HSV/STD Concern

[Gorge12]

Hello Dr. and thank you for your time.

I had an encounter with an escort 10 days ago. I received unprotected oral sex only. No vaginal sex.

After two days, I noticed a constant burning at the tip of my penis. The burning is constant during the day and is not caused by urination. In addition, I have no noticeable discharge, blisters or ulcers.

The burning seems constant but of course is more pronounced if I sit and think about it.

I visited an STD clinic yesterday and, after a physical examination, was given a 1g dose of azythromycin.

I know myself to be HSV-1 positive from cold sores as a child and from a type specific blood test one year ago that confirmed that as well as confirming I was HSV-2 negative.
This is the only risky encounter since that test.

I am curious not only if this severe burning at the tip of my penis could be HSV but, what else should I be concerned with or watching for?

Thanks again for the time.

[H. Hunter Handsfield, M.D.]

Azithrmycin indeed would have cured or aborted NGU if you had it.  In most men with symptoms like yours, no disease can be found.  As discussed above, a psychological origin seems the best bet.  See a doctor if it persists, but don't insist on antibiotics or other treatments if nothing abnormal is found.  Such symptoms typically clear up over time without causing any harm either to affected men or their sex partners.

[Gorge12]

Thank you doctor for your help.

My results, as you predicted, were negative for Chlamydia and Gonorrhea.

I have two quick follow up questions:

Would the 1G of Azythromycin I was given have cleared up any NGU infection I may have had?

I ask because I am having a distinct and constant burning at the tip of my urethra. It is also noticeably red in that area. No ulceration or pain on urination.

Also, if not an STD, what could cause this redness/burning?

Thanks again.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thank you for your question.

The STD risks from unprotected oral sex are primarily for gonorrhea, nongonococal urethritis (NGU), and herpes due to HSV-1.  We can dismiss each of these.  Gonorrhea would cause discharge of pus, as well as burning.  NGU symptoms don't start sooner than 7-10 days after exposure.  As for herpes, your past HSV-1 makes you immune (or at least highly resistant) to a new infection with that virus; HSV-2 is rarely transmitted by oral sex; and burning alone, without overt ulceration etc, is against herpes.

Most likely the STD clinic tested you for gonorrhea and chlamydia, and I would expect those results to be negative.  

I'm inclined to doubt you have any STD..  That the burning "is more pronounced if I sit and think about it" favors a psychological rather than inflammatory origin  I'm curious whether the STD clinic found anything wrong, like abnormal discharge or other evidence of inflammation in your urethra, such as white blood cells (WBC) on a urethral swab.  If not, my guess is they treated you as a precaution, without clear evidence you have any infection.

So my advice is to sit tight, with expectation that the symptoms will fade soon.  If your symptoms persist, return to the clinic for further evaluation.  But all things considered, I very much doubt you have any STD.

I hope this has been helpful.  Best wishes--  HHH, MD