Herpes or other possible STD's with these symptoms???

[cboarder]

Doctor HHH, thanks for you wonderful feedback and information.  I have been reading this site for several days and find it very helpful.  
My Situation is as follows:
I am a heterosexual male and about 12 days I received unprotected oral sex from a female who I do not know the sexual history of during a very intoxicated night.  On day 6 I started to have some discomfort when urinating and it turned into a very strong burning sensation when urinating by the end of the day.  I had a doctor run a urine dip on me and there was blood in my urine with a higher white blood cell count than normal.  She did give me the drug Tequin suspecting a possible UTI.  The burning has been decreasing each day, but there is still some discomfort.  Also, the tip of my penis is more sensitive and tender than normal since the burning urniation started.  If I squeeze the tip I get a paining sensation.  On Day 9, she also gave me a 1gm shot of rocephin and on Day 10 I got a perscription for Doxycycline in case of Chlamydia.  Now I have been noticing a tightness in my legs going from my buttox down to the calves.  Also I have some pain in my back, all of which seem to be from tight muscles, but I'm not sure.  I do not have any rashes, sores, itching, or blisters on my penis or anywhere else.  Nor do I have any pain in my groin, scrotum, or testicles.  My doctor did look at my penis and he said both the outside and inside of my urethra look 100% healthy.

My Questions:
1.  Could this discomfort in my muscles be related to herpes HSV-1 and is there any possibility that I could have herpes inside my urethra causing the burning when urinating?  If I had herpes in the genital area and no blisters or sores appeared within 21 days, would you suspect myself to be clear of contracting HSV-1 genitally?  Do you suspect anything else in this instance?

2.  With the medicines and treatments that I have received is there any need to be concerned with gonorrhea, chlamydia, or NGU due to a virus that has a high resistance to an antibiotic?  Otherwise I should be cured if contracted, correct?

3.  My primary care doctor did run bloodwork on me for HIV, syphilis, and Hep B.  He said that a herpeselect test is expensive and not very accurate.  Would  you still get a herpeselect test if you were in my position?  What are the possiblities of an HIV test showing positive after 12 days of exposure(I know oral HIV transmission is extremely low and I had no open cuts or sores on my penis).  I will follow up and get one done at 4 Weeks since that seems to be 95% accurate.

4.  Presently I have started dating a girl for two months.  How long should we abstain from sex, use protection, and wait to get tested for anything else?

Doctor, thanks for you help because this concern has been affecting me on a daily basis.  I need to move on, but I'm just not satisfied and I'm looking for your opinion and recommendatons.

Thanks for your prompt response,
cboarder

[H. Hunter Handsfield, M.D.]

Almost certainly you did not have a garden-variety UTI, which would be rare in a generally healthy younger man without a preexisting urinary tract abnormality.  Clearly you had sexually acquired urethritis, i.e. gonorrhea, chlamydia, nonchlamydia nongonococcal urethritis (NGU), or perhaps herpes.  Since you don't mention it, I gather your doc didn't test you for STDs.  S/He should have done that.  But if not, you'll probably never know for sure.  If you know how to contact your partner that night, you should tell her about your problem and encourage her to get examined and treated.

The relative severity of the pain you describe is more suggestive of gonorrhea or herpes than NGU or chlamydia.  Tequin and the other antibiotics would take care of all these except herpes, so the improvement makes herpes less likely.  But these are only probabilities, not proof one way or the other.  So to answer your specific questions:

1) Yes, your symptoms could be due to herpes (not necessarily HSV-1, could be HSV-2).  But no way to be sure, at least not yet; see above.

2) See above; if you had NGU, chlamydia, or gonorrhea, they're gone now given the treatments you had. But symptoms can take a while to clear up completely.

3) Your doc is right about HerpeSelect not being "accurate" only if s/he says so because 12 days indeed is too soon.  But even that can be useful; if negative now and becoming positive in a few weeks, that would confirm a diagnosis of HSV-1 or HSV-2.  In other words, you could be tested now with a repeat in 12 weeks; that would be the best way to nail down a new HSV diagnosis for certain.  If you are tested only at 12 weeks and positive for either virus, you won't know for sure when you were infected.

4) Given the absense of herpes lesions, on balance it is unlikely you have herpes; urethritis alone is an unusual presentation.  Most likely, therefore, it is safe now to have unprotected sex with your new partner.  But for more certain protection, wait until your herpes test after 12 weeks.

Good luck--  HHH, MD

[cboarder]

Dr. thanks for your response.  There are a few things that I left out unintentionally.  I was tested at day 3 for Chlamydia and Gonorrhea, still waiting on those test results.  Planned Parenthood said with any abnormalities that I would be called in less than a week and it has been 9 days.  

I did want to clarify that my incident was only oral sex (I received and did not perform on her) so should I be concerned about HSV-2?  I thought HSV-2 was only passed through intercourse and not oral sex from reading your past threads?  Did I misunderstand something?

Also, if my tests all come back negative for chlamydia and gonorrhea, should I suspect being positive for genital herpes?  Lastly, if I do have genital herpes, would the sores be any deeper than just inside my urethra?

Thanks for your help, it's been most appreciated!

[H. Hunter Handsfield, M.D.]

Sorry, I missed the fact that your exposure was oral.  Chlamydia is zero risk (no case ever shown transmitted to the urethra by oral sex), gonorrhea and herpes very low risk.  You're right, HSV-2 is not an issue, and HSV-1 probably not either.  As I said above, "Given the absense of herpes lesions, on balance it is unlikely you have herpes; urethritis alone is an unusual presentation."  Also, internal herpes lesions typically are excrutiating--some men describe it as the worst pain they have ever experienced.  And more diffuse discomfort ("muscle aching" etc) is not a symptom of herpes or any other STD.

HHH, MD

[cboarder]

Doctor HHH or anyone else,
Thanks for all your Advice and this is my last posting.  So far my tests have come back negative for gonorrhea, chlamydia, hep, HIV, and syphillis.  

Here is the update to my initial situation:
1.  On Day 13, I woke up with a single red spot with a tiny gray head on the underside midline of my penis.  The doctor cultured it, and all that remains today, day 16, is a small scab from the surgical blade.  I have also had a herpeselect test ordered.
2.  Day 14, the pain while urinating has gone away
3.  On 14, I got a sore throat and it has persisted through Day 16.  It hurts to swallow and seems to be only on the left side.

All of this being said, do you suspect that it was genital herpes causing the burning based on the fact that all other STD's have been ruled out.  I know that typcially herpes comes in clusters, could a single bump be an exception to the rule and does that make you believe I have HSV-1 Genitally?  Are there any other possibilities besides STD's causing these symptoms?

Thanks for all of your help,
CBoarder

[H. Hunter Handsfield, M.D.]

Your sore throat probably is just a cold.  I can't really say anything about the penile lesion.  Herpes can cause single lesions as well as clusters, so it may be a possibility.  What did the doctor who examined you say about it?  His or her opinion is more valid than mine can be with just a verbal description.

HHH, MD

[WhyAmIBurning]

A related discussion, Why does my penis head hurt when touched and burn when I urinate? was started.