Recurrent non-chlamydial NGU...herpes?

[pleasehelp777]

Thank you. I am 24 and male.  In January, I had unprotected sex and oral sex with gf. Two weeks after, I noticed tiny red dot on foreskin (which GUM doctor could barely see), and also some clear urethral discharge.  GUM doctor diagnosed me with urethritis --> given 7 day doxy treatment --> symptoms resolved within 2.5 weeks, (GC swab test came back negative). 2 months later, I developed weird spot on inner thigh which dermatologist said was jock itch. At this time, I also developed another bout of urethritis - discharge, itching and slight stinging inside urethra, urgency, frequency - and was prescribed cipro by urologist. The infection cleared 5 days after my last dose of cipro. Herpeselect test at 12 weeks was negative for HSV1 (0.07) and HSV2 (0.10) , yet IgM test was inconclusive. Herpeselect test at 16 weeks was also negative for both strains (HSV1: 0.00, HSV2: 0.13). I will be doing another blood test at 20 weeks post-exposure, which will include herpeselect AND IgM. I am at my wits’ end, because I had MD-diagnosed NGU twice since the January exposure. Other symptoms I’ve noticed at one time or another include slight flaking of penile skin and two folliculitis spots on the penis (diagnosed by derm). All doctors I’ve seen dismissed herpes until one urologist said herpes is a possibility simply because the NGU recurred. Based on all I've told you, do you think herpes is a possible exlanation for my NGUs? Will Herpeselect negative (HSV1 and 2) test at 20 weeks rule it out?

[H. Hunter Handsfield, M.D.]

Sorry, I really cannot help much.  Your herpes tests prove you are not infected with HSV-1 or -2.  The IgM HSV tests are totally useless, whether positive, negative, or indeterminate, and repeat testing will not sort things out further: the IgG results are all you need and you can be 100% certain HSV has nothing to do with any symptoms you have had.

NGU sometimes recurs, and mostly doesn't mean anything serious; in fact, such recurrences might not be due to infection of any kind.  Certainly it is not a significant risk to your health (no cancer, no infertility, nothing) or to that of a future sex partner.

You have been under the care of a GUM clinic, a dermatologist, and a urologist.  Follow their advice.  I can add nothing further.  

Good luck--  HHH, MD

[pleasehelp777]

Thank you for your reassuring reply.  The reason I asked is because you previously told someone in another post that if his NGU were to recur in 1-3 months, you would be concerned about herpes.  Also, you have stated before that IgM can sometimes be useful in detecting early infection.  In addition, you stated that some people can take as long as 6 months to igg-seroconvert.  I just want to know what (which bacteria, virus, etc.) caused these infections and if it's ok for me to resume having sex.

[H. Hunter Handsfield, M.D.]

You have misinterpreted my previous comments, or have selected my advice to other questions out of context. My views on all 3 points are just the opposite from the spin you have put on them. All things considered, herpes simply is not a plausible explanation for your problem. In hundreds of patients with symptoms like yours over 30 years, I have never seen herpes. You need to put that idea to rest.

Check with your own provider(s) about whether it is OK for you to have sex. From all you describe, I see no reason not to do so.