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Urinary-only HSV symptoms - or prostate/kidney stone issues?

Hi. Late 30s gay male here.

So, some background: I had what I suspect, though am not 100% sure was, a primary outbreak of genital HSV about 7 years ago. If it was an outbreak, it was pretty minor, but a doctor visually diagnosed it. I did a couple follow-up tests that came back negative but they may have been too soon after the OB to be an accurate neg. I chose to not obsess over it and just move on with my life.

Fast-forward more than six years and nothing recurred. Nothing at all, even without the help of an antiviral med.

This past summer (mid-August), I had what seemed like a UTI or STI, though the bacterial STIs were ruled out via testing. Symptoms: Urinary urgency (never feeling "empty") that, after ~5 days, gave way to a couple days of occasional bouts of painful urination. Despite the negative STI test, my doc put me on a course of Bactrim and within a few days the symptoms went mostly away; the only thing I was left dealing with was painful ejaculation. But again, no visible lesions, and I've heard that lesions inside the urethra hurt like *hell*. Nothing I experienced could be considered close to that. I've had non-STI UTIs in the past - I'm a rare male who gets them - so I assumed it was something subclinical or maybe a prostate issue. All told, the ordeal lasted less than 2 weeks.

About 10 weeks after that, so mid-November, I had a minor bout of weird urinary symptoms. Nothing painful, but just that "not empty" feeling and general urgency. I didn't take antibiotics this time and it resolved in a little over a week.

Now I'm ~10 weeks after that, and the symptoms are similar to the November round but even more mild. No painful ejaculation, no burning with urination - just a general weird feeling concentrated more in my bladder/prostate area, not the shaft/urethra. I'm ~5 days after the first symptom: discomfort on urination, at the tip of the urethra just once, then not again. I should note that I have pretty extreme anxiety, so much so that my therapist is wondering if the more mild issues are psychosomatic. Half of me wonders if I started fixating on my genital-area sensations after the first discomfort I noticed and have essentially manufactured this. I know we all have random aches and pains, and when they're in the genital area, we can blow them way out of proportion.

Given the recurrent nature of the issues and the fact that I had a kidney stone about 16 months ago, my doctor is referring me to a urologist for further evaluation. Based on the reading I've done here and elsewhere, I know that HSV certainly can be unpredictable, but what I've read here - largely from Dr. Handsfield - it seems that very minor urinary issues in the absence of visible lesions would seem out of character for HSV. I know you can't say "never, no way" with a virus like this, but it doesn't add up.

I'm wondering if it's possible that this could be something aside from surprise HSV flare-ups. I'm at the age where prostate stuff is a possibility, and I also had a definite kidney stone incident in fall of 2022 that I've always wondered may be a sign of more to come.

Yes, I plan on getting an IGG but I'm just wondering if anyone else who knows more may have some insight here in the interim.

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207091 tn?1337709493
So I don't have a penis, but I do have genital hsv2.

From what I am given to understand, having a urethral genital hsv outbreak is, as you said, PAINFUL - like hell levels of pain.

So do you have genital herpes? I don't know. I know that visual diagnoses of herpes are often wrong, but that doesn't mean yours was. You can get a type specific IgG blood test, but the blood test misses 30% of hsv1 infections, and there's a good chance your infection could be genital hsv1 (if you've received oral sex), and the blood test would miss it. If it came back as a low positive on hsv2, it could be a false positive.

There is a test called a Western Blot that is far more accurate and also far more expensive. It would answer your question if you have herpes, and still not answer your questions on what is causing your symptoms. Your doctor can order it though the University of Washington and your insurance may cover it.

If it comes back positive for hsv1, and not hsv2, you still won't know if you have that orally or genitally, though, or both.

Herpes testing kinda sucks.

I'd suspect, though obviously can't be certain, that something else is causing your issues. Maybe a bladder issue, prostate issue - something along those lines. Definitely see a urologist, and go from there.

Helpful - 1
20620809 tn?1504362969
So, who diagnosed you with hsv2? Do you still see this doctor? What does your current doctor say if you have not been seeing the one who diagnosed you as your caregiver? The only thing I can really say is that yes, you could get sores within the urethra but am not sure from what you describe that is what this sounds like but a complication that can happen--  from my reading so am not saying this is the case---  is inflammation can occur in reproductive organs. Which could possibly be contributing to your symptoms. https://www.mayoclinic.org/diseases-conditions/genital-herpes/symptoms-causes/syc-20356161  Since you mention further testing and recent antibiotic prescriptions for you, it sounds like you do have a doctor to consult. I would circle back and have them dig deeper to rule out either a visually obscured outbreak (although this sounds like it is going on for a long time and doesn't sound quite 'right') and the issue of a possible inflammatory reaction to get a direction of how to treat it. Then after that, I'd look at anxiety and if it is playing a role as psychosomatic issues can arise. But overall, working with your doctor is going to be the best course of action.
Helpful - 1

To answer your questions / provide further context:
- I was visually diagnosed with HSV by an urgent care doc who did not swab the lesion. I followed up with my PCP after visible signs of the issue were gone; he suggested confirmatory testing. I took two blood tests and they came back negative, though I do believe they may have been inside that 12- to 16-week stretch to rule out false negs. I decided to avoid obsessing over it and not test again unless I could swab visible lesions on a recurrence. I haven't seen one to this day.
- I'm sure a visually obscured outbreak is possible, but I have continued inspecting the areas where the first issue was, years ago, and I don't see anything that looks remotely like it. To the best of my knowledge, no visible signs of HSV have recurred.
- I'm not going to rule out HSV because, as noted, I may have acquired it several years ago (I suspect it was HSV-1, given the mild nature of the initial OB, if that's what it was) but after exhaustively reading comments from the experts on here, it just seems "off" for being HSV related. Dysuria, which I've had only on a recurrent basis, appears to be largely associated with primary outbreaks and my symptoms during the two most recent stretches of time where this has been an issue (November: ~9 days, currently: ~5 days in, one day in on Bactrim) have been exceedingly minor (to the extent that I have considered psychosomatic origins).

Not sure if any of that helps...
I found Dr. Handsfield's comments on this thread to be particularly insightful: https://medhelp.org/posts/STDs/Possible-herpes-2/show/1856690

Specifically this:

If you read lists of herpes symptoms, often you will find such things as genital itching, pain (in the urethra or elsewhere), pimple-like bumps on areas other than the genitals, and some of the other things you describe.  However, such lists often do not provide context.  The fact is that the pattern of symptoms you describe simply cannot be herpes.  Here are some reasons:  herpes outbreaks never last more than 1-2 weeks; do not recur more often than once every 4-6 weeks; and between those episodes there are no symptoms at all.  That pattern alone means your more or less continuous or frequently recurrent symptoms aren't herpetic.  Although recurrent herpes skin lesions could start as "red bumps", recurrent herpes is typically limited to a patch less than an inch in size, always in more or less one spot, and always on one side or the other of the body midline; bumps of both thighs cannot be herpes.  Finally, I'll add that herpes does not cause painful ejaculation or intermittent burning on urination.  When herpes does cause urethritis, it is usually accompanied by typical penile skin lesions, and causes much more severe pain than you seem to have.  (Some of my patients have described it as one of the worst pains they ever experienced.)
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