Follow Up for constant urethral burning

[seabee23]

Hello Drs,
I posted here back in December of 2008 Here is my posting: http://www.medhelp.org/posts/STDs/Non-Socomial-HSV-2/show/707446  ;
June 2007:  terrible pseudomonas skin infection from wetsuit on legs and groin and buttocks  August 2007:  End of 7 week abstinence.  The first time I ejaculated, a few hours later I had a drop of brownish blood in my underwear no LUTS at all.  Had a full workup, cysto (very painful) basic urine cultures which showed nothing.  December 2007:  blood in underwear. Difficulty urinating terrible urethral burning exacerbated  when sitting.  Jan - May 2007: treated for prostatitis with antibiotics (bactrim).  Tested for HSV by Herpselect (both negative HSV 1 and HSV 2 [HSV-2 level 0.43).   May 2007 Doc puts me under GA and sees "bulbar urethra markedly erythematous with a clear exudate with slight whitish tint to it.  A stricture is noted just distal to external sphincter region, scope would not pass without force".  DVIU and prostate biopsies.  Over next week, I have inflamed lymph nodes on one side of my penis and a dry itchy rash on my penis and groin (I am very susceptible to yeast infections). June 2007  DVIU  fails August 2007 end to end urethroplasty with reconstructive surgeon.  Pain continues.    November - January Sent back to I.D. and HSV-2 is positive twice at 1.15 and 1.4 and equivocal once at 0.96.  5 months after DVIU and 3 months urethroplasty.  Western Blot (negative) and Biokit at STD Clinic (also negative). So my questions as my burning pain and dysuria continues and surgeon is baffled...
1) IS HSV-2 WB and Biokit results to be believed (could I have been seroconverting from some exposure)?  Is it worth retesting?  Herpetic urethrits? 2)  Could bulbar urethritis and the stricture been infective from NGU (pseudomonas? and could that have caused the stricture of vice versa?  3)  Dangerous to sleep with wife?
I am monogomous and have been for my whole life
      

[seabee23]

Dr Hook.
Thanks so much.  This is a very valuable service.  Nice chatting with you again.  My best.

[Edward W Hook, MD]

Thanks for the clarification.  This makes the psuedomonas infection less likely to be realted to your continuuing pain.  that however does not change my assessment thatthere is no evidence of HSV or STD as the casue of your continuuing symptoms.  Sorry I am not more help on this one.  EWH

[seabee23]

Thanks very much Dr Hook for putting me at ease on HSV.  

Let me clarify re the pseudomonas and get one more perspective as I dont think I was 100% clear.  (Further my ID docs and uros have said there is no relation and that this "hot tub folliculitis" occured nearly 3 years ago next month) so this new perspective is very interesting to me.  

1)  I NEVER tested positive in my urine for pseudomonas and my urine was cultured twice after the first case of bleeding (8 weeks post the initial skin infection.)  At this point I had been on 1000mg of Cipro for 10 days.  My ID doc said that psuedomonas would ABSOLUTELY have come through in culture if it was in my urethra  It was only positively cultured from skin blisters.  

2)  The  pain did not start until 7 months post the skin infection but prior to any serious urologic procedures except one single painful in office flexible cysto (which for all I know could have caused the stricture)

3)  The bulbar urethritis the surgeon saw had an whitish exudate and curious if that could have been inflammation due to the stricture?

Thanks so much for one more f.u and I thank you again so much for your time.

I read your comments on gonorreah superbug today on abcnews and it brought this forum back to my mind.  
Cheers

[Edward W Hook, MD]

Welcome back to our Forum. I remember our past interaction.  the testing you had at that time proved that you do not have HSV-2 and that the test result which started all of the concerned was falsely positive.  You have not had other partners.  You do not have herpes. Repeat testing is a waste of time

As for your continuing discomfort, my guess is that this is either a complication of your infection or a complication of the multiple urological procedures which you have had.  it is not due to HSV or, for that matter, any other STD.

In answer to your specific questions:
1.  Your results are conclusive.  You do not have HSV and you do not need any further testing.
2.  The term bulbar urethritis simply describes the fact that you had urethral irritation.  it does not indicate, by any means, that you have an STD.  It could well be describing irritation ralteing to your pseudomonas infection.
3.  The is no reason to worry about sex with your wife.  You do not have something that can be transmitted to her.  Your test, combined with your continued monogamy prove this.  

I hope these comments help. You can stop worrying about STDs and about HSV in particular.  EWH