STDs Expert Forum
Urge to Urinate -
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Urge to Urinate -

Hello Doctor,

I am 34 year old female and I have a couple of questions surrounding the symptoms that I am displaying.

Several months ago I had protected sex with a friend of a friend and during the act the condom broke.  I do not know how long the unprotected exposure was after breaking.

About two weeks after this encounter I woke up and went to the bathroom.  I had no problem urinating but when I was done I still felt like I needed to go.  I had a heavy / bloated feeling in the area of the bladder and what felt like internal pressure near the opening my urethra.  

It went away after two days.  I went to clinic at 3 weeks and had complete test for STD's and all came back negative (they did not test for herpes because they said too soon to show up in blood test) since I did not display any symptoms the careworker told me it was unlikely that I had contracted anything.  

I have never had any sores or other sypmtomes other than a slight vaginal itch now and then.

About 6 weeks after the encounter I experienced the same sypmtoms I described above.  Again symptomes lasted two to three days.

At week 8  I had a slight back ache / upper leg ache and what appeared to be mild groin pain and slightly swollen lymph nodes.  I attributed the backache / leg ache and swollen groin lymph nodes (not tender) to the fact that I fell very hard on my butt while playing tennis two days prior to these symptoms coming on.  Backache went away in 2 - 3 days but lymph nodes seemed to stay swollen (not tender) for almost a month.

I went to my GP for flu shot and I informed her of my sypmtomes and two previous episodes of my urge to urinate.  She took a culture for bacterial infection and came back negative.  She said that none of the symptoms I described sounded like a herpes infection and did not think a blood test was required.  

My questions to you are:

1) Does herpes cause a bloated feeling in the abdominal area?

2) Does herpes cause a heavy feeling in the urethra and bladder and a feeling of an excessive urge to urinate?  AGAIN, WHEN THIS HAPPENS I DO NOT HAVE TROUBLE OR PAIN URINATING, just an urge to urinate when I dont have anything in my bladder.

3) Does herpes cause lymph node swelling in the absence of typical sores or lesions?  

4) Does lymph node swelling occur usually with initial outbreaks or recurrent outbreaks or both and how long does the swelling last?  Does the swelling happen only during times of active outbreak?

5) Does herpes cause groin pain?

Thank so much for your time and for answerig these questions for me.






  



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239123_tn?1267651214
I mostly agree with your GP:  urge to urinate, without other symptoms, is not a common symptom of herpes or other STD.  Your negative STD tests, which probably included tests for gonorrhea and chlamydia, have ruled out those infections.  However, I disagree a little bit about herpes blood testing.  Herpes can cause atypical symptoms, and nobody can say you don't have it unless the blood test is done.  If negative for HSV-2, you can be certain herpes isn't the explanation.  But if positive, it won't necessarily mean herpes is the cause; you could have asymptomatic genital herpes plus some other cause for your symtpoms.  However, a trial of anti-herpes treatment (valacyclovir, acyclovir, or famciclovir) might be worthwhile to see if it makes a difference.

Since the sexual exposure you describe was condom-protected, it is unlikely you acquired herpes at that time.  Condoms have gotten a bad rap with respect to herpes, but they usually are effective in preventing HSV infection.

To your specific questions:  1) I have never heard of herpes causing a bloated feeling.  2) See above; urge to urinate is not a common herpes symptom, but it might be possible.  3,4) I cannot say that herpes never would cause lymphadenopathy (lymph node inflammation) without lesions, but it's rare if it happens at all.  Lymphadenopathy generall occurs only with the initial genital herpes infection, not with recurrent outbreaks. 5) Again, groin pain without other symptoms is not a recognized symptom of herpes.

Bottom line:  I doubt herpes is the explanation for any of your symptoms.  I have to wonder whether they are due to anxiety rather than a physical cause.  But the only way to know about herpes is to have the blood test.  Discuss it with your GP; or consider getting a second opinion, such as from a GUM or public STD clinic.

Good luck--  HHH, MD
11 Comments
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Avatar_n_tn
One last question.  I forgot to mention that I did notice a couple of small red bumps about week 8 on my labia but they came up and went away within about 10 - 12 hours.  Would this lead you to believe that these were caused by herpes.  No itching or pain associated with them.  

I will proceed with blood tests.  Thank you but please answer question above.
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239123_tn?1267651214
The red spots cannot be herpes lesions, which cannot come and go in less than 7-10 days.
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79258_tn?1190634010
What about a UTI? Feeling bloated, having to pee right after going, the pressure, etc. can all be symptoms. Or maybe it's irritation from new soap, condoms, lubes (or inadequately lubricated intercourse), or even nothing at all--just noticing/paying extra attention to normal bodily sensations.
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Avatar_n_tn
I went for testing yeaterday at the same clinic I went to previously.  I had a great careworker (don't know if she was a doctor) but she has been dealing with STD's for over 22 years from military service to private sector.  She gave me her opinions and I was wondering how you felt about them. I think it would be educational for the forum community.

1) She stated that their clinic tests people at 6 weeks and that the difference in reliability between 6 weeks and 12 weeks is so small that she does not know how to quanitfy it.  She said in her 22 years she has never seen anyone with atypical symptoms test negative at 6 weeks and positive at 12 weeks and people who display typical sypmtoms that test negative at 6 and positive at 12 is small. (She did qualify that this is assuming that no additonal herpes exposure between the original and subsequent test dates occur)

2) She has never seen a case of swollen lymph nodes without obvious, typical sypmtoms being manifested.  Stated it could possibly happen but highly unlikely.  Agreed that swelling with primary infection was more likely and doubted that recurrent infections would cause this.

3)She said that female symptom diagnosis in regards to lesions are more difficult that males due to the fact that lesions on males appear in areas more easily examined than females.  She said that females can have lesions internally and therefore the absence of lesions cannot be absolutely verified.  But she said if you take her experience with males infected with herpes, most do not display additonal typical herpes symptoms in absence of typical herpes lesions. She assumes this to be accurate for females as well.

4) She agreed with you and suspects my urge to urinate was unrelated to a herpes infection and does not believe that anything I described directly relates to an active herpes infection.

Your thoughts would be appreciated and I will relay the results of my tests upon receiving them.  

Thank you for your informational support and service.
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239123_tn?1267651214
I agree almost entirely with your provider; clearly she is knowledgeable about STDs.

However, she might misunderstand my point about delayed retesting (rescreening) for chlamydia and gonorrhea.  CDC definitely recommends it be done at 3-6 months, not at 6 weeks or earlier (refer her to the 2006 STD Treatment Guidelines).  Recent research indicates that some chlamydial infections might be suppressed but not cured, but not detectable until more than 2 months later.  Further, rescreening detects reinfections as well as delayed treatment failures.  Among all people with gonorrhea or chlamydia, retsting at 3-6 months finds that 10-15% are infected again when tested at 3-6 months.

HHH, MD
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Avatar_n_tn
Dear Doctor,

I kow you are busy and I dont want to bother you but since this is such a great forum I would like to clarify my past post or other readers and have you clarify on the following so that the educational process is furthered:

I think my last post was confusing.  The testing I was speaking about was for HSV2, not chlamydia and gonorrhea.  The careworker was just stating that in her opinion and past experience 6 week tests usually produce the same result as 12 weeks tests for detecting HSV2.  Slightly more so in atypical symptom cases than in typical symptom cases (again, assuming no additional exposure from original test date) I do not know if you agree.  YOUR COMMENTS PLEASE.

Also, I called back to check about a retest in my situation and this is what I was told, please confirm your thoughts.

1) Specifically to me, since I tested negative on my first test for chlamydia and gonorrhea, according to the clinic no retest is necessary or recommended.  DO YOU AGREE?

2) I also forgot to mention that the health care worker looked at my lymph nodes and said that they were not swollen in her opinion.  At their largest they were only the size of a pea and not painful or tender.  She said swollen inigual lymph nodes due to active HSV2 infection with typical symptoms usually appear 3/8" to 1/2" or larger and are tender to touch.  She though I had more like a groing strain.  She said the nodes usually only remain swollen 2 - 3 weeks max.  Since mine lasted over 4 weeks and appeared at week 8 in absence of typical sypmtoms, she suspected a groin or muscle strain.  DO YOU AGREE WITH HER DESCRIPTION OF SIZE / CHARACHTERISTICS / AND DURATION OF LYMPH NODE SYMPTOMS?

3) In general - the clininc tests for chlamydia and gonorrhea with a urine sampe, not a culture type test.  They stated the test is HIGHLY RELIABLE AND EFFECTIVE for detecting both infections.  DO YOU AGREE?

4) If you test positive for either infection or both infections, here is their treatment.  chlamydia and gonorrhea -(1G Zithromax / single dose and 500 MG Cipro / single dose) chlamydia only (1G Zithromax / single dose) gonorrhea only (1G Cipro / 500MG - 2 doses 12 hours apart)  Then they recommend retest in 8 weeks. DOES THIS SOUND RIGHT?

5) Also, one last question because I am interested as I am sure other readers are too, can you explain how chlamydia and gonorrhea clear on their own without antibiotics and what percentage of cases due this on their own and how long each one can survive in the body without treatment?  I have read where you have stated this but I am still confused and puzzled about how this occurs and the process involved.  

Thank you so much and I should have my test results back this week and I will post them.

YOU ARE GREAT AND THANKS AGAIN!!



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239123_tn?1267651214
Sorry, too much detail; getting close to practicing medicine online, which I will not do.  Specific questions about your own care should be directed to your own provider.  From all you say, it sounds like you can trust her completely.

Our immune systems clear up most bacterial infections, given enough time.  In the pre-antibiotic era, pneumonia resolved in a few weeks in the 90+% of people who didn't die in the first couple of weeks.  Same for gonorrhea (typically a few weeks to a few months) and chlamydia (takes longer, but rarely more than a year).  Both resolve more rapidly in men than women.

HHH, MD
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Avatar_n_tn
My apologies.  By all means not my intention.  Whould you mind at least giving your opinion of testing for gonorrhea and chlamydia using urine sample as opposed to culture?  Are both reliable methods?
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239123_tn?1267651214
My refusal to go into detail was because I agree with everything your own provider said.  That includes the reliability of urine versus cervical testing.
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Avatar_n_tn
Sorry to not post sooner, test results negative for HSV2.  Thanks.
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