Unprotected oral and protected vaginal with CSW of unknown status. 

Symptoms that persist noticeable pain in urethra. Urgency to urinate almost to provide relief. No real pain urinating. 

I have tested negative for chlamydia and gonorrhea. I have taken two urine dip tests. No nitrites/nitrates and no wbc in urine both times. I received a shot and rear end and also a weeks worth of doxy and four pills still no relief.  

1. If this was Herpetic urethritis, would wbc always show up in the urine? I can’t find any info on this 

2. No bacteria in my urine, what can be causing the pain? 

3. Was I at any exposure for hiv? Condom did not break but did not cover all of my shaft 

4. A small white patch appeared on my urethra. Not itchy not raised. Looks like a white discoloration.  Can this be from the antibiotics. I have no sores or bumps besides this white patch 

I’m getting married in 3 weeks and I am desperate. I apologize. 

Your description this time makes your symptoms sound more anatomic i.e. physiologic than last time, and perhaps less anxiety driven than I believed previously. In terms of STIs that might do this and for which you were at risk, herpes indeed seems most likely. In my experience, most men with herpetic urethritis have more severe pain than you describe, and urinating makes the pain a lot worse. There also has often been tenderness somewhere along the penis, presumably at the site of herpetic lesion(s). And as I might have said in our previous discussion, most herpetic urethritis occurs in combination with obvious external genital herpes as well. So all in all it seems unlikely, but I cannot say it's impossible. To my knowledge there has never been a systematic study of the symptoms, signs, and lab abnormalities associated with herpes urethritis, and it seems likely that milder forms can exist. If you have it, almost certainly it would be caused by HSV1, from the oral exposure, and not HSV2 given the condom-protected vaginal event. (As we discussed previously, that the upper part of your penis was exposed is irrelevant.) 

Another possibility might be a yeast infection, which conceivably could be acquired by oral sex, and/or the result of the antibiotics. This would be more likely if your symptoms are progressing, or started after you began treatment rather than beforehand. The title of this question suggests genital mycoplasmas are on your mind, but none are carried in the mouth and therefore are not acquired by oral sex; and the vaginal exposure remains low risk for the reasons we have discussed. And the only genital mycoplasma that could be responsible is M. genitalium, and it would have caused the findings associated with NGU that you lack, like discharge and increased WBCs in urine.

To your specific questions:

1. WBC in urine? You can't find info on it because, I am quite sure, no such information has been published. I doubt that absence of WBC rules it out, however. Or yeast infection.

2. Discussed above. If I were betting on a provable outcome, I would still put my money on anxiety magnifying minor symptoms, but would not be surprised if it turns out you have herpes or yeast.

3. We discussed HIV last time. No meaningful risk:  condoms work if the head of the penis and urethra are covered; and oral sex is almost zero risk even without protection. However, as we may have discussed last time, you might want to be HIV tested just to enhance your confidence you don't have it. In any case, HIV cannot be responsible for the symptoms you describe.

 4. Presumably you have observed the "small white patch" inside the urethral opening, right? That could fit with yeast or herpes. Or nothing.

You should get professional care in person, preferably with a genuine expert such as STI specialist or urologist. The latter might be ideal, because urethroscopy (a look inside) might be a good idea. Whoever, you see, discuss having an HSV PCR on a urethral swab specimen, or possible treatment effective against yeast (e.g. oral fluconazole).

I hope these comments are useful. Best wishes.

1. If there’s an open sore, logically wouldn’t the urine pick up the wbc while passing over it? 

3. I’m meeting with a urologist in a week. At that point I’ll be roughly 25 days from exposure. What type of test do you recommend I request for hiv. I know it’s not likely but for my piece of mind. Which would be the most reliable at that point in time. I’ve read a lot of conflicting this on the internet. By the way the internet is by the worse resource for people in my situation. 

4. The white patch was on the head of the penis. Not in the urethra or penis opining. I had a dermatologist look at my genitalia and he noticed nothing out of the ordinary. He prescribed some antibiotics which I will. It be taking. It’s been 18 days no sores or bumps besides that white patch discoloration 

Can I get your thoughts please doctor? 

4. With a dermatologist seeing nothing abnormal, almost certainly you're over interpreting a minor difference in skin tone or something like that. Ignore it. I agree with your decision to avoid antibiotics at this time.

My exposure was unprotected oral and protected vaginal with CSW if you recall. 

I took a 4th generation blood drawn from the vein 29 days after my exposure. I asked the doctor if it was antibodies and antigen. He confirmed. Thankfully  The results were negative. 

I also took a finger prick alere fourth generation test at 31 days and it was negative. Thankfully 

1) can I consider these two negatives conclusive based on my low risk exposure? Do you recommend testing later on? 

Everything came back negative for my full panel std test besides hsv. 

2) is 29 days sufficient for a negative syphillis result? 

The hsv kinda was a shocker to me seeing how I have no sores, lesions or bumps. My only symptoms were frequent urination (which you informed me is not a symptom) and slight urethra pain that had subsided. The results read as: 

Hsv 1 igg 30.8

Hsv 2 igg 1.62 and igm .35 

I don’t know what blood test they used but I’ve read a lot about false positives. Hsv1 I’m aware of because I use to get cold sores as a child. 

Hsv2 I’ve never had an outbreak and don’t recall any typical symptoms. How likely is this to be a false positive? What do you recommend that I do? Should I test at a later date? Is the number indicative of a new infection?  Is it ok to have unprotected sex with my partner? 

I greatly appreciate any detailed response to my concerns/questions  seeing how this is my last reply. Once again doctor thank you for all that you guys do. Your service truly needs to be and should be recognized. 

As I said above, I left this thread open in order to comment after you had been evaluated by a urologist. Apparently not yet done or you would have mentioned it.

1) Yes, given your very low risk exposure, you can consider these results conclusive.

2) 29 days is too soon for syphilis testing. 6 weeks. But here too your risk was so low that you should also consider this result conclusive. HSV "shocker"? It shouldn't be. You have HSV1, which is consistent with your past cold sores. You may or may not have HSV2:  although technically positive, only an IgG index of 3 or higher is conclusive. Probably you don't have it, and if you do, probably it isn't from the exposure you have described. You could have a repeat test with a different technology; the most commonly recommended is the Biokit® test; look for a lab that offers it. You can expect a negative result. While nobody can yet guarantee you could not infect your partner with HSV2, it is unlikely. If somehow I were in your situation, I would continue unprotected sex with my wife without worry of infecting her.

That concludes this thread. I hope the discussion has been helpful.