Herpes or UTI

I am trying to gage my risk of transmission for hsv 2. From what I've read, the person is most contagious when they are having an outbreak and outbreaks don't necessarily have to be your textbook symptoms.
I have had intercourse  with the person I was dating twice, unfortunately right before his hsv bloodwork came back positive. I have always tested negative for both strands.

Before and around the first time we slept together, he was complaining about a slight burning pain when he urinated. This seemed to have gone on for 2-3 weeks. He also noticed that he picked up a tiny bit of lint on his penis, so he assumed he had a bit of discharge. He never had these symptoms before.  He had no lesions or any other typical symptoms. When he urinated, the pee wasn't a straight line and it burned. Could this have been herpes in the urethra? He went to a general practitioner after his symtpoms went away. He drank cranberry juice and said the next day it dissappeared. The doc said not to worry, but this was before he blood test came back for herpes. The doc also said his exposure to antibodies wasn't contagious, so clearly the doc didn't really know his facts about herpes.

I noticed that a couple of days after intercourse, I had more vaginal discharge: clear, no odor. A few days later I was itchy and noticed a little bit of white clumping-  seemed like a yeast infection so I took monostat. I went to  nurse practioner and she didn't see any lesions and said it wasn't herpes, but couldn't do a swab for a yeast infection since I had used lotion the night before. Now a month later, 10 days after the second time we slept together, I am itchy again, but no discharge. I went to the NP and she said that it looked like it was fungal, but not a yeast infection.

[Edward W Hook, MD]

Your situation is complex and I will try to wrk through the information relevant to it and your questions.  Before I do, a couple of more generic comments.  

First, congratulations to you and your partner on your level of communication.  It will serve you well and, I suspect, foster your relationship.  I wish more people would talk with partners about their concerns and the symptoms they were experiencing.

Second, I think there is a danger in either persons or their health care providers focusing too much on one diagnosis or disease possibility.  One thing we know about STDs is that there is great overlap in both risks and symptoms.  Thus too focused a question/examination can miss one STD while looking for another.  I say this by way of the fact that at this point I think both you and your partner would benefit from a more inclusive evaluation.  Now to the questions.

1.  Regarding your partner and his positive herpes test (a blood test, I presume).  Most genital herpes is actually transmitted while persons who have the infection are asymptomatic.  This is because the herpes virus is present on the normal skin of just about everyone who has genital herpes (we call this asymptomatic shedding) and asymptomatic shedding accounts for most transmission of herpes from one person to another.  Using condoms as you are doing greatly reduces the likelyhood of transmission occurring.

2.  Regarding both your partner's and your own symptoms, each of these could be caused by an infection that one or another of you has, but is/was unaware of.  At this time you both need to be examined, perhaps by an STD Specialist.  He should have a urethral Gram stain (after having not voided for at least 2 hours) and tests for gonorrhea and chlamydia.  Your evaluation should include a wet mount looking for yeast, trichomonas, bacterial vaginosis (not an STD and not requiring treatment of your partner but a common cause of vaginal discharge) as well as tests for gonorrhea and chlamydia.  For completeness sake, in most STD Clinics, your providers are also likely to suggest syphilis and HIV blood tests althogh your risk for these is VERY low.

3.  Your BF's symptoms are not typical for a gential (genital) herpes recurrence but do suggest an infection such as non-gonococcal urethirits or chlamydia, either of which would be detected by the plan I outlined above.

4.  Your risk of contracting genital herpes is not huge, particularly if you practice safer sex (condoms).  If you (as a couple) wish to do more, he could take chronic suppressive therapy with a medication like acyclovir to reduce the chance of transmitting infection.

I hope this helps.  EWH

[helpanswer]

Do you think my bf was having an outbreak based on his "uti-like" symptoms? And do you think this yeast infection was coincidental or could have been a mild OB? Around the time he had the burning, maybe a week into it, he had a sore throat (white in his mouth) and swollen glands for a day or two.

At first I thought my transmission risk was low- we used a condom. But I know that doesn't fully protect and if his symptoms were a sign of a non-textbook outbreak, I know my risk is very high of contracting the virus. I also don't know what to make of this itchiness/redness....even though there are no lesions.

Thanks

[H. Hunter Handsfield, M.D.]

AS IT HAPPENS, I WAS WRITING MY OWN RESPONSE WHILE DR. HOOK WAS WRITING HIS, WHICH I SAW WHEN TRYING TO POST MINE.  (I KNEW THIS WOULD HAPPEN SOMEDAY, NED!)  HAPPILY, OUR OPINIONS AND ADVICE ARE VIRTUALLY IDENTICAL.  HERE ARE MINE.

HHH, MD

Your partner's symptoms suggest urethritis, such as chlamydia, nongonococcal urethritis, or gonorrhea.  Herpes doesn't usually cause urethritis, and when it does, it usually is accompanied by overt sores on the outside of the penis and the urethritis is quite painful.  So regardless of the herpes situation, you need to be checked for chlamydia, gonorrhea, etc. If your NP didn't already do that, make sure it happens.  Also make sure your partner gets checked out for those possibilities.

In any case, although your partner's symptoms conceivably could be due to herpes, I doubt it.  And your symptoms don't sound like herpes either.  Although UTI, yeast and other genital irritation symptoms can be mixed up with herpes, most symptomatic herpes outbreaks include overt genital area blisters or open sores, which apparently you have not had.  Further, experienced health care providers can tell the difference between herpes and other things pretty reliably on examination.  Itchiness after sex doesn't suggest herpes; outbreaks are not triggered by sex.

It sounds like you have only partial confidence in your NP's expertise.  If that concerns you, get a second opinion, e.g. from your local health department STD clinic.  But from all you say, I very much doubt herpes is a problem, despite your partner's postive test for HSV-2.  But to erase any doubt, you could be tested yourself.  (Be aware there is a 25% chance it will be positive.  If so, it doesn't necessarily mean herpes explains your symptoms.  But if negative, it will prove without any doubt that herpes isn't the explanation.)

I hope this helps.  Best wishes--  HHH, MD

[helpanswer]

To both doctors,

I feel honored to have gotten advice from two experts! Thank you greatly. I am a student and this situation has amplified my stress over the past two weeks. I am very much looking forward to putting it to rest either by way of more exams or just excepting what may be. When I go to my regular gyno, either once or twice a year, I get tested for herpes, just because it has always been a worrisome std for me, regardless of it being more of a nuisance than a threat. Anyway, I have always had low numbers: eg, .01. Other boyfriends have always gotten tested as well and come out negative. Naturally, I was scared/saddened this time around. I do trust my doctor, but not necessarily the NP. I went to my student health center at NYU. I am currently waiting on blood test results: I got tested 5 weeks after the first act and only ten days after the second. I am aware that I'll have to get tested again, but I was a bit anxious so this is a start.

Again, your advice is greatly appreciated and helps me focus on other important things. I'll feel inclined to let you know what the results are!

Thanks again. Cheers.

[slacker101]

Does this mean you owe another 15 dollars?