Is it herpetical urethritis and/or herpes OB in urethra???

[Blah16]

Hello Doctor,

Approximately 2 weeks ago, I began to have the sensation of having to frequently pee.

Symptoms as follows: urinary frequency, terminal dribbling, incomplete voiding (usually corrected via dribbling), possibly mild (at worst) dysuria - though the dysuria could be in my head, by no means severe.  

Initial visit (Day 2)  to the clinic ruled out typical offending bacterial agents, as well as Chlamydia/gonorrhea.  Prescribed Cipro (500 mg/day for 7 days) to no avail.

Slight burning developed in penis tip in following days.  Visit to Family GP on Day 8 yielded nothing of note in course of rectal prostate exam.  Prescribed Sulfatrim (1000 mg/day for 10 days).  No improvement noted.

Woke up to discover a clear stain on the interior of my underwear on days 10 and 11.  On day 12, I discovered no such stains, but after some "milking" discovered a clear mucoid discharge, scant in volume.  I have no signs of external penile/groinal lesions whatsoever.  

I inspected the inside of my own urethra, noting a "discoloration" of the meatus right at the "top" side of the meatus, essentially right at the uppermost tip of the urethra.  It appeared simply white in colour , and blended seamlessly into the typical red/pink meatus.  I asked that my brother, who is healthy and an exceptionally good sport, to check his own urethra, and he confirmed that he also has a similar white "patch" in the same spot.  It does not appear raised or crusted, etc.  If I squeeze the tip of my penis (externally), I feel no pain on the internal "patch".

I know herpetical lesions can SOMETIMES appear in the urethra and not externally, so my questions are:

1.  What would these look like(if visible)?
2.  Does what I describe(the white patch) sounds like a lesion or normal?
3.  Is it possible/conceivable to have hepetical lesions in the urethra without experiencing any significant (or any) pain?
4.  What is the likelihood of having internal herpetical ulcerations, and none externally?

1.  

[Edward W Hook, MD]

Sorry, no other birigh ideas. My advice is that this is likely to be a non-STD dermatological process.  

Alternatively, sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turns leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation.  EWH

[Blah16]

Thanks again Doctor, I appreciate you taking the time.  Now, any other more likely possibilites...?

Day 15 is just beginning, no apparent change.

[Edward W Hook, MD]

Thaks for the clarification.  The additonal infomration makes me still more confident that what you are describing is not HSV.  The symptoms had there onset longer beyond the exposure you describe than is typcial for HSV and your earlier history is likewise rather low risk.  I would not worry.  EWH

[Blah16]

... the predated should read postdated

[Blah16]

... oops, I should add that I also had protected vaginal sex on several occasions, the last time being 17 days prior to onset of urinary frequency.  I did have a condom "mishap" with her once, during the course of which the condom came off as I pulled out, but that would've been months ago.  These encounters of course, predated my initial urinary episode 1.5 years ago.  

[Blah16]

Thank you for your reply Dr. Hook,

I should clarify, I am a 34 year old male,  and received unprotected fellatio from a female between 17-24 days prior to the onset of urinary frequency.   I should also note that I did experience a similar episode approximately 1.5 years ago.  I was in a 6 year long monogamous relationship at the time, and HSV didn't cross my mind as I had not had any casual sexual contact in the 6 years preceding the episode.   Again, the episode was characterized by urinary frequency and some mild dysuria in the absence of any lesions/overt ulcerations.  In that instance, the offending pathogen/non-pathogen was never identified, and the discomfort disappeared after 8-10 days of antibiotic treatment if memory serves...?  I have never in all my life experienced anything remotely similar to what would be described as a classic HSV clinical episode.  I worry regardless given the permanent nature of the affliction, and possibly because I have read a few scary, if not unusual or atypical, diagnosis related to HSV (some on this site).  I have an appointment with a specialist coming up, just wanting to know the facts in the meantime as I am ridden by anxiety.  I can scarcely imagine that this current episode is simply a recurrent herpetical outbreak related to the episode 1.5 years ago (which would presumably represent the primary episode...?), neither of which presented typical symptoms associated to HSV, nor resulted in severe pain.  I would describe the sensation more aptly as "warmth" or a mild burning in the tip of the penis.  

[Edward W Hook, MD]

Welcome to the Forum. Your problem really does not sound like herpetic urethritis. When herpetic urethritis occurs it tends to be present with a first episode and is typically also accompanied by lesions which are present externally. Herpetic urethritis is typically frankly painful, not just a bit uncomfortable. In answer to your specific questions:
1.  See above.  If anything is visible it tends to be a shallow ulceration, typically 3-4mm across.  Not as a white spot.
2.  This sounds normal, not pathological.  If you are concerned, you should see someone who deals with such tings often, i.e. at your local STD Clinic or perhaps a dermatologist (although some dermatologists are not particularly good at genital dermatology).
3.  Very unlikely.
4.  Again, not likely

Now a question for you. why be concerned about HSV?  you ask this question with no background and sometimes context is important.  EWH