Conflicting opinions

[Extremely confused]

Hi, Approx. 6 weeks ago I had an encounter with an old friend.  Lots of heavy grinding but no intercourse.  There was minor penetration but she had her panites on, so no direct penis to vagina insertion.  My penis was in contact with her skin between her legs and she briefly performed oral sex on me (for only a few seconds).  After the encounter she told me she had herpes.  A few days later I noticed my urine stream was not straight and opened my urethera to inspect and found an abrasion.  This abrasion took approximately 5 days to heal and did not hurt and I had no pain during urination.  I also noticed two red spots on the head of my penis which looked like broken blood vessels (which are still there and have not changed in shape, size, or color).  I assumed that the abrasion was from the rubbing of my penis on the inside of my clothing before I removed it.  At approx. 4 weeks after the encounter I noticed what I thought was a blister forming on the edge of the head of my penis.  I "messed" with it unitl it got bigger, at which point I poped it but nothing came out. I encountered no pain, but was very worried so two days later I visited a local urgen care clinic.  The nurse practioner did a viral culture on me which came up negative and told me she didn't think it was anything to worry about.  After receiving the results, I had mutual oral sex with my girlfriend.  Four days later (last Saturday), I found a blister on the shaft of my penis near where the other "blister" occurred.  This one popped up with no warning over a matter of a couple of hours.  The blister looked VERY much like the herpes pictures I've seen on the internet.  I promptly popped it and clear fluid came out. Sunday morning I noticed crusted discharge on the tip of my penis and contiue to have a small amount of discharge (milky white).  Yesterday I went to a Urologist who performed a vinegar test.  He said it was inconclusive but assumed I have herpes from my discription.  I asked for a blood test, and he said he did not know of any.  He prescribed 200mg acyclovir 4x day and 100mg doxcycycline 1x day.  I have read of blood tests available so I contacted the urgent care clinic again who promptly gave me a blood test.  The nurse practitioner reassured me that I showed no outward symptoms of herpes and that the discharge is not a symptom, however she did not examine me again.  My questions are these:  When "popped", do herpes blisters still ulcerate?
Is penile discharge a symptom of herpes (I've read a couple of sites which say that)?  Is it possible to pass genital herpes to my girlfriend through the oral encoutner (I ejaculated in her mouth)?  And lastly, who should I believe the urologist who didn't know about the blood test or the nurse practioner (both claim to have seen many herpes cases over the years)?  I am very worried and very confused does this sound like herpes ?  Thanks for taking my question !

[H. Hunter Handsfield, M.D.]

You could not have acquired herpes or any other STD by "grinding" with clothing intact.  Whatever is going on was not acquired during that event (with the possible exception of the original abrasion, if that's what it was).

Several aspects of your symptoms are atypical for herpes, including the painless nature of the lesion you saw in the urethral opening (urethral herpes typically is very painful) and the apparent speed of resolution of the "blisters" (makes me wonder about dyshidrosis, i.e. sweat accumulation behind a blocked sweat pore).  However, herpes remains a possibility.

The discharge and crusting suggests urethritis (NGU, chlamydia, gonorrhea), which sometimes (but uncommonly) can be due to herpes.  Presumably you wrre tested for gonorrhea and chlamydial infection.  Nonchlamydial NGU and gonorrhea can be acquired by oral sex, so that problem most likely originates with your regualar girlfriend, not the grinding event with your old partner.  But whether it resulted from oral or vaginal (or anal) sex, I cannot say--unless you and your partner only have oral sex.

It seems you have found a urologist who doesn't know much about STDs (hard to believe he doesn't know about any herpes blood tests!).  Both you and your regular girlfriend should be evaluated by an STD-knowledgeable health care provider; you both should be tested for HSV (blood test); and she should be tested for gonorrhea and chlamydia.

Good luck--  HH, MD

[HHH,MD]

The urologist's performance of a "vinegar test" is additional evidence that he's not much of an STD expert.  Such testing is intended to detect HPV infection, but is not recommended for that purpose; and testing for HPV wasn't indicated by the symptoms you describe.

HHH, MD

[Extremely confused]

Thank you for your propmt response.  The viral culture I mentioned was also accompanied by both bacterial and fungal cultures as well.  I wonder if these other cultures would rule anything else out ?

[Extremely confused]

In addition to the first part of your response.  My clothing was not on all the time.  Her underwear were.  My penis was between her legs near the vagina.  She said her outbreaks occur between her vagina and her rectum, and that she had not had an outbreak since January (the event took place toward the end of March).  Additionally she was not on suppressive medication.

[H. Hunter Handsfield, M.D.]

The additional information doesn't change my opinion or advice.

HHH, MD