Herpetic Urethritis

Hello,

I had oral sex from my girlfriend who had a cold sore at the time.  I used to have cold sores but have been asymptomatic for several years and had read information that suggested I could not catch or at least would probably not catch HSV-1 genital herpes.  However, I think I may have.  

I presented with white patchy lesions inside the urethra and a small scab at the opening of the urethra.  I had a swab test performed but it came back negative.  I have done much reading about urethritis and all the literature I have read seems to suggest that visible lesions just inside the male urethra suggests herpetic urethritis.  However, I did not experience any pain during urination and there was no itching.

Later, I had some blisters just under the meatus on the underside of my penis and went to an STD clinic to get another swab test.  The clinician said that my symptoms did not appear to be a herpes outbreak and did not perform a swab test.  At the time, I had a urinalysis for chlamydia, gonorrhea and syphilis.  All came back negative.

So my question is this.  Are there any other causes of urethritis that would cause me to develop visible lesions inside of the urethra?

As it stands, I have been told twice I do not have herpes.  I have not had a blood test yet, but plan to do so in about two weeks.  I know I will test + for HSV-1.  

Thank you.

[Edward W Hook, MD]

Welcome to the Forum.  Just to summarize, while you believe you have HSV from receipt of oral sex from your GF who had a cold sore present at the time of exposure, so far you have a negative culture of a suspected lesion and two health care providers who have told you that what you have does not appear to be herpes.   While I can provide some information and perspective, it would be silly and inappropriate for me to argue with two trained health care professionals who have had the opportunity to examine you  and your lesions of concern

Can someone get a second inoculation of HSV when they already have HSV.  Well, I've seen in once and heard of it one other time in over 30 years of taking care of persons with and at risk for STDs. I consider these two instances to be the exceptions that prove the rule and doubt that what you are describing is HSV-1.  If your second culture is positive for HSV-1 or -2, please let me know.

So, what could this be?   Well, rarely people have HSV-2 orally and that can be transmitted through oral sex.  Seems unlikely in your case as well.  The description of the symptoms and lesions is atypical and it is a very very rare occurrence.   there are numerous other dermatological problems which can also cause penile lesions and irritation.  My guess that this is more likely to be your problem than HSV.

As far a a blood test is concerned, if your test is positive for HSV-2 as well as HSV-1, unless you have had prior blood tests for comparison, a positive result does not necessarily mean that what you have noticed is HSV.  Only a culture or PCR test can provide proof of that.

Hope this helps.  EWH
p.s.  From your description you have been examining yourself often adn possibly vigorously.  Sometimes such patterns of self examination can cause their own irritation.
Take care.  EWH