itching help

[axe2009]

dear dr
i was infected hsv2 early this year, 1st outbreak wae severe itching around my urethra.
then no mre recurrent
i am on Valtrex 500mg daily

about 20 days ago, i recieved unprotected oral sex from an female secort
i suffered from itching onlyduring sleep
is it a recurrent hsv2 ob or symptom of another infection?
any other risk i have in this oral encounter?
thanks

[Edward W Hook, MD]

No, I see no need for further testing.   Take care.  EWH

[axe2009]

thanks dr
when should i have another full std test again?
this is my last question

[Edward W Hook, MD]

Please post your responses only once.

That your HSV was diagnosed with a blood test is important because, presuming that the blood test was not falsely positive, this makes it hard to be sure that the itching you describe was due to HSV infection.  In situations such as these, we recommend that when suspicous events occur, that clients get a culture or PCR test to help them be able to recognize their recurrences.  In your situation, I suspect the itching you describe in not HSV.   As to what it might be, that is more difficult to say.  Since you have taken azithromycin, you have very, very little risk of a bacterial STD.  EWH

[axe2009]

my hsv2 was confirmed by blood test
my present symptom is , when i sleep,my  penis erect then i feel itching from the urethra , there is no sore no reddish no swelling and no pus or discharge.
but if my penis is not erecting, i almost feel normal.
during the day time  i only feel a little bit more sensitive from the tip of the penis.

today i have taken 1g of Azithromycin as prophylasis against bacterial infection.
do i have other more severe risk from my symptom?
thanks

[axe2009]

my hsv2 was confirmed by blood test
my present symptom is , when i sleep,my  penis erect then i feel itching from the urethra , there is no sore no reddish no swelling and no pus or discharge.
but if my penis is not erecting, i almost feel normal.
during the day time  i only feel a little bit more sensitive from the tip of the penis.

today i have taken 11g of Azithromycin as prophylasis against bacterial infection.
do i have other more severe risk from my symptom?
thanks

[Edward W Hook, MD]

Welcome to the Forum.  As you point out the symptoms of genital HSV can be quite varied and persons with proven infection need to be alert to this.  I have a question, just to make sure I am not giving you mis-information.  How was your infection diagnosed?  Did you have a positive culture or PCR test or were you tested in some other manner?  Were lesions present for your first episode?

Presuming that you had lesions and a positive culture to prove the diagnosis, there are several comments.  That you are taking valacyclovir is likely to both dramatically reduce the frequency of your outbreaks and should you have a recurrence to reduce its severity.  About half of people who start valacyclovir prophylaxis do not have recurrences in the following year.  For people who do have recurrences, their recurrences, like those of people who are not taking antiviral therapy, can be preceded by a "prodrome" in which they have tingling or itching prior to the outbreak or what is called a "false prodrome" in which they experience tingling or itching without having the actual lesion formation.  Either way, both prodromes and false prodromes typically last just a few hours.  

I have said this because what you experienced may have been a false prodrome if it resembles my description.  Alternatively however, itching is a rather non-specific complaint which can occur as a result of many, many causes.  Thus it is hard to know if the itching your experienced was related to your HSV or not.  If it was, it was most likely co-incidence that it occurred following receipt of oral sex.

As for other potential consequences of oral sex, oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through receipt of 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.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  Thus, in your case, you had a single exposure; I would urge you not to worry. If you must, you could go to your local STD clinic or health care provider to be tested at this time.  The tests will be negative and in my opinion, you do not need testing at all.  

I hope these comments are helpful to you. EWH

[axe2009]

dear dr
i was infected hsv2 early this year, 1st outbreak was severe itching around my urethra.
then no more recurrent
i am on Valtrex 500mg daily

about 20 days ago, i recieved unprotected oral sex from an female escort
i suffered from itching only during sleep from this monday
is it a recurrent hsv2 ob or symptom of another infection?
any other risk i have in this oral encounter?
thanks