Herpetic Urethritis

[bb1234b]

Hi Doc,  2 weeks ago I received a hand job with oil from a masseuse.  Immediately prior to masturbating me she was masturbating herself. About 9 days after the episode I began having slight burning during urination.  I went to a specialist who took a swab and urine sample which came back positive for urethritis and neg for chlamdyia and gonorrea(NGU).  I also have had 2 IgG HSV2 blood draws which have come back negative although it has only been 2 weeks.  I also asked the girl to come with me to get tested and she did so.  She came back high positive for HSV1 and Less than .9 negative for hsv2.  Although this would not include possible exposure in the prior 12 weeks...  I am currently taking azithromycin and ciproflaxin but dont yet feel improvement 2 days in...  I also have these tiny little bumps on the side of my penis but nothing like the pictures I have seen on the internet.( maybe just dry irritated skin from inspecting 5 times a day).  Does this sound like it could be herpetic Urethritis?  my burning on urination is mild and I don't notice anything at the tip...

[Edward W Hook, MD]

I doubt taht your repsonse is related to the famciclovir.  I id ore proof that this is HSV.

As for the effect of treatment on antibody production, there are few data on this but the answer appears to be yes, antiviral therapy can delay antibody production but it should not halt it completely.  EWH

[bb1234b]

Hi Doc,
I just wanted to give you an update as I am really anxious regarding all my symptoms.  I know that mutual masturbation is considered safe but the coincidence of my symptoms is too much I believe.  Here is a summary of symptoms.

9 days in- slight burning on urination, swabbed the urethra and positive for NGU.  Negative for GON and CHL.  Took 3 days of Azithromycin and Cipro.

Approx 10 days in I felt a slight fever for about 3 days..

Took another urine test 12 days in and turns out clean(no high WBC).  Doctor puts me on famvir 500mg 4 times day as a precaution. 2nd urine test was prior to start of famvir.

Day 15 slight burning in anus region.  no blisters just whitehead oil glands that are still there...  Doctor swabs the region and a tzank smear which comes out negative.  Given myco cream and also use zeasorb and lamisil which provides some relief but overall rash has gotten worse 2 weeks later.  Upon wiping after a bowel movement I had very little bleeding and it felt as though a pimple or something had been cut.  Bowel movements since then have been slightly painful as they come out.  2 weeks later still no improvement on rash.

A one time burning after masturbation that lasted about 10min.  Has not happened again.  approx 15 days in.

day 24 I have very tender pelvic area and slightly swollen lymph nodes in groin area and also slightly above.(almost at waistline)

Day21 legs were sore for 4 days after a workout which is not normal for me...

day 25 a pain in the back of my knee( where I had surgery 10 years ago) which lasted for 3 days.

Also some random short lived pain in lower back and love handle region although lower back pain for me has happened before...

There was no touching in or around the anus region during encounter.  Further she was tested a second time for hsv2 at 3 weeks with a negative biokit.  I retested with biokit at 4 weeks and a neg result.  My fear is the incubation period as she is a sensual masseuse(maybe even a SW?).

In light of all these symptoms, What are your thoughts on a potential rare transmission during mutual masturbation as she probably still had vaginal secretions on her hand when she came over to my penis.  The collection of symptoms in my mind are too much to be a coincidence or could it possibly be a different virus/ bacteria????

Also when someone contracts hsv2 are they immediately contagious or does it take a few days/week?


I apologize for the long question and am happy to pay again if needed...Thank you so much in advance for your quick response as I am worried sick....


Day

[bb1234b]

My Doctor put me on 500mg of famvir every 8 hours starting yesterday(quit the ciproflaxin) as a complete precaution saying it couldn't hurt and might prevent seroconversion on the small chance that I picked up hsv2.  Only 24 hours later my burning upon urination is 98% gone....

1.  Does that mean that I have the HSV2 virus and I am reacting well to Famvir?

2.  Does taking the famvir in any way effect or delay the results of future blood tests?

Thank you so much for your responses and helping people at their most vulnerable time..  I apologize in advance for being a bit neurotic!!

[Edward W Hook, MD]

No, this really does not sound at all like HSV.  I understand your anxiety but sincerely believe you have nothing to worry about.  EWH

[bb1234b]

Thank you so much for your response.  Is it possible that the Urethritis is a symptom of an initial hsv2 outbreak but not necessarily Herpetic Urethritis?  Is that possible?  I also developed a slight rash in my anus region yesterday(day 15).
I apologize for the anxious questions but the coincidence of these symptoms just after the episode along with neg chlamydia and gonorrhea frightens me quite a bit.(BTW, have not had any other sexual contact in over 4 months)

[Edward W Hook, MD]

Welcome to the Forum and congratulations to your logical and stepwise approach to your symptoms.  It sounds as though you were evaluated by a knowledgeable and careful health care provider.  The evaluation that you had effectively rules out both gonorrhea and chlamydia and the chance that this is herpetic urethritis is essentially zero.  Herpetic urethritis is rare and when it occurs external lesions typically accompany the urethral symptoms.  Further, hand to genital contact is not a source of genital herpes infections and your masseuse’s negative antibody tests indicate that she does not have HSV-2.  

I suspect that your urethritis is unrelated to your receipt of masturbation and, with negative tests for gonorrhea and chlamydia you are not a danger for infection of sexual partners.  I would look for other causes of your symptoms. In addition, I would not waste more money or time with further HSV blood tests - they are not a reliable means for diagnosis recently acquired HSV.   EWH