Recurring Urethritis. Could it be serious? HSV-related?

Dr.  Handsfield,

I wrote a couple months ago, so this while be my last for awhile. I am a bisexual man who was the top in anal sex 12.5 weeks ago. It was protected until the condom slid inside without me noticing. My last negative HIV test was at 10 weeks, so obviously I'm feeling great about my chances for a 13 week negative, which I have scheduled for next week. I already received your lecture, and I am not stupid enough to make another mistake to that degree.

Anyway, I've been through all kinds of testing and all of it seems to be coming up negative. Chlamydia swab at the onset of symptoms (1 week after exposure). Negative. Gonorrhea/chlam urine tests negative. I was diagnosed with NGU. Recurred after 1 dose of Zithromax, recurred after 10 days of doxycyline (but it did respond originally), and levaquin 10 days didn't do much of anything. Finally went away on its own. I saw and infectious disease doc and he gave me PCR testing including gonorrhea and chlamydia. Negative.

Now I'm wondering about the possibility of two things, because my urethritis just returned the other day, and I'm really sick of living in pain. Could this be herpes-related, given the resistance to antibiotics. I am having a type-specific blood test done this week at 13 weeks past exposure, so I will let you know what the results are. About 2-3 weeks past exposure, I had a small area that looked like a red cut right under the head of my penis where the skin is. But it went away in a couple days with cream. If I have intraurethral herpes, would there be pain during urination? I don't have any of that, just constant throbbing annoying pain.

I have had throat sores, which my doctor looked at and said looks like a regular viral infection, but they've been there for a couple months now, on one side of the back of my throat. And one single bump on the way back of my tongue that looks like a pimple, but I'm guessing thats nothing. I also continually have upset bowels, which leads me to the question below.

I was wondering about the possibility also of Chlamydia LGV. Especially since this guy was from NYC where some cases were documented right? So now on to the questions.

1.) Is there a chance this could be chlamydia's LGV strain, and if it was, shouldn't my treatment have gotten rid of it? I read it might cause a small penile sore and then some possible intestinal symptoms?

2.) Do you think I have herpes in the urethra from my resitance to the antiobiotics, or just recurring NGU? I don't have any external lesions, but I do have the lining of my penis HEAD red, and I've been using 1% hydrocortisone on it for a few days to see if it will go away. Once again, I'll be testing this week for it.

3.) Can I be certain I don't have HIV after my 10-week finger ***** Oraquick test? I'm going for my 13-weeker next week.

Thanks so much for the help doc, I really hope you can give me some suggestions that might lead me to find out what is causing the pain.

[H. Hunter Handsfield, M.D.]

NGU often persists or recurrs, especially when not due to chlamydia.  Some such recurrences might not be due to infection at all, but to an immunologic response.  In any case, however inconvenient it is, there apparently is no danger.  Recurrent nonchlamydial NGU has never been found to be associated with serious health outcomes in either the infected men or their sex partners (whether male or female):  no epididymitis, cancer, infertility, urethral stricture, or any other problem.  Herpes is rarely if ever a cause.

1) Your symptoms are definitely not those of LGV; and anyway any chlamydial infection, including LGV, would have responded to the antibiotics you have had.

2) Your symptoms do not suggest herpes.  Even if you turn out to have a positive test for HSV-2 (as is likely, since 50-70% of gay/bi men are infected with HSV-2), it will not necessarily explain your symptoms.  However, if positive for HSV-2, you should speak with your health care provider about trying an antiherpes drug to see if it has any effect.  But I doubt it would.

3) I think you know my perspectives on HIV testing and the time to a reliable test. None of your symptoms suggest HIV and it is extremely likely your 13 week test will be positive.

Your first follow-up question (long term health problems) is addressed above.  A white bump on your tongue is unlikely to be an STD.  As to the specific cause(s) of your problems, all I can do is suggest you follow up with your health care provider.  I don't have any further insights.

Good luck--  HHH, MD

[Concerned5]

4.) One more question I forgot and left out. What are the odds that my urethritis is linked to something serious that could cause long term problems?

Thanks

[Concerned5]

Any also wanted to ask if any STD would cause the white raised bump  on the very back of my tongue?

[Concerned5]

Thanks Doc,

I think you meant "extremely likely your test will be negative"

But thanks, I just noticed the bumps today, but if they don't go away in a week or so I'll show them to my primary doctor.

Take care

[Concerned5]

My final question of concern is while obviously having pain in the urethra, it feels as though there is something in the urethra when you move back and forth, like maybe a discharge that wont come out or something else so..

Is it possible to have HPV (warts) in the urethra? My urination is a little shaky and split ever since this NGU and I'm wondering if that might be a possibility. Is it worth mentioning to my urologist or perhaps a cystocopy? I just want to make sure I'm not missing something here.

Thanks for your time

[H. Hunter Handsfield, M.D.]

Sorry about typo; likely negative (or unlikely positive, which what I actually intended to write).

Yes, warts can occur in the urethra and can cause split urine stream.  Definitely mention it to your urologist.

HHH, MD

[Concerned5]

"2) Your symptoms do not suggest herpes. Even if you turn out to have a positive test for HSV-2 (as is likely, since 50-70% of gay/bi men are infected with HSV-2), it will not necessarily explain your symptoms. However, if positive for HSV-2, you should speak with your health care provider about trying an antiherpes drug to see if it has any effect. But I doubt it would."

Thanks doctor, but in regard to that statement, I had a full panel done 3 weeks after the incident, and I was negative with IgG testing for both HSV-1 and HSV-2. I've always been monogamous and use safe everytime. This was the first time I wasn't with a monogamous partner.

So if I do come up positive for HSV, its 100% from this incident. But your assurance that my symptoms don't sound particularly like herpes makes me feel a little bit better about my chances of squeaking by from this incident.

Why would antiherpes drugs not have an effect? I haven't been able to find why online.

[H. Hunter Handsfield, M.D.]

Notice I said a positve HSV-2 test wouldn't necessarily explain your symptoms; I didn't comment on whether you could have caught HSV-2 from any particular exposure.  But if you indeed seroconvert, I wouldn't argue against trying antiherpetic therapy to see if it helps.  But such treatment obviously cannot have any effect if the symptoms aren't due to herpes.  In my 30+ years in this business, I have never seen a patient with herpes with symptoms like yours.

I'm not trying to discourage you, but I also don't want you to get your hopes up unrealistically.  It is unlikely you will find easy answers or some simple, effective treatment.  But it also is virtually certain you have nothing that will ever seriously affect your health or that of any future sex partner.

HHH, MD

[H. Hunter Handsfield, M.D.]

Notice I said a positve HSV-2 test wouldn't necessarily explain your symptoms; I didn't comment on whether you could have caught HSV-2 from any particular exposure.  But if you indeed seroconvert, I wouldn't argue against trying antiherpetic therapy to see if it helps.  But such treatment obviously cannot have any effect if the symptoms aren't due to herpes.  In my 30+ years in this business, I have never seen a patient with herpes with symptoms like yours.

I'm not trying to discourage you, but I also don't want you to get your hopes up unrealistically.  It is unlikely you will find easy answers or some simple, effective treatment.  But it also is virtually certain you have nothing that will ever seriously affect your health or that of any future sex partner.

HHH, MD

[oxyone]

Hello,

What did your urologist say about having warts in the urethra?

Any news on that are you okay now.
Can you please let me know because im having the same problem that you are having.

Thanks,
Oxyone