause of such a rash. I have to wonder whether you had a fixed drug erupton. FDE is a type of allergic reaction, with a very localized rash -- often on the genitals -- that can be caused by various antbiotics, and the timing was right. (If due to the treatment the day before, azithromycin -- the pills -- are a more likely culprit than the ceftriaxone, but it could be either one.) If the rash had stinging pain and looked similar to a burn, that also would fit with FDE.

Probably around 60-70% of people with new HSV infections have positive blood tests by 4 weeks, so your negative HSV test result is soft evidence against herpes -- but since your symptoms don't fit

Those comments cover your questions, directly or indirectly. But to be explicit:

1. The risk of genital herpes from a single episode of condom protected vaginal sex with a partner known to have HSV2 is no higher than 1 chance in a thousand. And if that had happened, it couldn't involve your urethra, assuming the condom was properly used and didn't break. The chance from a single episode of unprotected oral sex is 1 in many thousand for HSV1 and even lower for HSV2. All things considered -- the exposure, your test results, nature and duration of sympotms, and apparently continuing symptoms on Valtrex, there is no realistic chance you have genital herpes.

2,6. Initial herpes symptoms typically start 3-5 days after exposure, sometimes up to 10 days, and rarely maybe 2-3 weeks. You don't say what you mean by symptom onset "shortly after" the sexual events described, but anything sooner than 26 hours cannot be any infection from that event. Herpes is not a consideration as the cause of your urethral symptoms. But if you want to have a conclusive blood test, you could have another HSV2 antibody test about 4 months after the exposure. If you do it, you can expect another negative result.

3. See above:  I am confident you have no STD.

4. If you had herpes, the first recurrent outreak could occur at 8 weeks or any time after that.

5. I would not have prescribed valacyclovir (Valtrex) and I strongly suggest you stop taking it. Not only is it apparently not helping your urethral discomfort, continuing it could make another blood test less reliable.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Hello Sir and thank you for your prompt response.
I never took valtrex because I havent seen any or experienced any sores or ulcers. The urologist was one and he got upset when I told him. The urologist put me on doxycycline for 14 days 100 mg twice a day 2 weeks ago but no response either. 
She mention that her OB was zoster or something like that, don't know much about it though. Is a facial OB concidered oral? She said she hasn't had one since then and nothing ever on her lips either.
I was thinking retesting again at 12 weeks, would that be good enough for me to let this go?
What I meant by I cant see the light is that to many things from feeling discomfort l, rash, pain...etc 
My dr. Tested me today for trichomoniasis and he should get the results by this friday and all based on my urethra symptoms.
Thank you once again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Thanks for the additional information.

Herpes zoster (shingles) is caused by varicilla zoster virus (VZV), which is related to HSV but is an entirely different virus and not a cause of oral or genital herpes. Stay off the valacyclovir and have another HSV 1 adn 2 blood test at 12-16 weeks. It will also be negative. Your doctor probably tried doxycycline n case you had chlamydia, nongonococcal urethritis (NGU), or a non-STD urinary tract infection. Lack of response shows you do not have any of these. Trichomonas is not a likely cause either; you cannot catch trich from oral sex or condom-protected vaginal sex; that test also will be negative. You should be tested for prostatitis, which is not due to any STD; but I also doubt this is the problem. You might have the male chronic pelvic pain syndrome:  google CPPS (spell it out) for more information; the Wikipedia article is quite good; CPPS also is not an STD.

I am confident you have no infection of any kind, and nothing you caught from the sexual exposure described. You might ask your urologist if you might have a urethral stricture, but I doubt it.

I'm afraid that's as far as this forum can go. Clearly you have no STD, and that's the only topic for this forum. We do not deal with non-STD genital symptoms. But I hope the discussion has been helpful.
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