Herpes? Gonorrhea?

[toutajan]

Dear Docs,

Thank you all so much for your help recently.  I'm sorry to say, I have yet another question.  I'm prone to paranoia so pardon if I sound irrational.

I've had several different partners over the course of the past few days.  All of them, I jacked off with, except for one that I also received oral sex from.  My first was on 11/17, my last was on 11/20.  On 11/21 I developed a painful burning sensation on the tip of my penis.  It is now 11/23 and that sensation hasn't gone away.  I saw a doctor on 11/22 because I was concerned about possibly having gonorrhea.  He also mentioned herpes as a potential condition.  He examined my penis, said my urethra looked normal.  He said it was a little bit red but that it was within the normal limits.  There has been no fever, no joint pain, or general feelings of sickness, no and no discharge or milky white fluid from my penis.  I have no blisters or sores at the tip of my urethra.  He did not test for gonorrhea because he said that without any discharge it was unlikely that I had it.  Doc did suggest that I could have inflamed the head of my penis from my gym shorts or from wearing underwear that is tight fitting,  but I had not been to the gym recently.  Since it developed, this condition has not gotten worse, nor has it improved.

So here I sit with a pretty painful condition, and no real answers.  I'm skeptical about the tight fitting underwear, but I don't think the time frame would indicate gonorrhea, either.  I'm unsure about the inubation period for herpes.

So my question is...what's my next best step?  What do you think the odds are that this is herpes?  gonorrhea?  Am I just being paranoid?

[toutajan]

Feeling somewhat better after treatment but not entirely. I  guess I'm being so impatient and want this to disappear in an hour.  I am curious though, about how long should I expect for the urethritis to go away?  If it doesn't, in your opinion when should I think about returning to the doctor?

[Edward W Hook, MD]

Nothing much to add here.  I agree with everything your doctor has told you.  The most recent treatment he gave you (today) will close the book on any risk that you might have had.  My own assessment is that it is unlikely that you had anything but we will never know. Either way however, you have now been treatred for just about everything.  As you point out, it is time to get this behind you and move on.  Good luck.  EWH

[toutajan]

I'm sorry I wasn't very clear. This has been so hard for me to go through.  I just finished my cipro last night and the symptoms had not gotten better.  Let me give you a better timeline.  

Exposed prior to 11/21 multiple times over the past 60 days.
11/22 noticed symptoms (pain in tip of penis), freaked out
11/23 took 3 g amoxicillin because I was freaked out and symptoms were not improving.
11/24 went to the doc, symptoms still hadn't improved, was tested  (all came back negative, cultures and g/c dna amplification).  Was prescribed  8 days of cipro 500 mg 2x daily.  

Just today went back to the doc after having finished my cipro and symptoms are stil not gone.  I was given 1 gram azythromycin and 2 grams metronidazole per cdc recommendations as of 2006.  He thinks there's a possibility the cipro didn't get the NGU (if I had it), and that I should add this course. Truly not sure if he did this because he thinks there's infection or just to ease my mind, my bp at the office was 187/93.   He's in agreement that it's possible the culture wasn't valid because of the amoxicillin, but noted that there was no pus or white blood cells in my urine.  He's sure that I don't have chlamydia (because you don't get it from oral sex, he says) and not gonorrhea because the tests look for DNA, not based on culture (like you said).  Basically there's been no diagnosis because other than my persistent pain, there have been no observable signs or symptoms.

Because I took the amoxicillin prior to the urine culture, we'll probably never know for sure if I ever had NGU because of the timing.  I'm just so freaked out at this point I've been to the doctor so many times and well I just have too much to lose to not be aggressive about this...I've seen all the other irrational paranoid people on these forums.  I guess I'm just one of them now.  I feel so guilty, ashamed, and embarrassed.  Now I face losing something that's so dear to me.  It's awful.

It *****.

To anyone who might be reading this, don't cheat on your partner, and just use some protection if you play.  CSW's and anonymous sex only lead to these kinds of problems.  Embarrassment, shame, and guilt.  It's not worth it.  It's not worth the stress on you or your relationships.  

Doc if you have anything to add, that's great.  I'm curious as to your opinion on the current treatment regimen.  Hopefully I'll be feeling much better in a few days, my partner will never become symptomatic, and that all this will go away.  If not...well, I guess in the end, I get what I deserve?  Thank god for the support of good friends and for your work.  

[Edward W Hook, MD]

I'm not sure I follow your question. If the question is, could the antibiotics you took have partially treated NGU causing the test to be negative but the problem not to be resolved, then the answer is yes.  A repeat test now that you are no longer taking antibiotics will  rule NGU out.  I anticipate it will be negative proving that you hav nothing to worry about.  EWH

[toutajan]

I suppose then the culture for NGU which I believe we all think is the primary cause of this could be in question?

[Edward W Hook, MD]

Self medication is never a good idea and can cause its own complications.  That said, currently available tests for gonorrhea and chlamydia are non-culture tests and would not be messed up by your antibiotic ingestion.  EWH

[toutajan]

Doc

Thank you so much for all your help.  I just have one final concern, which I think is primarily anxiety driven.  I will stop worrying after this point, if you tell me so.

I got my results today.  All tests came back negative.  My concern is that the burning sensation hasn't stopped, though it seems to have improved significantly.  I've been on Cipro 500 mg 2x daily for 8 days now.  I took my last dose tonight.  

My anxiety here is about the possibility of a false negative on the tests.  I (know stupid...) self medicated the day before I went in for tests with 3000 mg of amoxicillin (which I had left over from a previous sinus infection).  I'm just concerned that this could have skewed my tests results?  I'm much better..but not totally.

I've read in your other posts that any urethritis could take a while to go away...days/months even.  I just want your reassurance that the negative results I have are in fact valid and/or the 8 daysof Cipro are enough to effectively treat whatever I might have contracted (assuming it was some type of std and not irritation due to something else).

Thanks again for your time.  You all provide a very valuable service.

[Edward W Hook, MD]

The urine test results are fine.  You do not need a swab.

You are unlikely to be infected with gonorrhea so you don't need to worry about ciprofloxacin resistance.  

I doubt that you ahve missed anythng but that is the reason is is a good idea to work with your docotr on these sorts of complaints.  A_If the irritation persists, you can return to her for re-evaluation. Some of these things do take a bit of trial and error.  EWH

[toutajan]

Thank you doc for your information.  I visited my regular doc and still have a few concerns.  She did order a urinalysis, and checked for white blood cells (which she did not find, and indicated she wasn't surprised by this).  She sent the sample out for analysis for gonorrhea and chlamydia and also for culture.  Should I have also requested a swab?

She gave my Cipro, 500 mg for 3 days. You think Cipro is a good choice?  Are the concerns about drug resistance valid?

My other concern is there anything else I could have missed?  Is it possible (5 days post exposure) that this is truly just irritation from abrasion and not what I'm afraid it might be?  Wouldn't the penis have healed in this time?  What if this isn't what I'm afraid it might be, what if it's something totally else?  Is there anything else that could present in this manner?  The pain is only at the tip of my penis, and there is no redness or discharge.  Just irritation and hypersensitivity to touch.  Everything else is normal, no pain on urination either.

btw...if it makes much difference, I am a homosexual.

[Edward W Hook, MD]

There is no risk of STD from having received masturbation, no matter whether the partner was infected or not.  On the other hand, vigorous masturbation can cause soreness of the genitals as the result of friction.  This would present as redness and would be expected to go away in a few days.  

Your other exposure was receipt of oral sex and there is a little bit more risk with this sort of exposure although oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  In your case, with persistent symptoms you may wish to get tested.  I agree that gonorrhea without a discharge would be unusual.  On the other hand, NGU often does not have discharge associated with it and is only detected by testing for the presence of increased numbers of white blood cells in your urine or in a swab test taken from the penis.  

You asked several questions about herpes.  Indeed genital herpes due to HSV-1 is occasionally spread through oral sex but when it does, the person giving the sex usually has a cold sore and the person who gets infection then develops the sores/lesions of herpes 4-6 days after the exposure.  If you have not developed lesions, it is unlikely that herpes is causing your discomfort.

Hope this helps.  Get a test for white blood cells in your urine or with a penile swab.  EWH