[Question #6722] A number of symptoms ... what to do?

14 months ago
Dear Doctors, first thank you for the services you are providing.
 
I am male, 30s in UK. In a long term relationship and this has been my only sexual partner ever, never had any concerns before.

3 months ago had a drunken encounter. This involved unprotected oral sex from a girl I don’t know. Also, I rubbed my unprotected penis against her vagina and briefly the tip of my penis did penetrate unprotected.

Day after I noticed a slight redness on my glans. There was slight itching and irritation. Over the next 2/3 days I was having an increased urge to urinate, dull ache in testicles and abdomen. Gave urine sample at doctors and was told no sign of UTI. 

I have taken a urine test for chlamydia, gonorrhoea and Trich which was all clear. The symptoms gradually improved. One month after exposure I masturbated one day for a very long time. After this my shaft was very sore and red and I had a small sore right on the tip of my penis. This stung when I urinated, gradually clearing over a week or so. All the time I was feeling a tingling in my testicles and perenium, increased urge to urinate and feeling like I am still dripping after urination. 

The redness on my glans has never gone away, some days it is quite obvious and other days it is very faint I also get redness right on the “lips” at my urethra opening. I will go for a week with very mild symptoms only for the redness to flare up again - always followed by tingling in testicles, increased urge to urinate and now I am also getting irritation around my anus. Sometimes it feels like I am sitting on an object/lump and my anus feels itchy.

The cyclic nature does make me concerned about herpes. My doctor took a PCR swab inside my urethra which came back negative. But I didn’t really have any sores there at the time. I was also tried on a single dose of Azithro 1000mg which didn’t seem to help. I have had my prostate examined and told it feels normal. Another urine test and told it was clear of signs of infection.

With no disxhsrge




14 months ago
I apologise for the high word count. Essentially, with no discharge and no sign of WBCs in urine my doctor is convinced I have nothing sexually transmitted. 

I am worried as I am getting these symptoms which keep recurring, usually over two weeks then one week off. 

In your expert opinion, can you suggest what might be going on?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thanks for your confidence in our services.

My reply can be characterized as good news and bad news. The good:  I am confident no STD explains any of your symptoms. In other words, I agree with your doctor. The bad: I can't otherwise explain your symptoms. Our intent for this forum is to address STD/HIV issues only; we evaluate symptoms when STDs or HIV are possible, but once excluded we make no attempt to address non STD genital symptoms.

As a general rule, almost no genital skin rashes or irritation are due to STDs. You are correct to worry about herpes in light of recurrent symptoms. But lots of other conditions cause recurrent symptoms, and you describe nothing esle that suggests herpes or even hints at it. Contrary to information you can find online (but only from non-professional sites), herpes doesn't cause skin tingling in the absence of otherwise typical (i.e. visible) outbreaks; that is, tingling alone does not suggest herpes. And on and off redness, itching, and irritation also are not typical STD symptoms.

In addition, the expousre you describe was low risk for STDs. Certainly urethritis (gonorrhea, nongonococcal urethritis) can be acquired by oral sex, and so can herpes due to HISV1. And in theory, genital apposition without peneitration carried slight risk for HSV2. But those have been excluded on the basis of both the symptoms described and testing done so far. The only other testing to potentially consider is a blood test for HSV. However, I do not recommend that. The tests are not compeltely reliable:  positive results can be false, and negative results don't necessarily exclude HSV. If positive for either HSV1 or HSV2, I would interpret that as evidence you have entirely asymptomatic infection, plus some other explanation(s) for your symptoms. (And if positive for HSV1, it would just mean you probably had an oral infection, perhaps in childhood.) On the other hand, if negative for HSV2 -- and especially if negative for both HSV1 and 2 -- it might help convince you that you don't have genital herpes.

So what IS causing your symptoms? As noted above, that's not the forum's main focus. I'll just point out that most of what you describe is entirely consistent with anxiety and other negative emotions (such as guilt over a sexual decision you regret). Not that such emotions cause symptoms, but they certainly can greatly magnify trivial symptoms or even normal body sensations that otherwise would be ignored or not even noticed.

Keep working with your doctors if your symptoms continue or you otherwise remain concerned. But you can dismiss any and all STDs. They aren't an issue. Your symptoms may clear once you come to understand and believe it, not only intellectually but at a gut, emotional level. In any case, I hope these comments are helpful.

HHH, MD
---
---
14 months ago
Dear Dr Handsfield,

Thank you for the swift response. I am grateful for your insight and I can tell you that your comments have been very helpful.

I think what alerted me to herpes was the reoccurring symptoms. Also, I have read in a number of places that people might experience repeated symptoms of yeast infection, UTI, or hemerhoids which turns out to be herpes. Due to my redness/irritation, urinary symptoms and irritation at the anus, I was convincing myself this must be what was happening. Also, antibiotics did not seem to help.

It is interesting you mention stress/ guilt. I have been feeling extreme guilt, anxiety and stress since this happened. Do you think it sounds like a case of CPPS? 

The only thing I am unsure of with that however, is when the symptoms do fade I begin to feel more relaxed and don’t feel as though I am stressed. The symptoms will always flare up again however.

Any advice greatly appreciated. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
The reports of yeast or other recurrent symptoms turning out to have herpes is nothing like your situation. Those reports almost exclusively are people with quite typical recurrent herpes outbreaks who do not understand their symptoms. They have recurrent blisters/sores, somtimes preceded by a prodrome of itching or tingling, and believe such symptoms are yeast or something else. Once accuratly diagnosed, they then correctly recognize future outbreaks for what they are. This isn't always the pattern, but it's the usual one. People with symptoms like yours virtually never turn out to have genital herpes.

Antibiotics didn't help because you have no bacterial infection. But that doesn't point to herpes.

CPPS often (usually?) has an emotional/psychological component. But your symptoms don't suggest CPPS.

Stress/emotional/psychological symptoms often don't track sensations of being stressed or anxious. It's still a reasonable explanation for much of what you are experiencing.
---
14 months ago
Dear Dr Handsfield,

Thank you for the further information. If I may, I’d like to follow up with some final questions to put my mind at rest. 

I was tested for Gonorrhea, chlamydia and Trich with a urine sample. How reliable do you think this testing is (in the UK)?

My doctor checked a urine sample by dipping some indicator paper and seeing what colour it turned. How conclusive is this test for bacteria without any additional analysis?  I know there are a myriad other infections I haven’t tested for, such as Mycoplasma which can be resistant to Azithromycin.

If someone were to experience repeated herpes outbreaks, is it possible they would be so frequent as on/off every one to two weeks?

How about Post Herpetic Neuralgia.... can this cause symptoms of irritation and anus pain, feeling like sitting on a foreign object or urinary symptoms?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
I'm sure the G, C, and T tests were top of the line technology and completelyr eliable (in the UK or anywhere else).

The dipstick was for white blood cells or bacteria, or both. Negative result isn't necessarily conclusive, but tends to exclude urethral infection. There is no point in testing for mycoplasma, which is not carried in the oral cavity and hence not a risk from oral sex -- only from vaginal or anal penetration.

Genital herpes outbreaks are never that frequent. For HSV2, the average outbreak frequency is every 2-4 months and maximum once a month, with each episode lasting 7-10 days. For HSV1, the only risk from oral exposure, most people have no recurrent oubreaks at all after the first episode; and when oubreaks occur, they average once every 1-2 years. Post herpetic neuralgia is a common complication of herpes zoster (singles). It does not occur following HSV infections, including genital herpes. Based on all the information you have provided, there is no chance you have genital herpes.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Do your best to move on without worry!
---