how long till

[JohnDoe345]

Hi  Doc,

I had unprotected oral sex with a gal I didn’t really know.  Anyways about 4 days later I started getting some redness at the tip of my penis and it was a little uncomfortable to urinate, about a 2 on a scale of 1-10.  So, I went and saw my doctor.  Told him everything and he prescribed me Doxycycline.  So, now it has been a few days and the pain level has increased to about a 6 or 7 and it is not very fun going to the bathroom.

So my questions are
1 - How long before the pain goes away? Does it usually get worse before it gets better?
2 - Obviously I don’t want to be going to the bathroom more than I need right now, but should I still be drinking lots of water to flush my system?  Or is it ok to be a camel for now and just get by?
3 - Can I take asprin or tylenol to cut the pain?
4 - Can I transmit this via kissing? Since I received it orally.  Does it roam through out ones body and can be transmitted via the month even if the area that is effected is the penis?


Thx

[H. Hunter Handsfield, M.D.]

Sounds like you have pretty severe dysuria (the medical term for painful urination).  You don't mention any pus or other abnormal discharge from the penis, so I assume you don't have it.  Severe dysuria without discharge suggests herpes.  This idea is supported by the worsening of symptoms while on doxycycline; 90% of the likely bacterial infections would respond to that antibiotic, but there is no effect on viruses (like herpes).  Although herpes usually causes skin lesions, some infections in men are limited to the urethra.  If it's herpes, it likely is due to herpes simplex virus type 1 (HSV-1), the usual cause of oral infection.  But there are some bacterial infections resistant to doxycycline, including some strains of gonorrhea.  Nothing you have in your urinary tract will be transmitted to anybody by kissing.  (Oops, one rare exception:  There is a virus called adenovirus, in particular adenovirus type 19.  It can cause simultaneous upper respiratory and urethral infection.  But you don't describe sore throat, eye irritation, or other adenovirus symptoms, so it's a long shot.)

If I am right about herpes, I doubt aspirin or tylenol will help much, but it can't hurt--give it a try.  Yes, more dilute urine might be less painful when you pass it, despite the need to go more frequently.

Return to your health care provider and get reevaluated; take this information with you.  In fact, herpes is likely enough that if I were your doctor, I wouldn't wait for test results; I probably would prescribe an antiherpetic drug (valacyclovir, famciclovir, or acyclovir) while awaiting test results.  Also, a drug called phenazopyridine (trade name Pyridium) is a urinary anesthetic--i.e., it concentrates in the urine and anethsitizes the urethra.  It might be very helpful in providing short-term relief.

Please post a message in a few days and let us know how things shake out.  Good luck--   HHH, MD

[JohnDoe345]

My doc prescribed me levaquin and things have cooled down a lot. Still have some discomfort, but things get better each time i urinate.  

i have been drinking more water.  even though i have to go more, it does lessen the sting.

as for the tylenol.  i need to take it because the levaquin gives me a headache.

thanks for your advise!!!

[JohnDoe345]

My STD Screen came back negative.  So I am perplexed as to my symptoms?  Does the normal STD test screen for HSV-1?  Because i also have the 'pink eye' now that jesse40 is asking about.

[H. Hunter Handsfield, M.D.]

You need to get back to your doctor immediately to get your eye checked out.  Specifically, call your doctor and get an immediate referral to an ophthalmologist.  If you really have conjunctivitis ("pink eye"), it reinforces the possibility of adenovirus infection, which I mentioned as a long shot in my reply to your original message, and herpes.  Here is how I would rank the possibilities at this point.

1) A respiratory virus, acquired either by the oral sex exposure you describe or by kissing the same person.  Of the likely respiratory viruses, adenovirus (especially type 19) can cause simultaneous urethritis and conjunctivitis.  In my mind this is tied with no. 2 as the best bet.  It isn't serious; if this is what you have, it will clear up soon without important consequences.

2) Herpes due to HSV-1.  I gave the reasoning for my suspicion in my initial reply.  To that I would add the fact that you described redness near the opening--which is not normally seen with bacterial infections.  Initial herpes can indeed be transmitted to the eye.  If so, it is potentially serious; serious eye damage--i.e., corneal scarring with permanently impaired vision--can occur if treatment isn't prompt.  Effective treatment is available, but in general only ophthalmologists are likely to be able to quickly make an accurate diagnosis and prescribe the right therapy.

3) Nongonococcal urethritis (NGU) due to oral bacteria.  As I said before, this should have promptly improved with doxycycline.  Also, if you have NGU, then we need to assume an entirely different problem causing conjunctivitis.  That certainly could happen, but it would be purely by coincidence.

As implied above, the herpes possibility is potentially the most serious.  Get the eye checked out immediately.

To answer part of your question, no, routine STD testing would not normally include tests for HSV-1.

Good luck again--  HHH, MD

[JohnDoe345]

I went back to my doctor with this info.  He agreed for the most part on what you had to say and went ahead and put me on Valtrex.  I also saw a ophthalmologist and he did see and herpetic ulcers, but since i wasn't producing lots of conjunctivitis that he was not going to rule out herpes at this point.  He prescribed me Zymar opth sol, just in case it is bacterial.  I also have follow up w/ him next week.

fyi - the painful urination has gone down some more and is localized right at the end of the urethra.

Is there anything else that I can do at this point?  Do you have an estimated time that if this is herpes hsv-1 will last till the pain and the eye are back to normal?  What about future sexual encounters?  Am I now going to be able to transmit this to others either orally or vaginally?

[H. Hunter Handsfield, M.D.]

By now, things should be improved.  If it was HSV-1, you likely will have only a couple of recurrences over the next 1-2 yr, then nothing; or maybe no recurrences at all.  You probably will not have asymptomatic viral shedding.  That's my long-winded wa¥ of saying you probably won't be at risk for transmission to future partners.

HHH, MD