Herpetic urethritis v undiagnosed UTI

[ConcernedGuy2012]

Hello Dr. Warren, long-time listener, first-time caller here (sort of, see below). This post is going to be kinda long. It is in regard to a question of undiagnosed uti v herpetic urethritis. This story begins, like so many, with very poor decisions. I previously had questionable sexual encounters on 8/12 (received unprotected oral and performed vaginal sex with condom, also rubbed my uncovered penis on her labia for about 5 secs), 9/25 (gave and received oral with guy and girl, vaginal sex protected), 10/10 (received unprotected oral from guy). Around 10/10, I noticed a canker sore in side my lower front cheek, but it went away. Subsequently,  I came down with symptoms of a UTI on 10/25 - frequent urination, pressure on bladder, tingling urethra. Went to my doctor on 10/26, had chills and fatigue as well. He diagnosed me with a UTI (urinalysis/culture came back negative.  10/27 - went to STD clinic and got tested for chlam and gon (NAAT), both came back neg one week later. During that time the symptoms improved and basically got better, though still had some tingling, pressure in lower abdomen right and left side.

[Terri Warren, RN, Adult Nurse Practitioner]

1.  Yes the titer fluctuates over time, and if you get a false positive once on the ELISA, you are likely to get it again.  Probably every time.  

2.  Antibiotics or any other medicine will not interfere with the test, except antivirals, which could.

3.  You need to order a western blot about 4 months after any concerning sexual encounter.  No sooner.

4.  We do see herpetic urethritis, yes, but urinary frequency is NOT a sign of herpetic urethritis, that is a bladder sign, not a urethral sign.  Also the pressure you describe does not fit with herpes.

Terri

[ConcernedGuy2012]

MORE INFO - Havent had a fever this whole time, and surprsingly, no burning during urination. All parties contacted told me they're clean (you heard that one before), but I don't know if all were actually tested. One says he was and I believe him.

So, my plan is to do another round of gon/chlam test at 3-weeks postantibiotic treatment. My doc wants to
do more antibiotic but I'm reluctant bc i dont want it to interfere with my results. Also, I know I need to do
another HSV2 elisa at some point and probably follow it up with a WB sometime in late jan/early feb.  my questions are:

1. Does the blood titer fluctuate up and down over time?

2. Will antibiotics/meds interfere with the test?

3. When should I order the WB?

4. Have u seen a presentation like mine? Thoughts on chronic/persistent herpetic urethritis?

[ConcernedGuy2012]

MORE INFO - I got concerned i still had something and started noticing symptoms again, ie, frequent urination, dull pressure in right and left side abdomen (it moves), tingling urethra. I got tested again, full std panel (so hsv elisa test) on 12/3 at this point I'd stopped the antibiotics, so was hoping they would not interfere with test, all results were neg (HSV2 was below 1.0 range so no # given). Did more std tests, including a gon swab and full blood panel,  the swab was done after urinating though, which docs dont recommend. Everything came back neg except my HSV2 IgG was 1.03. They reported this as positive which I know is not right (actually equivocal). This did not exactly surprise me. See, Dr. Warren, in 8/2011 I previously got tested after another bas decision, no symptoms, but got a full panel. My HSV2 IgG came back at 1.38, retested two weeks later, HSV2 came back at 1.56. I them setup a WB through your clinic, and it came back neg, the tests were done 10-12 weeks post hookup, with the WB done about 14 weeks posthookup. So while the low titer does not surprise me, it does scare me. This whole time, the frequent urination and tingling urethra have remained along with the lower abdomen pressure (that moves). Some times there is a dull pressure in my testicle, right or left, occassional leg pain, some lower back pain (who doesnt have this) but never any sores/lesions. I did have three canker sores inside my upper and lower left cheek last week and lower front cheek, but never on lips or outside mouth, and had swollen lymph nodes with the first uti and again this week. I managed to convince myself this weekend that the tingling urethra was a prodrome and that the ob was imminent, but nothing happened