Sclerosing Lymphangitis among other things

I am a 35 year old male that had intercourse with a sex worker, the condom fell off. Three days after, I felt mild burning when urinating. After 2 weeks I felt pain and pressure in the area of my pubic hair for 2 days. At 2.5 weeks the burning pain became severe. The opening of the urethra was red and a little swollen at this time. At 3 weeks, I took two 500 mg cippro. After 4 days the pain dissappeard. During that time however, the left side of my penis began to swell. First I felt a small mass under the head. Eventually the mass (felt like cord) went from the base to underneath the head. This lasted a 4-5 days. Sclerosing Lymphangitis? I also felt groin pain on both sides for 2 days or so. I could feel the swollen lymph nodes. At 4 weeks from exposure, I had a full std panel. All negative. The Herpes IGG test kit was from a company called Euroimmun. At 6 weeks I went to the city std clinic. They don't do Herpes blood tests. They drew blood for HIV and Syphilis and did a urethral swab. The clinic only notifies you if there is a positive result, they never called back. I found a lab that does Herpeselect and took the Hsv 2. This was at 45 days, result negative. It's been 8 weeks. I plan on going back at 90 days and having another Herpes test. At this point that is my main concern. I never had lesions, but I also never had an obvious discharge or a pronounced drip. I know I have or had something. Is there anything else that I should be getting checked out for?

[H. Hunter Handsfield, M.D.]

Your penile symptoms sound like you could have had genital herpes, but unlikely--since you don't describe typical lesions.  You might have had chlamydia or gonorrhea, which sometimes causes the sort of penile swelling you describe--but it sounds like you made the mistake of treating yourself with cipro before getting it checked out; that would have turned your later STD tests negative.  The groin symtpoms clearly were not herpes.

All in all, I doubt you have herpes and just cannot say much more about other STDs.  The negative HerpeSelect test at 6 weeks is partly reassuring evidence against new herpes, but not perfect; it would be positive in maybe 50-60% of cases by that time.  A negative result at 3 months would be definitive.  But I expect that result to be negative.

Good luck--  HHH, MD

[BostonGirl1]

Doc, I usually read that you say that about 90% of percent of people will be positve at 6 weeks, and that about 50% will be positive at 4 weeks. But above you state that 50-60% will become postive at 6 weeks? I was just wondering! Thanks

[H. Hunter Handsfield, M.D.]

If I really said HSV-2 antibody tests are convert to positive 90% of the time within 6 weeks, that was a mistake.  Any chance you confused HSV with HIV?  The window period varies for different type-specific tests, but the most rapid (e.g., HerpeSelect) probably is positive about 80% of the time by 6-8 weeks, reaching 90-95% by 3 months.

Sorry for any confusion.