Expert Herpes Advice Appreciated...

[TexasJ90]

In August of last year I engaged in a single act of unprotected sex and began to feel a burning sensation while passing urine about three weeks later. After giving a urine and blood sample at my local STD clinic I was given medication for chlamydia and the symptoms disappeared the very next day, except for some pain in my testicles that went away in a few days. I tested positive for chlamydia and negative for gonorrhea, syphilis, and HIV (at three months I re-tested for HIV and syphilis at the clinic's request-both negative). So five months went by and I had completely put all of that behind me, until one night after a night of heavy drinking and some cocaine use (the bump I did was laced with a little bit of meth I later found out) I noticed sort of a bruise-y feeling, for lack of a better description, on the head of my penis (but not around the opening) while in bed that lasted no longer than one hour if I remember correctly. A few days afterward I began to feel a stinging sensation around the opening of my penis that would show up after urination that lasted for about two weeks. I went back to my physician who examined the opening of my penis and he said that he saw no sign of herpes or any other STD (no broken skin, etc.) but tested me again for gonorrhea and chlamydia just to make sure, both came back negative. And as if all of that wasn't enough to make me sweat bullets, I noticed a dry, tiny flake of skin under the head of my penis that began to peel about a week after the stinging sensation went away. There wasn't any redness in the area until I peeled the skin off, after which I noticed the new skin underneath to be pinkish in color, like skin normally does when it peels.

My questions are:

1)  Could the "bruise-y" feeling I experienced be considered the herpes prodrome?

2)  Does the stinging sensation and peeling skin I described seem indicative of a recurrent herpes outbreak?

[TexasJ90]

Your comments have been very helpful. Thanks again.

[Edward W Hook, MD]

You got one STD so statistically you are at somewhat increased risk for another.  The increment is not great however and there is no evidence of the biological interaction that you ask about.

You are correct that HSV can cause urethritis but there are no data to indicate that this is the case in the absence of lesions or as the only manifestation of herpes.  If your discomfort has lasted two weeks, that is also further evidence that this is not herpes.  I don't know where you heard that recurrences can last up to 2 weeks but that is not the case.  The typical recurrence lasts 2-4 days.  Finally, the tingling episodes which sometimes precede HSV outbreaks (which you have no evidence for) last only a few hours, not days.  

The evidence is overwhelming that your problem is not HSV.  Please also realize that when people are concerned, they often become aware of signs and symptoms which have always been there but were overlooked on ignored.  

There is nothing you have suggested to indicate HSV.  EWH

[TexasJ90]

Thank you for your prompt response. The reason why I'm a little concerned about herpes is the fact that I was infected with chlamydia, and am just curious if that fact alone puts me in a higher risk category for herpes, or if, like HIV, the presence of other bacterial STDs cause the rates of transmission to increase.

But with that being said, I have heard that herpes can cause urethritis in men, which is another reason why I grew concerned when the stinging sensation came about, given the fact that I no longer have chlamydia. What I'm not quite clear on is if that were the case, is it possible that you can still feel those burning symptoms when passing urine when there are no blisters or broken skin inside the opening of the penis or on the penis itself detectable but still be contributed to herpes? And does the duration of two weeks change your opinion of it being an "occasional mild stinging". I have heard recurrent episodes can last for up to two weeks-so in other words, would a pattern of recurrent genital herpes consisting of a two week long period of a stinging sensation when passing urine with no lesions anywhere on the penis every five months sound plausible?

Also from what I understand there are no such thing as "invisible" herpes outbreaks-that is herpes doesn't cause any itching, burning, or prickly sensations without blisters (which I have never seen anywhere on my penis), is that correct? But with that being said I am curious as to what the prodrome feels like. I keep seeing the word "tingling" pop up,so would it feel similar to the sensation you feel when your foot or leg falls asleep? And is it safe to assume that if the bruise-y feeling was the prodrome, the discomfort would be in that area and not the tip?

I apologize if I sound anxious and paranoid, I try to keep composure, but as you hinted earlier, I don't want to jump into testing if it wasn't completely necessary.

Once again, many thanks.

[Edward W Hook, MD]

Having read your tale, I find myself wondering why you are concerned with the possibility of herpes.  There was nothing in particular about your exposure to raise the concern and the odd sensation you describe does not bring herpes to mind either.  Certainly the flaking skin you describe does not raise concern and the red skin you saw after feeling off the flake is normal as well

As far as the stinging sensation you describe, you'd be surprised just how often men will have occasional mild stinging.  That you were treated correctly for your chlamydia, that you doctor saw nothing to be concerned about and that the sensation went away all indicate it is nothing to worry about.  Nor do I see any reason for you to pursue testing

Hope these comments help.  If you think I've missed something in your questions, let me know.  EWH