[Question #8446] Confusing Symptoms

44 months ago

Background: Male, early 20s. I have tested for chlamidya/gonnorhea/syphilis multiple times and result was negative. Also have a Negative HSV1/HSV2 IGG about seven months after encounter.

About a year ago, I had a sexual encounter with a female (unprotected). A few days later, I had a red/stinging scrotum. This subsided after a few days. It has reoccurred since then every few months and lasts for a few days, and I have noticed especially after I have been sick, which had me concerned about it being HSV. This stinging sensation has been accompanied by a very small clear sticky discharge that leaks out (just dribbles). It leaves a whiteish stain in underwear. One time, I pressed on the head a bit and the discharge changed from a clear to a more yellowish color. Other than that, the discharge has always been clear. There is no pain urinating whatsoever, but the meatus becomes more red and inflamed. Just this light painless sticky clear discharge and burning scrotum. In my most recent episodes, it also caused pretty significant anal itching. I have visited several doctors and they all say nothing is wrong. However, the symptoms say otherwise.

The symptoms themselves do not align with HSV necessarily, but the fact that the pattern of symptoms reoccur every few months and last for a few days is concerning me (despite no further exposures). I have never had any vesicles.

To summarize: reoccurring burning scrotum, burning/itching anus, clear discharge after an unprotected sexual encounter. STI results negative.

What could be causing this and how should I proceed? I am very lost right. Thanks for your help.

H. Hunter Handsfield, MD

44 months ago

Welcome. Thanks for your question. I'll try to help.

I agree your symptoms "do not align with HSV", and the fact that they recur doesn't necessarily point in that direction. Anyway, the negative HSV blood test is solid evidence against herpes as the cause. I don't know what to make of the "burning scrotum": that doesn't fit with any known STI. Occasional anal itching, being among the most common of all symptoms experienced by all humans, doesn't suggest anything in particular.

The only symptom that might be consistent with an STI is the urethral discharge. Intermittent discharge for such long time isn't typical for any STI. I'm not sure I agree with your "several doctors" that "nothing is wrong", but I wonder whether you have been evaluated for prostatitis. But that's not an STI -- and whatever the cause, I am confident you have no STI and that your symptoms are not due to any infection from the sexual encounter a year ago.

And I'm also confident that this isn't serious. I see no reason to be concerned about anything that will ever cause any sort of serious health problem for you or your current or future sex partners. The only thing I can suggest is that you see a doctor -- ideally a urologist --at a time you have active symptoms, especially urethral discharge. Then take it from there.

Sorry I can't come up with the conclusive answers you seek, but I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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44 months ago

Thanks for the reply, I appreciate it! The info was useful and I am glad you see no reason for concern. However, I have to insist that these symptoms were a result of this encounter, as I never had these symptoms before the encounter, and they had a sudden onset very noticeably just a few days later. I am confident this was no coincidence. The symptoms were the strongest the first time they appeared (few days after encounter). Recent reoccurrence have been more mild, however. I would also like to add that the discharge causes the urethral opening to be slightly glued together. I would also like to highlight that when these symptoms appear, (burning/tingling scrotum accompanied with the discharge/inflammation) they come on together suddenly, last a few days, then disappear completely until the next reoccurrence a few months later. I have not been examined for prostatitis, but the pattern of symptoms seems to make prostatitis unlikely. I have no trouble urinating, no dysuria, and no pain at all in the general region which also makes me think it's not prostatitis. I definitely understand these are nonspecific symptoms so it is hard to point me in a clear direction, but let me know if there is any other info you might have. Have you ever seen these symptoms together? I appreciate your help.

H. Hunter Handsfield, MD

44 months ago

Thanks for these comments. But they don't seem to respond to anything I said -- there are no comments in my reply above that suggest your symptoms are unrelated to the sexual exposure describe. And I have no doubt your symptoms are real and not imagined. However, they aren't necessarily due to an infection of any kind, and -- perhaps this is why you raise these issues -- I have to be suspicious that some or all of your symptoms have a psychological origin. That doesn't mean they aren't physiologic or real, just as psychological factors are responsible for the real pain of tension headache and the increased scalp muscle tone that causes the discomfort. In my 4 decades experience, I have cared (either directly or online) with hundreds of patients in whom the anxiety is genitally focused, usually following an anxiety-producing or regretted sexual experience, and your symptoms are the same or similar.

I'll also point out that in the (unlikely) scenario that some sort of infection explains your symptoms, the sexual exposure almost certainly wasn't the only potential source. During the timeframe of that event undoubtedly you interacted personally with many friends, co-workers, service personnel; and could have been exposed to unknown environmental factors.

None of this changes my confidence that your symptoms are not alarming. Among those hundreds of patients I mentioned above, not one ever turned up later with any important long term consequences. Also no change in my core advice: that you see a knowledgeable physician at a time the symptoms are prominent, especially visible discharge. Given their irregularity, another option would be self assessment. You could purchase urinalysis dipsticks, in particular leukocyte esterase test and, when discharge appears or your meatus is sticky, test the secretions: positive LE would support an inflammatory (perhaps infectious) cause, and negative would suggest some sort of non-inflammatory secretion, such as prostate fluid or semen. You also could deposit a dab of secretions on a microscope slide for later staining and examination for white blood cells and bacteria -- i.e. partly getting around the possible difficulty of arranging a professional exam when discharge is present.

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44 months ago

Thank you again for the response. I might be a little confused. If the symptoms were from the encounter, wouldn’t they be considered an infection then? How else could symptoms like these arise from a sexual encounter if it’s not an infection?

If I could just have a few more questions clarified:

Should I be confident in HSV negative IGG results despite ~8% false negatives? My initial concern of HSV was because I keep getting these reoccurring symptoms of discharge/scrotal inflammation when I am fighting an illness.
Have you ever seen HSV urethritis cause painless discharge/no pain upon urination?
I am planning on taking your advice with the urine dipsticks in the future if necessary. Do you recommend a certain one? Also, will it work if there’s not much liquid?

Thanks for your expertise and will plan on seeing a knowledgable physician should these symptoms arise once again. Take care

H. Hunter Handsfield, MD

44 months ago

"How else could symptoms like these arise from a sexual encounter if it's not an infection?" I think my comments about a possible psychological connection were pretty clear. Maybe re-read them.

1. The absence of symptoms that suggest herpes plus the negative HSV blood test results amount to 100% certainty you didn't acquire HSV.

2. No, I'm not aware that herpes urethritis ever behaves in this manner; and I've never seen a case of herpetic urethritis that wasn't seriously painful with urination.

3. I don't keep track of different brands of urine dipsticks. But all those that include leukocyte esterase use basically the same technology and probably are equally reliable. The amount of discharge shouldn't make any difference: any moisture at the meatus will be sufficient for accurate testing; just touch the LE section to the discharge or moisture.

I remain confident you have no infection of any kind from the exposure described. If your symptoms persist, and especially if LE testing and/or further clinical evaluation by your doctor document no inflammatory component, I hope you will raise the possible psychological aspects with your doctor.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.

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