Burning Glans + other symtoms; herpes?

[Triumph75]

Hello Dr.

Thank you for help.

I recently had a mishap with a prostitute after breaking up in a 10 yr monogamous relationship. The condom broke, I felt when it broke on the first thrust back in. I pulled out & put a new condom on. Two hours later I urinated and afterwards I felt a burning in my shaft. Other symptoms followed quickly in the next two days: burning shaft and glans after urinating, sore testicles, painful joints (knees, elbows, wrists), burning  on thighs, calves, arms, a sore throat and itchy eyes

I saw my GP when I got back 3 days after exposure. He did a throat swab, prostate exam, penile swab, cbc, hiv, rpr. All came back negative. I saw another dr. 6 days after exposure. He did a type specific test for hsv1, hsv2 and hepB, all came back negative. I remember reading somewhere hsv anitbodies take at least 12 days to show up so I was expecting the test to be negative.

He put me on 10 days of doxycyline, this cleared up the sore throat and eyes but did nothing for the other symptoms. I was taking acetominophen and aspirin for the other symptoms. I also noticed small red dots appear where the burning was in my arms and legs. They look like red dots just underneath the skin and do not hurt or pop. Definetely dont look like pimples. I am wondering if this was a reaction to the doxycycline. The antibiotic 10 day treatment ended 4 days ago and I am scheduled for a follow up.

Here is what I am seeing and feeling now- penis still BURNS! & by the tip on the left side there is some dark discoloration now. When I draw more blood to the area by giving it a little squeeze it becomes a more pronounced in a circular shape with a very tiny cluster of small bumps. I have seen no blisters, only two small cuts, One on my thigh and wrist. The thigh cut became surrounded by 4 of the small red dots

Is it bad to take antibiotics during the initial breakout of hsv2 while your body is producing the antibodies for the first time? Does this sound like hsv?

[H. Hunter Handsfield, M.D.]

Starting an initial response, based on the title you chose for your question, before I read the question itself:  Burning or tingling sensation, in the absence of obvious blisters or sores, is not a symptom of herpes.  It can be confusing, because these symptoms are listed on many web sites.  But those sites don't make clear that such symptoms occur only as prodrome, i.e. coming on for 1-2 days before an actual outbreak occurs; and that burning or tingling due to herpes never lasts more than 1-2 days.

Now on to the question itself:  In addition to the comments above, there is a ton of other evidence that herpes doesn't explain your symptoms.  No STD, including herpes, can cause symptoms less than 2-3 days after exposure, and 2 hours is simply impossible.  Such a symptom that soon after sex has to be some sort of physical or chemical irritation (or anxiety), not an infection of any kind.  Further, the other symptoms you describe (red dots, testiclar pain, painful joints and muscles, burning of either the arms or the penis, discoloration of the penis, thigh or wrist "cuts", a cluster of bumps that aren't blisters) are not possibly due to herpes or any other STD.

As to whether some of your symptoms might be due to a reaction to doxycycline, they don't sound typical for that, but I can't say for sure one way or the other.  

Much of what you describe sounds most suspicious for the physical manifestations of anxiety or stress.  None of this even hints at herpes or any other STD, and probably your symptoms have nothing to do with the sexual encounter you describe, except for the possible connection to anxiety and stress.  And no, taking antibiotics would not affect herpes or the tests for it.

Follow up with your personal health care provider if your symptoms continue or you otherwise remain concerned.  No further STD testing is necessary.  In the meantime, don't worry about this; for sure your symptoms don't suggest any sort of serious illness.

Best wishes--  HHH, MD

[Triumph75]

I've seen 3 previous practitioners about this so far and your answer seems to be the most specific and educated. This is good news doc thank you. This was a high risk individual. I failed to mention I gave her unprotected oral sex as well, and I gave another high risk woman unprotected oral sex two days before this incident. It was a mistake and after all this I have a completely new view on things. I didn't think to mention the other girl as the symptoms seem to coincide with the last event, but it came to mind when you mentioned its impossible to feel any std symptom in 2 hours. What can I say, I just got out of a 10 year relationship and I went a little wild.

I am scheduled for a follow up with my GP tomorrow. I'm relieved to hear you say that hsv2 never burns for more than a couple days and the symptoms may be anxiety and stress based. Still have a problem though -- the ‘ol Olympic Torch has been-a-blazin' for 16 straight days now! I am doubting I could make up this symptom if I tried. I'm pretty in tune with my body and although I may be stressed and anxious, the burning in my penis is just not making sense as something my mind is creating. I should mention though, when not drinking any alcohol the burning subsides a little bit.

Let's say for arguments sake it is a different type of virus, a bacterial infection, or a chemical or physical irritation resistant to a 10-day 200mg/day run of doxyxycline. Should I try to let it clear up on its own at this point like the adenovirus you mentioned in another post with the man with almost identical description of the pain in his urethra? Should I try anymore antibiotic or antiviral medicine? From what I’ve read online, all the STD tests I’ve taken were taken too early after the exposure to test positive for anything (3 days). Just trying to make the best choices right now and would like to thank you again. You obviously know your stuff!

[H. Hunter Handsfield, M.D.]

Thanks for the compliment.  But I have nothing more to offer.  Please stop doctor shopping for new opinions; stick with one provider and follow that person's advice.  Accept the fact that some symptoms have no clear explanation, but don't necessarily mean anything harmful is going on.  You might just have to learn to live with your symptoms.