I have constant urethral burning and left leg/foot pain/tingling, what should I do?

[David22222]

A month ago I had protected sex, using a condom. Already the same day I felt some burning when urinating. Over the following few days the burning increased and spread. My genital area started itching and tingling and I also started feeling some pain in my left foot. My upper lip was also tingling on the left side. I did a lot of reading about STI:s and found HSV-2 to be the most likely diagnosis...

I didn't have any fever, swollen lymph nodes or blisters, which I thought was weird, but nothing else fit.

Looking back, I remember the girl I was with had to go to the bathroom quite often and suddenly.
We hung out for a few days and there were quite a few times that she had to run to a bathroom.
Stupidly, I didn't think much of it at the time.

Four days after exposure I went to the doctor. I still didn't have any blisters, so he gave me 10 tablets of Valacyclovir as a trial. 2x500mg/day. I also got tested for Chlamydia and UTI. Both came back negative. The symptoms subsided so I got 20 more tablets and continued taking them for 8 more days, 13 days total, until the symptoms completely disappeared.

However, just a few days after stopping, the symptoms came back.

Burning urethra and foot pain. Still no lesions, though.

I started taking 2x500mg Valacyclovir again. This time the symptoms only subsided slightly. I found the recommended dosage for Valtrex. Initial outbreak: 2x1g/day for 10 days. I increased my dosage to match that for about 4 days. Nothing changed, so I went back to 2x500mg again, which I've continued taking until this day. I'm too afraid it will get worse to stop.

I should still be able to build up immunity, even when holding the virus down with Valacyclovir, right?

I know not much time has passed, but I'm afraid of how this will develop. Will it get better?
I think my symptoms fit with HSV-2, but they shouldn't persist the way they do... Leg/foot pain, tingling in genital area, burning around the anus and in urethra... They should have disappeared by now :(

I've read that Herpes Zoster, and apparently in rare cases also HSV-2, can give Post-Herpetic Neuralgia.
For most people it passes, but I haven't found any data for HSV-2, so I don't know what to expect, which is scary.

I've read about others having persistent issues, but I figure it's probably the worst cases and very uncommon...

I've also read up on NGU, but there is so little information on what to expect...
According to the paper "Need for Diagnostic Screening of Herpes Simplex Virus in Patients with Nongonococcal Urethritis", published in June 2000 in "Clinical Infectious Diseases", the etiologic agent was only found in 30% of the cases they studied. I don't like those percentages...
What happens to the other 70%? Will they have to live with it? Will it pass?

I'm waiting for a bacterial culture and mycoplasma genitalium test results.

I'm sorry for rambling and being unstructured.

Can someone please give me and expert opinion? What can I expect?

Thank you.

[auntiejessi]

First, no STD would give you symptoms the same day. The incubation period (time from infection to symptoms) for herpes is 2 days, at minimum. The others vary, but it would be at least 2 days before you saw symptoms for any STD, some much longer.

That said, clearly, you have something going on. A pinched or entrapped nerve, possibly, and maybe you tweaked something during the sex. Perhaps the sex aggravated sciatica you didn't know you had.

Please don't base anything on her urinary frequency. Some women - including myself - urinate frequently. Also, women often urinate immediately after sex to prevent UTIs. It's something we're taught by doctors shortly after we start having sex, or if we get a lot of UTIs. It's not sexy or romantic, but quite often, we bolt out of bed to go pee. It doesn't mean we have an STD.

The act of sex itself, and orgasming, can make us feel like we have to urinate, so that may also be why she goes to the bathroom right after sex.

In NGU, the other 30% respond to antibiotics, and it's cured without knowing the cause. It's called nongonoggocal urethritis, because it's any infection in the urethra that isn't gonorrhea. Sometimes it's called non-specific urethritis, which means there is no specific bacteria found. Often, it's caused by normal mouth bacteria entering the urethra during oral sex. It's very common, and easily cured.

Did they have you pee in a cup? They can find NGU by looking for white blood cells in your urine.

Stop taking the Valtrex. It's not working for you, and it could delay you testing positive on a herpes type specific IgG blood test.

The chances of you getting anything from this encounter are slim, even if she performed oral sex on you. You wore a condom during the vaginal intercourse, which reduces your risk quite a bit. If she has genital herpes, the chances of you getting during condom-protected sex are quite low.

Follow up with your doctor about your symptoms, and start looking outside STDs as the cause. You are limiting yourself, and perhaps prolonging a diagnosis and relief.

[auntiejessi]

Oops - "In NGU, the other 30% respond to antibiotics" - I mean the other 70%.

This is what happens when my brain goes faster than my fingers.

[David22222]

Thank you so much for the in-depth reply!
I've given a number of urine samples. I'm not sure they've tested for white blood cells. They tested for UTI the first time I went, but I'm not sure that's the same thing... and that was only after 4 days, so there might not have been enough time for me to get NGU yet. I'll ask them to test for white blood cells again.

[auntiejessi]

Yes, 4 days might be too soon - it's possible to detect it then, but it's on the early side.

Let us know what happens. :)