Worried about possible herpes symtoms?

[jimmy837]

Dr., I'm concerned about possible herpes symptoms. I'm  37, male and 5 1/2 weeks ago I had unprotected oral and vaginal sex. About 5 days after the episode, the tip of my penis and my scrotum began to burn. My scrotum felt raw, was red and felt heavy. Opening of my penis and underside of the head hurt. I also had a headaches and felt fatigued. No fever, discharge, pain during urination or any visible sores. I went to my doctor. STD tests were negative but was not tested for herpes.

My partner said she had been tested since her last encounter and was fine. Didn't ask what she was tested for..

After a week my enegery picked up but still felt a periodic burning in my penis and scrotum, was more sensitive than usual and occasional shooting pain in both locations, some groin pain, sometimes a mild burn after urination. Some of these pains and twinges were subtle but enough to notice, certainly out of the ordinary.

Then my knees, right hip joint, and eventually my lower right back hurt. My right arch in my foot also hurt. I went back to my Dr. who told me maybe I was starting to obsess, which I was and that the joint/back pain would not be STD related. After a week the joint pain disappeared just like that. But not the mild burning and itching.

I went to the STD clinic at a major hospital. An infectious disease specialist examined me and found nothing of concern. I asked about herpes; he said I shouldn't worry about it and couldn't diagnose me without sores and that I need to forget about it.

Symptoms lasted nearly 5 weeks, along with loose stools (sometimes diarrhea), anal itching and occassional slight inner thigh burn. They've finally started to calm down.

I've tried to forget about it. But I find sites like this that state you can have herpes without overt sores. I trust these doctors, but they said nothing about taking a herpes select test now and then in 12 weeks, like I've read in this forum. What would your advice be? Thank you.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.  The bottom line is that I'm quite certain herpes doesn't explain your symptoms.

Although it is conceivable herpes caused some the initial symptoms (the penile "burning"), no other symptoms suggest that diagnosis.  And I don't think it explains the penile burning either.  Herpes lesions can be painful with stinging or "burning", but HSV doesn't cause burning in the absence of herpes blisters and sores.  And herpes certainly does not cause back and join pain or anything else you describe.  Finally, herpes symptoms are intermittent and rarely last more than 1-2 weeks, with no symptoms whatsoever between outbreaks; and 5 weeks is definitely too long.  Further, the opinion of an infectious diseases/STD specialist after direct examination is highly reliable.

So in summary, you really describe nothing that suggests genital herpes.  If your symptoms continue, return to your doctor for further evaluation.  If you or s/he remain concerned, you could always have an HSV blood test -- but even if positive, it wouldn't be a likely explanation for your symptoms.

I hope this helps.  Best wishes---  HHH, MD

[jimmy837]

Thank you for your prompt reply, doctor. I do trust the doctors I saw and certainly trust your opinion. Thank you for providing this service on this forum.

[jimmy837]

Hi, doctor. Thanks again for your advice. I've tried to forget about this episode but one thing I failed to write in my original post was during all this I had a small line, like a paper cut or scratch where i felt the initial pain in my penis on the underside of the head. This appeared for a day went away and then came back a week later and went away just as quickly. The doctor at the STD clinic examined it and said it was nothing. I trust his opinion but I'm curious if herpes would even present itself like this? I mean, would a lesion appear for that short of time and then come back a week later, especially in an initial outbreak?

Also, I'm starting a new relationship. I have been tested during this episode for everything but herpes, but would you recommend a herpes blood test for a routine std panel for someone starting a new relationship? Thanks

[H. Hunter Handsfield, M.D.]

Since an STD clinic provider has said the mark was nothing and did not think you needed testing, that is also my opinion.  In person exam is always more reliable than written description -- and your description doesn't suggest herpes or STD anyway.

Please accept the reality that you don't have herpes or any other STD.  It is long past time to snap out of your anxiety about it and move on.

[H. Hunter Handsfield, M.D.]

I meant to add that it can never hurt to be tested for common STDs, and people who are sexually active outside mutually monogamous relationships should do that from time to time.  So there's certainly no reason for you not to be tested on that basis, regardless of your symptoms.  HSV testing is not normally done for routine STD screening, although some experts believe it should be.  If you do it, I agree you should wait until 3 months (preferably 4 months) after your last sexaul exposure, and be prepared for the possibility it will be positive but not explain your symptoms.  About a quarter of the adult US population has positve blood tests for HSV-2 so you could be positive without it having anything to do with your last sexual encounter or your symptoms.

[jimmy837]

For my own peace of mind, I had a herpeselect test done and the results were negative for both HSV1 and 2, just as you predicted.

However, I'm still bothered by urethra symptoms, mostly itching and occassional pain. Sometimes a slight burning after urination but usually not and sometimes there seems to be a clear discharge in the morning, which could be completely normal, but certainly a feeling of discharge other times during the day but when I check there's nothing. These symptoms come and go and I'm going back to the doctor this week. For reference I obtained my full results from my STD screen in Feb., which was done 11-12 days after I took 500 mg of zithromax perscribed by my doctor, who also gave me urethral swab that was negative for chlamydia and gon (before the antibiotic treatment). Anyway, my screen was neg for STDs but I'm curious about the urinalysis results, which read like this

Urine WBC's   0-5 [R05] /HPF
Urine RBC's    0-3 [R03] /HPF

While I realize this represents the normal range for this lab, but does this mean my white blood cell count is at the high normal? And with urethral discomfort, would this represent something like non chlamydia NGU? Or no?

My doctor also prescribed me a 10-day cipro trial later in feb when I went back for a follow-up still with discomfort. I never took it, though, because I was feeling better a few days later. But now that these symptoms continue months later as well as joint pain still, I'm still anxious.

I know you think I'm driven by anxienty, but these symptoms are real and I'd appreciate your advice. Thanks.

[H. Hunter Handsfield, M.D.]

I believe you are citing the lab's standard for urine WBC and RBC, not your own results.  But even if 0-3 or 0-5 were found, those results indeed are normal.

You have my opinion, that you do not have an STD or an infection of any kind.  Nobody suggested your symptoms are not "real", but that doesn't mean anxiety isn't at least partly responsible.  In any case, I doubt ciproloxacin will make any difference in your symptoms -- and I'll bet your doctor agrees; most likely he prescribed it mostly for benefit of the doubt, not because he believes anything is really wrong.

Please accept the reassurance.  Whatever the cause of your symptoms, it definitely is nothing that can ever harm you or a sex partner.  I suggest you learn to live with them and go on with your life.

That will have to end this thread.