Possible STD or UTI?

[ml80nebr]

Almost 3 weeks ago I had unprotected oral sex.  About 2 or 3 days later I got a burning irritation on the head of my penis.  The pain and itching seemed transient but got worse as the day progressed.  Since then, the burning has subsided but, it is still sensitive especially if I mess with it.  I have a slight urge to urinate and there is a slight discomfort in my urethra and sensitivity near the opening, especially after I urinate, where it feels like something is left inside and I can't get it out.  There is general minor itching in my testicles too and they look a bit red at times with some occasional minor pain.  The urethral "awareness", as I've heard it called, is rather irritating right now.  I've tested negative at day 14 for NGU, and twice negative for BOTH Chlamydia/Gonorrhea.  At this point, I'm at a loss as the irritation is rather, well, irritating.  The quick care place prescribed me Zithromax for 3 days which I finished earlier this week on Monday.  Zithromax had and still has nasty side effects.  (Somebody told me it could be a yeast infection and some of the symptoms match Herpes)

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.  But unfortunately, I am at a loss.  You have been evaluated appropriately; had you come to me, I would have done pretty much exactly what your provider did.  In fact, your treatment was more aggressive than I would have done; a single dose of azithromycin would be just as effective against the infections it targets.

The only thing that conceivably might cause such symptoms would be herpes, which can be due to HSV-1 and acquired by oral sex and can cause NGU with little discharge but primarily urethral discomfort -- and does not respond to the antibiotics you have had.  Yeast might be theoretically possible, but I doubt that's it.  Urethral yeast infections are rare and would not be expected from oral exposure.

So I suggest you discuss the herpes idea with your doctor.  It's probably too late for a viral culture from the urethra, but you could have a blood test for HSV-1 -- and if negative, have another test in a few weeks to see if it becomes positive.  (If an early test is positive, it is evidence against, HSV as the cause, not for it.)  Don't get me wrong; most likely it isn't herpes.  Just raising it as a possibility.

The good news is that, you can be confident you have nothing that will be harmful in the long run and nothing you can transmit to a sex partner.  Even if it is herpes, there is not much risk for recurret outbreaks with genital HSV-1 and not much chance of transmission to a partner.  

I hope this helps.  Please return with a follow-up comment if or when you have a definite diagnosis.

HHH, MD

[ml80nebr]

I have a feeling it is HSV-1 (or rarely HSV-2) because I can never recall getting a cold sore anywhere and the symptoms are similar.  I will have to wait until I can get a good blood test, i.e., waiting 12-16 weeks as I have been told, because this medical stuff adds up fast ($).  I've done Herpes research and it seems the "PCR swab" is most accurate in diagnosing, but I don't know how much it costs.  I'm still not sure when these symptoms go away...

[H. Hunter Handsfield, M.D.]

It probably is too late for swabbing to detect HSV, either by culture or PCR.  Yes, PCR is "best", but no test for the virus can be positive if the lesion is well on the way to healing.  PCR is not as widely available as culture and usually is more expensive.

Without a positive culture or PCR, the only way to know if the current problem is due to HSV-1 is to have 2 blood tests, with negative results the first time and positive the second.  Do not cut corners on this; have both tests.  A positive result only after a few weeks will not tell how long you have been infected.  That you have no history of oral herpes makes no difference.  That applies to 90% of people with positive HSV-1 blood tests.

But please don't make your own decisions about when and what tests to use.  See a provider for personalized care and advice.

[iknowbetter378]

if due to herpes how long would the urethral discomfort last?ie..weeks.

[H. Hunter Handsfield, M.D.]

The first infection could last a couple of weeks, probably not much longer.

[ml80nebr]

I'm not sure if this is a violation of terms to post this long after the original post...

The penile burning on the surface of the glans and top of foreksin continues with redness on and off but no Herpes sores yet.  It's been over 3 and a half weeks and plenty of digging for information.  If it were Herpes, shouldn't sores generally develop in the burning areas?  And should it last THIS long?  I want to get looked at the Fast Care Clinic (non-STD) but I'm sure they won't find anything.  Interesting, yogurt ( a yeast infection "cure") makes it feel better for a while as long as I don't mess with it.

[H. Hunter Handsfield, M.D.]

Herpes blisters/sores may burn and have redness around them, but burning and redness without sores is not a herpes symptom.  And herpes symptoms would not last this long.  Further, "I'm sure they won't find anything" suggests the "redness" must be awfully subtle.  If it's abnormal, a health care provider will be see it; if s/he can't, then it isn't abnormally reddened.

I'm glad to hear you planning to get examined.  You should do so despite your assumption nothing will be found.  That in itself should be reassuring, since it will reinforce the probability you don't have genital herpes.  However, you might consider your local health department STD clinic.  Some urgent care docs are very knowledgeable on STD issues, but many are not.

I have no comment about the yogurt.  I certainly support the idea that you continue to not "mess with it".

Whatever is going on, you can put herpes to rest.  Not all symptoms mean disease, and almost certainly you have no health problem that will ever harm you or a sex partner.  Knowing that, you may find the symptoms tolerable even if they continue.

If your clinic or doctor finds something wrong, please come back to tell us about it.  Otherwise, that will have to be all for this thread.

[ml80nebr]

The doc suspected a penile fungal infection and told me to use Clotrimazole cream which I just started applying.  There is a bit of urethral irritation so he suggested Cipro.  Great, another antibiotic to torture my knees, as Zithromax did this to me already and still causes rather painful soreness while I try in vain to sleep.

He said I could do either, so I opted against Cipro for now.  Cipro would be a 10 day course he said of 500mg pills twice a day.  

I finished my Zithromax(I didn't need this) a week and a half ago.  I'm a bit concerned whether the Clotrimazole will help the minor urethral irritation or if I need Cipro, too.  If I do decide to go with the Cipro, does that mean double the pain for my knees, since some Zithromax could still be in my body tissues.  While I'm concerned about the knee pain, I'm more concerned about my knees' well being in the future.  Is Cipro a wise choice given that it is an antibiotic like Zithromax and might inflame my knees further?

[monkeyflower]

Not the doctor, but I don't think knee pain is generally a side effect of Zithromax or Cipro. Are you sure they're related?

[H. Hunter Handsfield, M.D.]

We've gone as far as possible for an online advice service. These are questions for the doctor treating you.  I won't have any further comments.  Best wishes.