Lingering / Recurring Symptoms

[cajunwillow]

Doctors - Posted in community forum, but another night of reading posts decided worthwhile to getyour thoughtful opinion.  Appreciate your work.

Timeline: Male rec unprotected oral sex form high resk female.  At 4 days constant need to urinate, stinging tip of penis, pain at urination.  5 days: took 1 gram cipro, followed by 500 mg twice a day for one day (until doc presc azithromicin).  Day 6 full early detection std panel from labcorp (later back negative for all common, including herpes IgG + IgM, but already on antibiotics when took).  Day 6 cloudy discharge in urine- only time.  Day 6 took 2 grams azithromicin.  Day 7 rec 250 mg rocephin shot + started 3 days of cipro 500 mg twice/day.   Symptoms diminished for 12 - 24 hours and returned.  Day 8 visited urologist, did urinalysis and swab (both later negative).  Concern is  doesn't seem like the sort of thing this docdeals with much, he's not real communicative, + was already on antibiotics for all tests.  He presc 7 days doxycyclene begin after cipro finished.  Followup urologist exam day 14 showed no obvious lesions on penis.  From day 14 onward symptoms improved to almost normal except slight sensitivity in tip of penis.  Day 20 slight  sensitivity progressed again overnight to uncomfortable stinging Day 21 + feeling of swelling/burning at tip of urethra (less severe than original symptoms).  Continued discomfort day 22 and general tenderness in groin-seam area that could be irritated lymph nodes  Possible internal pressure in pubic region just above penis.  Can't find actual raised lymph nodes.  Terrified!!

Believe had something bacterial, or still have something viral.  1. What likely happened / is happening??  2. why would symptoms recur/persist at 22 days after so much antibiotics?   3. Why faded and come back more than once?   4.  No lesions on penis at 23 days, but some anal itching like hemhroids (drugs caused constipation) / responds to hemhroid ointment.  How likely hsv?

[Edward W Hook, MD]

Welcome to the Forum.  I think my answer, while longer, still carries a message similar to the response you got on the Community Forum.  Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.    Even if your partner had an oral STD (any STD and it is likely she did not), most exposures do not lead to infection.  In your case, you have now been tested and found to be negative.  You can have confidence the results for gonorrhea and NGU.  It sounds as though you may have had NGU and, if so, the treatment you have had (the azithromycin, the doxycycline and perhaps with some contribution from the ceftriaxone and ciprofloxacin) is the recommended therapy, several times over.  That your subsequent tests have been negative also tend to confirm your successful treatment.  From an STD perspective there is no reason for further concern.

So what could be going on?  There is a very small possibility that this could be a viral infection (respiratory tract viruses) acquired from your partner's throat.  If this is the case, there is little reason for concern - there are no data to suggest that when such things happen (and as I’ve already said, it is quite rare) they are transmissible to partners and they tend to go away by themselves.  Alternatively, sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turns leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation.  

either way, I can see little reason for concern about STD.  If the symptoms do not resolve on their own over time, then I would seek the assistance of your urologist.  

As far as your anal itching is concerned, there is no reason to think that this might be related either..  Nothing you have mentions suggests herpes in any way.  Think hemorrhoids.

Hope these comments help.  EWH

[cajunwillow]

Thank you for responding.

[Edward W Hook, MD]

PCR tests for HIV at 6 days are a waste of time and money.  A negative test means nothing.  An HIV test at 4 weeks will detect at least 90%  of persons infected 4 weeks earlier.  Your risk for HIV is very low, in fact so low that test really is proably not waranted.  A negative test at 4 weeks should be considered to confirm this.  This thread is now really over.  There will be nomore answers of any sort.  EWH

[cajunwillow]

Thanks for the response.  I am not talking about herpes tests, however.  I'm talking about hiv pcr and antibody tests - pcr at 6 days and elisa antibody at 4 weeks - as the symptoms and concerns seem to have evolved toward that.  Reading back through the posts I see I failed to make that clear.  I'm sorry.  I'd be happy to pay again and start a different thread on the hiv expert board if that is the appropriate way to ask the question.

[Edward W Hook, MD]

PCR tests are the most sensitve tests available for evaluation of lesions and are about 3-4 times more sensitive than cultures.  As for the blood test, at 4 weeks about 2/3 or persons who are known to have acquired HSV will have blood tests positive at that time.  In your case, given that there really is NO indication that you have herpes to start with, the fact that you ahve a negative test makes it very, very unlikely that you got herpes from the encounter you ware concerned about.  It is now time to stop with the "what if quesitons" which is where you are at.  there will be no further answers.  EWH

[cajunwillow]

Managed to mess up desription of encounter - unprotected oral, followed by what thought was protected vaginal then protected anal sex, followed by unprotected oral.  Lots of alcohol involved and did not examine condom at the end, but suspicious.  Have specific question about the validity of tests taken and if kind enought to answer will leave you to other important work.

[cajunwillow]

Thanks.  No apology necessary for sharing positives!  Would really like to know, however, what you think about the validity of the tests taken - PCR at six days and Elisa antibody at 4 weeks?  Thought was getting the PCR instead of the Elisa at 4 weeks and am thinking of going back and doing that.  Have the usual reasons for needing to know sooner than later.

[Edward W Hook, MD]

Sorry, nothing you have mentioned raises any concern for STD beyond the issue of NGU which was treated.  Thre really is no reason for you to have continuuing concerns about STDs.  You have good reasons for thrush and diarrhea ( antibiotics).  Similarly things such as sore throats and tingling are non-specific and do not raise STD concerns.  Stress could well be a major and important contributor. Your characterization as being terified supports this.  My advice would be to address the stress component of what is going on, perhaps through a direct interaction with a counselor or other trained mental health professional.  EWH

[cajunwillow]

Doc - limited my description of interaction because thought the rest was protected, but won't get good answers unless I detail all and now symptoms make me question whether there might have been a condom problem.  The incident was unprotected oral, followed by protected oral/anal, ending with unprotected oral.  Had the NGU symptoms we discussed and that is why posted on this board rather than HIV.  Now, at 4 weeks have oral thrush (though following tremendous antibiotics), sore throat, minor night sweats, diahrea (once), and tingling in palms of hand and soles of feet.  Took temp this morning and no temp.  Had neg PCR at 6 days then neg herpes +  neg hiv antibody at 4 weeks (results yest).  Examined by doc and have no swollen lymph nodes.  Please give me your thoughts.  What is est of accuracy of early pcr and 4 week antibody tests?  Could such a complete list of symptoms really be stress related?  Am terrified, but not trying to cause trouble on board.  Having trouble making it through the day.

[Edward W Hook, MD]

You appear to be having toruble with my statement that at this time there is no reason for you to be concerned about STD.  Your story and symptoms do not raise any concnern for herpes at all.  Similarly, with the treatment you have received, your persistent sypmtoms without any objective abnormalities at this time make it most unlikely that your sypmtoms are related to persistence of any STD.   EWH

[cajunwillow]

Thanks, Dr.  Hope this is right way to follow up.  Does a mild, on again, off again sore throat + occasional headache change anything regarding hsv probability?  Assuming NGU, is it normal to still have these somewhat milder symptoms / trauma 15+ days after successful antibiotic treatment?  Is there a good online resource to read about anxiety produced pelvic inflammation in men?  What are odds initial hsv would show up at anus/on bottom after interaction described?  How valid is the 2 -11 day lesion time frame for hsv?  If you'll help with these that'll be it for me and might also help clarify some other threads.  You guys do something very meaningful and the work has helped through some rough nights!