I'm a mess

[travelingmale]

1/23 - Unprotected sex (protected until comdom broke, head exposed 3 minutes) with asian csw in Hong Kong. I was taking 500mg of Keflex X 3 a day for five days prior to exposer and continued another 5 days after.
2/15 Protected viginal sex with CSW for 5 minutes with no completion.
2/25 Unprotected oral 3 mintues no completion and protected viginal with CSW. Started taking 500mg x 3 a day of Cipro for four days.
3/12 Went to local Health Clinic for STD test. I thought I had Lymph Nodes that were swollen around my penis and I just wanted checked. Examined by Dr. who found nothing out of the ordinary with my lymph nodes nor did he find anything out of ordinary with my penis. No bumps, rashes or open sores or discharge on milking. Tested me for Syphillis, Gonorrhea, Clamydia (chlamydia) and HIV but with no signs of infection and I had to go to the non priority list. Started taking 500mg x 2 a day of Cirpo which I'm still doing.
3/15 Woke with a small amount of milky white discharge on the tip of my penis and when I urinated it felt slightly irritated. I have not noticed any bumps or sores at all. During day urinating got irritated but at no time would I classify any of it as painful.
3/16 - Milky white discharge. Urinating is still not painful but noticable (could be anxiety now). Also notice onset of Pink Eye (slight crust in the morning and red).
3/17 Slight discharge. Urinating seems fine. Pink Eye has set in. Went to HCP and examination revealed no HSV just a normal Virus/Bacterial produced Pink Eye. Given antibiotic drops. Contacted Health Department about my test which came back all negative (except HIV which I'm still waiting on)

1) What do I do next? is this possibly related to HSV, and should I have testing to done for that?
2) I know you will say NGU is a possibility and so is Adenovirus no. 19 but what else should I tell my HCP to look for (he said if I had a white discharge is was 100% an STD.) so is there another STD I should be testing for?

[H. Hunter Handsfield, M.D.]

I agree adenovirus (type 19 or other types) is a pretty fair bet.  As you seem to know, adenovirus causes a few percent of cases of nongonococcal urethritis (NGU), and often causes conjunctivitis (pink-eye) and urethritis at the same time.

Whatever you have, you can be sure it isn't gonorrhea, chlamydia, syphilis, or other bacterial STD.  Herpes is a theoretical possibility, but when herpes infects the urethra, it usually also causes overt herpes blister/sores on the penis, and also causes rather severe pain on urination, which you don't describe.

To the specific questions:

1) If the symptoms go away over the next few days, just drop the whole thing.  You can be certain you have nothing serious and there's no easy diagnostic test for adenovirus anyway.  But if the symptoms persist for more than another few days, return to your HCP for further evaluation and advice.

2) Answered above.  Nothing likely to be serious here.

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

[travelingmale]

Thanks Doctor Handsfield. I wanted to tell how much you have helped. I have learned a lot reading your replies both here and in the archives. It allowed me to have a more educated converstaion with my doctor during this matter.

quick update. No pain during urination and no discharge this morning. So once the pink eyes clears and if nothing changes, I plan to move on without further testing. I do have two more questions and then I will move on.

Is Hep B testing a good idea for this exposure? (I know I have been Hep A vaccinated, I think I was Hep B but I can't locate my vaccination record at this time).

How long before I can resume comdom free sex with my regular partner without fear of infecting her?

Thanks

[H. Hunter Handsfield, M.D.]

Hep B testing is never a good idea after a single sexual exposure, except perhaps for sex with a known infected person.  No experts recommend it.  If you're worried about HBV, get immunized.

Since you probably have no STD in the traditional sense (adenovirus doesn't count), you probably can have sex with your regular partner at any time.  Adenovirus isn't transmitted through genital secretions, but by kissing and oral sex.  Of course I cannot guarantee that someone isn't infected with something.