[Question #6853] STI risk after unprotected sex, symptoms

64 months ago

I recently was tested 2 months ago for all STIs except herpes. I tested negative for everything (HIV, Syp, Gon, Chl). I was in an exclusive relationship for a year. After we ended, I had unprotected sex with 2 diff girls. I slept with one girl in mid-March. The last girl I slept with on April 1.

April 11 I started to get this hot/burning/tingling sensation in my urethra and the same inside my penis at times throughout the day. I been inspecting my penis for the last week straight and do not see anything on the skin. There appears to be a mark on the shaft, size of a pea. Honestly, I may be inspecting my penis so much that I am seeing things, not something new. What I see is below the tip of my penis on the shaft and also where I have felt the pain and. It is not raised or blistered. The skin is flat and smooth. There is no discharge or pus.

There is a mild burning sensation when I urinate and after I urinate. I also feel general itching in the genital area. I also feel strange when I masturbate/cum. I do not seem to have strong sexual drive.

I got tested twice this week (April 12 & April 16) for Gon and Chlam, both negative. UTI test negative. Two healthcare professionals visually inspected my penis twice. They refused to test me for genital herpes, saying the signs and symptoms do not correlate to genital herpes. They also refused to test me for HIV & syphilis b/c they said it was too soon.

The PA who saw me 2 days ago prescribed cipro. He thinks it’s urethritis. I have taken 3 pills, I still feel these symptoms explained above. He looked in my urethra, said it looked normal.

My questions:

1. Could this be genital herpes? Should I take a test?

2. Do you agree with these 2 healthcare professionals that this is not genital herpes?

3. Do you agree it is urethritis?

4. Could it be NGU or contact dermatitis?

5. What do you think could it be? What do you recommend that I do now? Any general advice or knowledge?

Super frustrated. I want to get this off my mind already.

Thank you

Edward W. Hook M.D.

64 months ago

Welcome to our forum and thanks for your confidence in our work. I’ll do my best to help. Your symptoms deserve further evaluation. Specifically, the symptoms you describe could be a manifestation of nongonococcal urethritis (NGU). NGU is a urethritis syndrome which can be caused by a number of organisms including but not only chlamydia. It is best diagnosed by an evaluation of urethral secretions for increased numbers of white blood cells. The most reliable test for this is a swab specimen taken from the urethra at least an hour after your last urination. Although slightly less sensitive, a urinalysis looking for a white cells may also support the diagnose of NGU. Like the clinicians who have already evaluated you, I see little yield in testing for herpes. In situations such as yours blood test for herpes are often misleading and as you describe there are no specific lesions to test directly.

The ciprofloxacin you have taken may obscure the diagnosis of urethritis and is not the recommended treatment for the syndrome. Rather, recommended treatment for NGU is seven days of doxycycline taken twice daily or, a single 1 g dose of azithromycin. With respect to your specific questions:

1. See above. I do not see any benefit from testing for HSV at this time.

2. Yes

3. Possibly. The problem at this time is that testing could miss the diagnosis because of partial treatment. Nonetheless, were I seeing you in my clinic, I would perform the tests mentioned above.

4. Contact dermatitis would have it’s onset sooner then you have experienced and would have a rash which as I understand it, is not present.

5. Please see my comments above,

I hope the information and suggestions I have made are helpful. If there are further questions, please use your up to to follow up questions for clarification. EWH

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64 months ago

Thank you for all of your input and I do have full confidence in your work. I have utilized your work for years. Also Ms. Warrens and Dr. Handfield’s work are greatly appreciated.

My follow up questions:

1. For my knowledge, does or can genital herpes have a prodromal-like phase that can last up to 7+ days without an outbreak, blister or sore?

2. Can you help find meaning to this? I am not sure if it is relevant, I was tested for HSV IGM 1 and 2 Combination, Jan 2019, after my partner told me she had Genital HSV-1 and was taking actively taking Valacyclovir for extended period of time, the result was 1.13 (which is .04 higher than positive). I have never had a sore anywhere that I can remember mouth or penis, my entire life even to today. I was retested approx. 5 months after this, May 2019, for the IgG 1 and 2 CLIA method test which both came back negative (0.10 and 0.18 results respectively). What does it all mean? I have not been retested for HSV since May 2009. Could my current symptoms be from that 1.13 test in Jan 2019? Is your recommendation to still not to be retested now?

3. Should I stop the cipro and request a prescription for doxycycline? Or azithromycin? Or should I finish cipro and then request to prescription to take azithromycin?

4. When you say my symptoms deserve further evaluation, do you mean by a urologist? And do you mean for STD or other illness?

I will make sure to practice safe sex. I will not continue to ask questions from this point on. Once again, I appreciate all of your help.

Edward W. Hook M.D.

64 months ago

Straight to your follow up questions:

1. When persons with genital herpes experience prodromes, they are no more than a few hours in duration, not 7 days.

2. Virtually all experts strongly recommend against ever getting IgM tests for herpes. The results are uniformly unreliable and typically misleading. Please do not get further IgM tests! Your IgG tests, which are also not recommended as a screening test suggest that you do not have HSV-2. Repeating the test for your current concerns is unlikely to be useful as well.

3. At this time, since further evaluation may be compromised by the antibiotics you have already taken, it would be reasonable to obtain and take either doxycycline or azithromycin.

4. I would suggest further evaluation by a generalist with experience in STIs.

Hope this helps. EWH

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