Candida or Herpes??

[Spandisman]

About three weeks ago I had sex with a female friend of mine and the condom fell off part way through (although we did not notice until the end). About 5 days later I experienced a persistent tingling sensation in the end of my penis and inside my urethra. This developed into a burning sensation, which was aggravated when I urinated. This is still present. I am now terrified that I have contracted genital herpes.

I have not developed any sores, although I did have what appeared to be an enflamed hair follicle for a few days. This was completely painless and settled down to look just like another sebaceous gland. I have had frequent yeast infections on my penis in the past, but they have never come on so suddenly and severely.

I have already been tested for all other STDs and had a swab taken from inside my urethra and tested for HSV (negative), but in the absence of any sores I cannot really rely on that diagnosis. HSV blood tests are not offered anywhere locally (I am in the UK). The girl has also been tested and treated for cervicitis. She has never shown any symptoms, although is prone to getting thrush.

My reasons for suspecting herpes is the tingling sensation, the suddenness of the symptoms and the fact that I started getting cold sores for the first time this year, having performed oral sex on this same girl about a year ago.

I am in a long distance relationship and my girlfriend is coming to visit soon. We do not use barrier protection and I am terrified that I will give her herpes. I do not, however, want to have to confess to cheating on her without good reason (i.e. if this is likely to just be candida again). Any and all advice will be very gratefully received.

[H. Hunter Handsfield, M.D.]

It probably isn't candida; I have never seen a case of yeast infection (thrush) causing such symptoms in men.  Conceivably it could be herpes, but it is uncommon for herpes to cause urethritis without typical herpes sores.  Further, urethral herpes doesn't just "tingle"; excrutiating pain is the rule.  In any case, either of those would have shown up on routine evaluation, ie there would be signs of inflammation in a urethral swab and/or urine.  You are wrong about HSV blood tests not being offered in the UK; not every provider or lab perhaps, but testing can be done.  If you have not visited a genitourinary medicine (GUM) clinic, that would a logical next step.  UK's network of GUM clinics is generally excellent.  But in the meantime, it seems unlikely you have any active infection that will harm you or that can be transmitted to a partner.

Good luck--  HHH, MD

[confused1234]

I am in the UK and had an HSV blood test recently at a GUM clinic. They are initially reluctant to provide one as a positive result will not neccessarily explain your symptoms. Although I eventually insisted on having one. You will really need to wait a couple of months though because it will take some time for the body to develop antibodies to an infection so a blood test will not be able to detect a primary infection of recent exposure.

If you are getting cold sores on your lips and that is presumably due to HSV-1, then there is no chance that your genital symptoms are also caused by HSV-1 as you cannot be reinfected in other parts of the body.

[Spandisman]

Cheers mellomike - will look into that.

I am surprised by the response that candida does not cause burning in the urethra/head of penis. I was under the impression (from many websites on the subject and the GP that diagnosed me with a yeast infection a while back) that they were precisely the sort of symptoms that it caused.

Is it not also true that lots of people infected with HSV display much milder symptoms (like mine), hence leading to a large proportion of infected people being unaware? It seems that the absense of sores and excrutiating pain is not evidence enough to presume HSV is not there.

(I have been to a GUM clinic - that's where I got tested.)

Any further comments? I am not convinced that my girlfriend will be safe having unprotected sex with me.

[H. Hunter Handsfield, M.D.]

I can give no guarantees, just tell you what I know.  In 30 years in the STD business, to my knowledge I have never seen a yeast infection of the urethra in men.  I don't know why it is a rare to nonexistant event, but it seems to be.  In a recent research study of ~320 men with urethritis, yeast wasn't implicated in a single case.  And I have never seen a case of herpes presenting with the symptoms you describe.  I can't say it doesn't happen, but clearly it is rare.  Most people with symptoms like yours have no discernible infection, never develop serious health problems, and never transmit anything to their partners.  As a result, most STD providers tend to ascribe the problem to emotion, but you are in a better position to judge that for yourself than I am; most of the time the actual explanation simply isn't known.

HHH, MD

[bigdaddy1992]

Hi, thought i would add, i also am in the uk and asked them to test for herpes in a gum clinic. They did this straight away without any questions asked. I hope you have the same experiance but if you ask i am sure they will test you without any problems. i wish you luck, ( but i doubt you will need it. ) - bigdaddy1992

[Need help UK]

My GUM clinic wouldn't offer me any Herpes blood test, nor would my GP (I could get a referral, but they wouldn't pay). However, if you are in a central location, there are plenty of places to get it done.

You will have to go private though.

Go to any of the Medi Centres that are situated around many parts of central London. They offer the HerpeSelect test done by Quest Diagnostics - a bleeding fee and the test cost a total of £79.

The Doctors Laboratory - You need a referral for this one. But you can get the blood drawn at their office on WImpole Street and they send it straight to their lab up the road. It's not HerpeSelect but it is reliable (around 95% sensitive) and type specific. Again, around £80.

If your doc won't give you a referral try these:

The Regents Park Clinic (again on Wimpole Street). They use the Doctors Laboratory. Around £120.

Also, online service DrThom offers the Doctors Laboratory test, but again will cost around £100.

Most places send their tests to one of these two labs.

I am not sure about out of London though.

Good Luck!

[Spandisman]

Thanks, I am near enough to London for that to be very useful.

Am curious about cold sores though - some sources say you cant be reinfected in another site if you've already been infected with one type of HSV. If my cold sores are in fact HSV-2, then would that prevent me from getting genital symptoms, or pehaps reduce them? (Performing oral sex on this girl and starting to get cold sores both happened about a year ago.)

While candida seems to have been practically ruled out as a cause here, I have found that the clotrimazole anti-fungal cream that I have used for previous penile yeast infection does help reduce the pain on the end of my penis. (Is this likely to contain a generic "soothing" ingredient?) I have read on another site that a bad yeast infection of the penis can feel like "sunburn". That pretty much describes the sensation now.

As for the idea that this is "emotional" - that is really not the case. I am a natuarally optimistic bloke and did not even consider the possibility of STDs til my penis decided to burst into flames!

Anyone else out there had symptoms like mine?

[Spandisman]

Oh yeah, one more thought:

The girl had cervicitis. This can be caused by a variety of things - if not HSV then could whatever it is have passed on to me to give me a general infection that would not be picked up and named by the usual batch of tests?

[Spandisman]

Okay, two more thoughts.

If her cervicitis was caused by HSV and she was enflamed at the time we had sex, does that qualify as her being "active" (i.e. more likely to transmit)?

I'll shut up now.

[H. Hunter Handsfield, M.D.]

OK, one at a time from your follow-up comments:  1) Oral cold sores due to HSV-2 are extremely rare.  HSV-2 doesn't "like" oral tissues and rarely sets up recurrent infection.  If you have had cold cores, you can bet they are due to HSV-1.  In that case, you would be resistant to new HSV-1 infection but fully susceptible to HSV-2.  2) Penile yeast infection sometimes is seen in men who are partners of women with vaginal yeasts.  But the infection is exclusively external; it tends to be most prominent in uncircumcised men.  I stand by my previous comments about yeast and urethritis, i.e. not a proved cause.  But there are few absolutes in medicine and biology, so maybe it occurs from time to time. 3) Yes, symptomatic improvment might result from the soothing effect of the cream, unrelated to the antifungal drug therein.  4) I certainly agree you are in a better position than I am to judge the likelihood of an emotional component to your symptoms.  All I can do is yammer on about the probabilities, not make a diagnosis in any particular case.  5) HSV indeed can cause cervicitis, but only episodically; HSV is virtually never the cause of garden-variety cervicitis that persists for weeks on end.  You also are right in raising the possibility that whatever is causing your symptoms could be linked to your partner's cervicitis.  However, this too is unprvoved.  (There is a lot we don't know!).  6) Yes:  IF her cervicitis is due to HSV, and IF she had a cervical recurrence, HSV could be readily transmitted at those times.  But this is an unlkely scenario - and as I said above, I quite doubt that herpes explains your symptoms.

Best wishes--  HHH, MD

[Spandisman]

Was looking on the net for my symptoms and was delighted to find the following, which EXACTLY describes the progession of my symptoms:

"Non-specific urethritis (NSU) ...In men, first sign is tingling sensation at tip of penis, especially after urinating first thing in morning; this is followed by clear discharge from penis, scanty at first, then thicker and heavier."

Does that sound right to you? I only gradually started showing clear, viscous discharge over the past week - long after my visit to the GUM clinic (I went only two days after I first felt the tingling).

Is it likely that the lack of discharge and the early stage of the disease just meant that they missed the infection when they took a swab? Also, how long am I likely to be infectious once on a course of antibiotics?

Have accepted that it's highly unlikely for me to have herpes, and am going with NSU. Would be grateful for your opinion on this final thing - your advice so far has been invaluable. Thanks.

(Never thought I'd be so keen to have an STD, but NSU would explain everything AND be curable!)

[steve123]

I had a genital candida infection twice in the past,  The rash was pretty wide spread covering one half of my genitals. In both situations I was with a girl that also broke out at the same time.  Went to the doctor and was given 7 days of diflucan that cleared it up in both of us. Neither of us though had any burning or tingling in the uretha. Just external itching.