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STD Test Negative - Still Concerned

I am a hetero male in my 40s.

Get STD tests every year.  In August 2013 - Negative for all tested STDs including herpes.

Two weeks ago, I had unprotected oral sex (deep) with a high end escort and protected intercourse (vaginal).

6 days ago, burning urination, delayed urine flow, redness around urethra opening. no discharge.  Went to see doctor.  Tested for UTI, Chlamydia, Gon.  Got test back yesterday.  All negative.  When I saw the doctor, 6 days ago was given  4 250 mg tablets of azithromycin to be taken with food as Dr. said likely chlamydia as quick urine test was negative for UTI.

No real change in symptoms - still burring urination with bad flow and unusual spray when urinate.  Dr. said unlikely false negative for gon and chlamydia and UTI would have cleared with 1 gram does of antibiotics.  Dr. said he has seen these symptoms lately but not sure what causing it.

Do I have an STD / STI?  If so what likely is it?  What is the possibility of a false negative?  What additional tests should be done.

12 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your question.

There's a good possibility you have viral urethritis.  About 5% of nongonococcal urethritis (NGU) in men is due to adenovirus or to herpes simplex virus (HSV), usually type 1 -- and both typically follow oral sex.  Adenovirus is a common cold virus.  The erythema (redness) of the meatus (urethral opening) is a typical hallmark of viral NGU -- and the lack of response to azithrmycin also is consistent with a viral infection.

Adenovirus isn't a problem for the long term -- if that's the cause, it will clear up in a few days and will not recur.  And there aren't any readily available tests for it.  However, your comment below ("a small cut near my urethral opening") is worrisome for herpes -- which as you likely know, has different implications.  Even this usually isn't a big deal; genital herpes due to HSV-1 usually recurs infrequently if at all and is not frequently sexually transmitted.  Still, you want to know if that's what you have.

My suggestion is that you return to your doctor ASAP, perhaps with this thread printed out as a framework for discussion.  You should have a urethral swab test for HSV testing by culture or PCR (the latter is preferable) and should start treatment with valacyclovir or one of the other anti-herpes drugs, which would speed clearing of your symptoms (and won't be harmful if it isn't herpes).

I'll be interested in hearing how this shakes out.  Best wishes--

HHH, MD
Helpful - 2
Avatar universal
A related discussion, Tested negative for chlamydia in the eyes was started.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
I'm glad to have helped.  Happy holidays.
Helpful - 0
Avatar universal
Dr. Handsfield,

Thank you so much for your diagnosis.  Without your assistance this situation would have been much more stressful for me. I am very impressed that you were able to diagnose the rare virus that I had from a brief description on an on-line forum.  I saw two doctors and one specialist who were all unaware of  adenovirus as a cause of NGU.  Perhaps doctors need additional education or training in this area.

My symptoms have virtually resolved.  I will outline my symptoms below and other parts to the story to assist others who may get this virus in the future.

About 12 days before symptoms started I had unprotected oral insertive sex with escort and protected vaginal intercourse.


Day 1 - Minor urethritis

Day 2 - Increasing burning pain while urinating;  Went to see doctor quick urine test negative for uti.  Urine tested at lab for stds (Chlamydia, Gon).  Was given 4 250 mg tablets azithromycin as doctor thought likely Chlaymydia.  Redness around urethra opening and inflammation around urethra opening

Day 3 to 5 - Urethritis was worse - very painful urination.  Symptons worsening despite antibiotic treatment.  Unusual spray during urination.

Day 6 - Urine test comes back negative.  1st doctor says does not know what is causing it - (Asked about herpes - says does not look like herpes at all).  Conjunctivitis left eye.

Day 7 to 9 - Urethritis begins to clear.  About a 25% reduction in pain.  Unusual spray issues almost completely resolved.  Second urine test comes back negative for uti and chl. and gon.  Pink eye in left eye is at peak.

Day 10 - to 14 - 50% reduction in urethritis (pain).  Pink eye in left eye commences to resolve - get pink eye in right eye around day 12.

Day 15 to 17 (day 17 is today) - Redness and inflammation gone on right side around urethra opening.  Still a little inflammation on left side of urethra opening.  Burning urination 95%+ resolved.  I expect I will be back to normal in about one week.  Minor pink eye still in right eye.

Other - Mild cold symptoms (minor sore throat, fatigue, etc.) began two days before Urethritis commenced.  Minor cold symptoms would come and go throughout entire period.


Helpful - 0
Avatar universal
Thank you for your assistance. I will let you know if and when symptoms clear or if they do not, any additional findings of the urologist.





Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
I'm sorry you didn't mention your conjunctivitis at the outset.  As you have found, that indeed makes adenovirus especially likely as the cause of your urethral symptoms.  You can expect your symptoms to clear over the next 1-2 weeks.

I would skip the urologist appointment.  It will be expensive and won't give any better answers than you already have.  Most urologists in many countries, including the US, are not especially expert in STDs, and I would guess that most are unfamiliar with adenovirus as a cause of NGU. You can reconsider if your symptoms last more than a couple of weeks.

FYI, here are links to additional publications that addressed adenovirus and NGU.  One of the authors may seem familiar.  ;-)

http://www.ncbi.nlm.nih.gov/pubmed/17382037
http://www.ncbi.nlm.nih.gov/pubmed/16388480
http://www.ncbi.nlm.nih.gov/pubmed/16388479
Helpful - 0
Avatar universal
Thank you for your comments.  It led to a good discussion.

I did not mention I had what appears to be pink eye develop a few days ago. I thought it was unrelated to the urethritis.  (See below)

Dr. says not very likely herpes - redness was not a cut just redness around opening.  Dr. not sure so I have an appointment to see a urologist soon.

I found these two articles this morning on-line - which makes me confident - I have Adenovirus urethritis.  I just want to confirm that this will subside on-its own within two weeks from initial symptom.  Which means I likely will start to see improvement next week.

http://www.redorbit.com/news/health/448107/adenoviral_nongonococcal_urethritis/

http://sti.bmj.com/content/78/6/445.full



I will let you know what the urologist says...
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
The causes of NGU are chlamydia 30-40% of cases, Mycoplasma genitalium 10-15%, and in about half the cases the cause is unknown. Most cases don't have the redness you describe, and the symptoms usually start at 1-2 weeks after exposure.  You were given azithromycin (the only antibiotic nomally given as a single 1 g dose), which is the drug of choice for most NGU.  Had you had any of the causes above, or NGU of unknown cause, your symptoms would have cleared promptly.  The redness, earlier onset, and failure to improve with azithromycin are what make me suspicious of a viral infection.

Early onset of symptoms, redness also are compatible with gonorrhea, but you have tested negative for it.
Helpful - 0
Avatar universal
One other thing.  You indicated that 5% of viral urethritis is due to NGU virus or herpes.  What is the 95% due to - What is the cure / procedures for the other 95%?
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Avatar universal
Thank you.  I will let you know how the outcome.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Noted; see above.
Helpful - 0
Avatar universal
One other thing - it appears that I have a small cut near my urethra opening which may be inflamed.  Could this cut cause the burning sensation?
Helpful - 0

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