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STDs (Expert Forum)
Can this be herpes infection
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Can this be herpes infection
by cautiously oppomistic, Nov 24, 2006 12:00AM
I am very worried that I may have been exposed to herpes and would greatly appreciate your advice and help. Oct 1st I recieved unprotectd oral sex from a friend which lasted less than 10 minutes. 4 days later I started to experience severe urethral pain, frquent urination, and pain in the head of my penis. There was some swelling of foreskin and redness near the head, but never had any pimples, red spots or sores of any kind. The person told me they have never had any cold sores in their life.(I know now this is false reassurance) The symptoms persisted, I went to the DR and was diagnosed with prostatitis and given levaquin to take for a month. The symptoms did get somewhat better after a month but never went away, and seemed to change to some scrotal tingling, moderate itching (Not bad) and swelling of my scrotum and perineum. 2 times i had a milky discharge from my penis during urination. Sometimes it made it hard to sit in a chair without discomfort. I did notice after awhile very, very small bumps on the head of my penis which can only be seen when I have an erection. At the one month I had a Herpes Select IgM 1&2test (which I know now was probably a waste of time) and it came back negative. At 6 weeks after potential exposure I had the following blood tests Herpes Select IgG test 1&2, chalmydia, syphyllis, one urine test possibly for gonnarrhea and hiv. All negative results. Things seemed to be better somewhat(never totally going away) until today when all the same urethral symptoms (like the first time), swelling and perineal pain reocurred. Motrin does help with symptoms/pain. I see a urologist Monday. My Questions are 1) Could this be a herpes infection based on my symptoms 2)based on my test results, should I go ahead with the 3 month test or is now (2 months) adequate 3) Am I being overly worried 4) What is the likehood i am infected. Sorry so long, any help would be greatly appreciated.
Doctor's Answer
by H. Hunter Handsfield, M.D., Nov 25, 2006 12:00AM
, Nov 25, 2006 12:00AM
Some of your early symptoms, particularly the urethral pain and swelling/redness, conceivably could have been herpes, but the negative HSV-1 and -2 results at 6 weeks largely rule it out. As you already understand, it can take 3 months for the test to become positive--but the even was low risk and the absence of typical herpes lesions are strong evidence against it; combined with the negative 6 week test, it would be extraordinarily unlikely that a 3 month test will be any different.
I doubt you had prostatitis, by the way. That's often a "wastebasket" diagnosis when a provider has no other good explanation. Statistically, it is far more likely that you had nonchlamydial, nongonococcal urethritis (NGU) acquired by oral sex (or conceivably gonorrhea) than the possibility that you coincidentally had prostatitis (which is not sexually acquired and is rare in healthy young men) a few days after a new sexual exposure. Another possibility is NGU due to a respiratory virus, like adenovirus. In any case, I doubt your continuing discomfort means any residual infection of any kind. If you had NGU due to oral bacteria, the Levaquin would have cleared it up; and if you had a virus other than herpes, it has gone away without causing any long term harm. If I were you, I would hold off on returning to the urologist and just sit tight for another few weeks, and see the urologist (or another provider) at 3 months if symptoms persist.
So the direct replies to your questions are: 1) I cannot completely rule out herpes, but it is an unlikely explanation for any of your symptoms. 2) Can't definitely say yes or no. Probably not necessary to have another HSV test, but it wouldn't do any harm. You can be quite sure the result will be negative. 3,4) I doubt you have any ongoing STD, regardless of whether things started out with NGU. Probably yes, you are more concerned about all this than is necessary. It is very unlikely you have anything that will ever harm you or a future sex partner.
Good luck-- HHH, MD
I doubt you had prostatitis, by the way. That's often a "wastebasket" diagnosis when a provider has no other good explanation. Statistically, it is far more likely that you had nonchlamydial, nongonococcal urethritis (NGU) acquired by oral sex (or conceivably gonorrhea) than the possibility that you coincidentally had prostatitis (which is not sexually acquired and is rare in healthy young men) a few days after a new sexual exposure. Another possibility is NGU due to a respiratory virus, like adenovirus. In any case, I doubt your continuing discomfort means any residual infection of any kind. If you had NGU due to oral bacteria, the Levaquin would have cleared it up; and if you had a virus other than herpes, it has gone away without causing any long term harm. If I were you, I would hold off on returning to the urologist and just sit tight for another few weeks, and see the urologist (or another provider) at 3 months if symptoms persist.
So the direct replies to your questions are: 1) I cannot completely rule out herpes, but it is an unlikely explanation for any of your symptoms. 2) Can't definitely say yes or no. Probably not necessary to have another HSV test, but it wouldn't do any harm. You can be quite sure the result will be negative. 3,4) I doubt you have any ongoing STD, regardless of whether things started out with NGU. Probably yes, you are more concerned about all this than is necessary. It is very unlikely you have anything that will ever harm you or a future sex partner.
Good luck-- HHH, MD
