Pain after UTI, Could it be something else?

[john989]

Dr. Pho,

I recently was treated for a bout of what was diagnosed NGU (had clear discharge, etc.) I was treated with 10 days of doxy for the NGU, which did clear up discharge, but not urethral pain.

But now Im starting to wonder about the possibility of HSV.

I noticed a single very small red sore just under the head of my penis on the shaft. It was very small and red irritation and there was almost an odor to it. It was not elevated at all, it was flat. Pain on pressure only. When I first noticed it, it was surrounded by flaky skin.

This was about 3.5 weeks after a possible exposure. I immediately went to my doctor and he examined it and said it doesn't look like herpes or any STD to him, it just looks like irritation. He did prescribe me an antibiotic cream for it (Nystatin/Triamcinolone), and that seemed to get rid of it in probably 48 hours. But to be on the safe side he sent me for a blood test on various STI's, including HSV Antibody Type 2. It came up negative at 4 weeks.

However, even about a week after this I still have urethral discomfort and a burning sensation in my groin area. Mild, but nagging. So my question is can herpes lesions be inside the urethra? And can that be the reason for my discomfort/and or the cause of my discharge? It doesn't hurt to urinate in general, but the urine is mostly always cloudy, and doesn't come out straight when I urinate sometimes. I know after doing a lot of research I read that it is common to have some urethral discomfort even after the antibiotic knocks out the STD/UTI, and I went off the doxy probably a week and a half ago.

Does any of this sound like it could be herpes or initial HSV-2 infection? The sore on my skin my doctor didn't seem to think much of, but there is a possibility the lesions are inside the urethra and causing me the pain/and caused the discharge?

4 weeks is entirely too early to test for any herpes antibodies accurately correct?

Thanks for your time

John

[Kevin Pho, MD]

It may be possible for a herpes lesion to still cause the symptoms.  However, with the negative antibody test, this will be less likely.  You can also culture the urethra and send any specimen off for herpes culture.

Other causes of sores or genital lesions include chancroid or syphillis.  These can be tested for via blood tests or culture respectively.  

Testing for herpes antibodies under the best circumstances is not 100% accurate.  This can be repeated if the diagnosis is still in doubt.

Another consideration would be prostatitis.  A digital rectal exam can be considered.  Sending off any prostatic fluid for culture and analysis should be done.  A transrectal ultrasound can be considered to image the prostate for any abscess.

Another option would be a cystoscopy to evaluate for any anatomical abnormalities (i.e. a stricture or polyp) that can also be causing the symptoms.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[terrified_brian]

0