Aa
Herpes/NSU/Chlamydia?
Dear Dr
I would be very grateful if you could help me...
I’m a 26yo male from the UK. I’ve had unprotected sex with 4 girls in my life (protected with a few others). I slept with one of those girls 9 months ago. I’ve been going out with my current partner for 7 months, and we’ve had unprotected sex for the last 5 months. I tested –ve for Chlamydia, Gonorreah and HIV 6 months ago, before sleeping with my current partner.
About 4/5 days ago I developed a slight feeling on the tip of my penis whilst urinating, which returned every time I went to the toilet. Around 48 hours ago I got some eczema on my penis and scratched it until parts were bleeding. Then, shortly after about 10 sizeable bumps came up on my shaft.. there is a little bit of moisture/crust on parts of them. I went to the GUM clinic today a few hrs ago - they took swabs and urine samples, said I had NSU and gave me pills of Chlamydia and Herpes incase it is one of those. The results take a week... a few questions have come into my mind since I left the hospital...
1. Is herpes likely given the 9 month timeline since my previous partner and the description above (presuming my current gf is clean..)?
2. I’ve read that NSU can cause infertility in men but is often asymptomatic. If I had is a number of years ago but got no symptoms, could it have affected my fertility?
3. I think I read in one of your other answers that Chlamydia is the main cause of NSU linked fertility problems. Although I’ve been tested fairly regularly, there is chance I could have gone a few (maybe 3 or 4) years with it, if it was asymptomatic (I’ve been treated a couple of times without being tested, which may have got rid of an old infection I didn’t know about). Can Chlamydia cause infertility in men over a few years, without showing any symptoms?
Many thanks,
Ed
I would be very grateful if you could help me...
I’m a 26yo male from the UK. I’ve had unprotected sex with 4 girls in my life (protected with a few others). I slept with one of those girls 9 months ago. I’ve been going out with my current partner for 7 months, and we’ve had unprotected sex for the last 5 months. I tested –ve for Chlamydia, Gonorreah and HIV 6 months ago, before sleeping with my current partner.
About 4/5 days ago I developed a slight feeling on the tip of my penis whilst urinating, which returned every time I went to the toilet. Around 48 hours ago I got some eczema on my penis and scratched it until parts were bleeding. Then, shortly after about 10 sizeable bumps came up on my shaft.. there is a little bit of moisture/crust on parts of them. I went to the GUM clinic today a few hrs ago - they took swabs and urine samples, said I had NSU and gave me pills of Chlamydia and Herpes incase it is one of those. The results take a week... a few questions have come into my mind since I left the hospital...
1. Is herpes likely given the 9 month timeline since my previous partner and the description above (presuming my current gf is clean..)?
2. I’ve read that NSU can cause infertility in men but is often asymptomatic. If I had is a number of years ago but got no symptoms, could it have affected my fertility?
3. I think I read in one of your other answers that Chlamydia is the main cause of NSU linked fertility problems. Although I’ve been tested fairly regularly, there is chance I could have gone a few (maybe 3 or 4) years with it, if it was asymptomatic (I’ve been treated a couple of times without being tested, which may have got rid of an old infection I didn’t know about). Can Chlamydia cause infertility in men over a few years, without showing any symptoms?
Many thanks,
Ed
MEDICAL PROFESSIONAL
Thanks for the clarifications. It sounds highly likely you have initial genital herpes, which I suspect is also the cause of your NGU.
1) With multiple and widespread skin lesions like you describe, if you have herpes it pretty much has to be the initial HSV infection, within 1-2 weeks of catching it. The initial infection can be asymptomatic, so a later outbreak seems to be the initial episode but actually is a recurrence. In that case, the outbreak is like a recurrent one -- a small, limited patch of lesions, not widespread like yours; and without lymph node inflammation in the groin. If this is confirmed as herpes, it is from your current partner.
2) The pamphlet is being very cautious and conservative. Any association of NGU with later infertility is tenuous and unproved. In my opinion, it simply doesn't happen.
3) As you have found, there has been research on chlamydia and impaired fertility in men, not connected to epididymitis. But it's highly preliminary stuff and the link is definitely not proved. And as you point out, antichlamydial treatment seems to return sperm counts to normal -- so there should be no effect once chlamydia has been diagnosed and treated. In any case, as noted above I doubt you have chlamydia; probably herpes is the only problem here.
I'll be interested to hear the results of the lab test results, and the outcome of an HSV blood test in your partner. If HSV-2 or HSV-1 is identified in your genital lesions, I would expect your partner to have a positive blood test for the same type. Oh, and by the way: some clinics and labs identify HSV in genital lesions, but do not take the next step to determine virus type, i.e. HSV-1 or 2. This actually is crucial information; if HSV is identified, you should insist on having them test for virus type. (The frequency of future outbreaks, potential for sexual transmission to future partners, and need for continued anti-herpetic suppressive therapy all are quite different for the two virus types.)
1) With multiple and widespread skin lesions like you describe, if you have herpes it pretty much has to be the initial HSV infection, within 1-2 weeks of catching it. The initial infection can be asymptomatic, so a later outbreak seems to be the initial episode but actually is a recurrence. In that case, the outbreak is like a recurrent one -- a small, limited patch of lesions, not widespread like yours; and without lymph node inflammation in the groin. If this is confirmed as herpes, it is from your current partner.
2) The pamphlet is being very cautious and conservative. Any association of NGU with later infertility is tenuous and unproved. In my opinion, it simply doesn't happen.
3) As you have found, there has been research on chlamydia and impaired fertility in men, not connected to epididymitis. But it's highly preliminary stuff and the link is definitely not proved. And as you point out, antichlamydial treatment seems to return sperm counts to normal -- so there should be no effect once chlamydia has been diagnosed and treated. In any case, as noted above I doubt you have chlamydia; probably herpes is the only problem here.
I'll be interested to hear the results of the lab test results, and the outcome of an HSV blood test in your partner. If HSV-2 or HSV-1 is identified in your genital lesions, I would expect your partner to have a positive blood test for the same type. Oh, and by the way: some clinics and labs identify HSV in genital lesions, but do not take the next step to determine virus type, i.e. HSV-1 or 2. This actually is crucial information; if HSV is identified, you should insist on having them test for virus type. (The frequency of future outbreaks, potential for sexual transmission to future partners, and need for continued anti-herpetic suppressive therapy all are quite different for the two virus types.)
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. However, I'm sure the GUM clinic is just as knowledgeable about these issues as I am; and since they have examined you, their answers to these questions might be more accurate than mine. I'll give you my thoughts, but I suggest you also discuss your continuing concerns with the GUM clinic -- and if their explanations and recommendations differ from mine, it is best you follow theirs.
That said, it would be helpful if you could describe the penile rash more carefully. Did any of the bumps become blisters before they opened into moist sores? How many are there? Is there pain or swelling in your groin? Also say more about the GUM clinic's diagnosis and advice. Did they seem quite confident about herpes as the cause of this problem? Did they take swabs from the sores to test for HSV? Exactly what medicines did they prescribe, and in what doses?
Based on what I know so far, my guess is that you indeed have a new case of genital herpes and that the virus infected your urethra (penile opening), causing urethritis. To your specific questions:
1) If you have herpes, it probably is the initial infection, not a recurrent one. (Recurrent herpes rarely causes urethritis/NSU). Thus, you probably were infected by your current partner, not the one from 9 months earlier. Many people carry genital or oral HSV without symptoms, and transmission often occurs months or years into a relationship. If the GUM clinic is confident you have new herpes, your current partner needs to have a blood test to check whether she is infected and with which virus type.
2) I am aware of no data linking NSU to infertility. It probably doesn't happen; I suspect you found an unreliable website. When chlamydia causes NSU, infertility can result -- but only if it causes epididymitis, a severe testicular infection, which you definitely would have noticed. I see no reason for you to be at all concerned about infertility in your present situation.
3) Is true that chlamydia is the most common cause, but it still is responsible for only about one third of all cases. If the penile skin problem indeed is herpes, it is much more likely that herpes, and not chlamydia, is the cause of your NSU. And no, chlamydia does not cause infertility unless it also causes epididymitis, as noted above.
I'll be happy to comment furhter if you can fill in some of the missing information. In the meantime, take the treatments prescribed by the GUM clinic, and return to the clinic for follow-up if things aren't a lot better within 2-3 days.
Regards-- HHH, MD
That said, it would be helpful if you could describe the penile rash more carefully. Did any of the bumps become blisters before they opened into moist sores? How many are there? Is there pain or swelling in your groin? Also say more about the GUM clinic's diagnosis and advice. Did they seem quite confident about herpes as the cause of this problem? Did they take swabs from the sores to test for HSV? Exactly what medicines did they prescribe, and in what doses?
Based on what I know so far, my guess is that you indeed have a new case of genital herpes and that the virus infected your urethra (penile opening), causing urethritis. To your specific questions:
1) If you have herpes, it probably is the initial infection, not a recurrent one. (Recurrent herpes rarely causes urethritis/NSU). Thus, you probably were infected by your current partner, not the one from 9 months earlier. Many people carry genital or oral HSV without symptoms, and transmission often occurs months or years into a relationship. If the GUM clinic is confident you have new herpes, your current partner needs to have a blood test to check whether she is infected and with which virus type.
2) I am aware of no data linking NSU to infertility. It probably doesn't happen; I suspect you found an unreliable website. When chlamydia causes NSU, infertility can result -- but only if it causes epididymitis, a severe testicular infection, which you definitely would have noticed. I see no reason for you to be at all concerned about infertility in your present situation.
3) Is true that chlamydia is the most common cause, but it still is responsible for only about one third of all cases. If the penile skin problem indeed is herpes, it is much more likely that herpes, and not chlamydia, is the cause of your NSU. And no, chlamydia does not cause infertility unless it also causes epididymitis, as noted above.
I'll be happy to comment furhter if you can fill in some of the missing information. In the meantime, take the treatments prescribed by the GUM clinic, and return to the clinic for follow-up if things aren't a lot better within 2-3 days.
Regards-- HHH, MD
MEDICAL PROFESSIONAL
Nobody wants genital herpes, but if it has to happen, HSV-1 is the preferred type. Recurrent genital HSV-1 outbreaks are usually infrequent, sexual transmission to future partners is uncommon, and suppressive anti-herpes treatment therefore usually is not necessary. Here are three other threads that go into detail on genital HSV-1 compared with HSV-2:
http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931
http://www.medhelp.org/posts/STDs/HSV-1--devastated/show/1159077
http://www.medhelp.org/posts/STDs/Asymptomatic-Shedding-hsv-1/show/1274603
The GUM doctor is correct: people infected with either HSV-1 or 2 are highly resistant -- probably etirely immune -- to new infections with the same virus type. And they are especially resistant to the specific strain with which they are already infected. Therefore, couples do not "ping pong" their HSV infections back and forth.
Inconclusive gonorrhea tests are not common, but when they occur, generally the true result is negative.
http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931
http://www.medhelp.org/posts/STDs/HSV-1--devastated/show/1159077
http://www.medhelp.org/posts/STDs/Asymptomatic-Shedding-hsv-1/show/1274603
The GUM doctor is correct: people infected with either HSV-1 or 2 are highly resistant -- probably etirely immune -- to new infections with the same virus type. And they are especially resistant to the specific strain with which they are already infected. Therefore, couples do not "ping pong" their HSV infections back and forth.
Inconclusive gonorrhea tests are not common, but when they occur, generally the true result is negative.
Dr HHH,
My results came back positive for HSV-1. Given how severe the outbreak was they agree that it must have come from my current partner, via oral sex. She has had cold sores in the past.
The Dr told me we can carry on (having sex etc.) as normal now, and I don't need to worry about re-infecting her in any way. Would you agree with that / is there anything important you would add..?
Btw the gonorhhea test (urine) came back inconclusive so it's being repeated. Does that happen very often?
Thanks,
Ed
Dr HHH,
Thanks very much for the further explanations, which all make perfect sense. I'll ensure my partner gets the blood test if I do have herpes, and will keep you posted on the end result...
Regards,
Ed
Dr HHH,
Thanks very much for your swift and comprehensive answer. Here are a few more details -
There were about 10 quite large bumps on my shaft and a number of smaller ones around them, with a few on the scrotum. I guess you could have described the larger ones as blisters… some had a bit of a white or clear top like a spot might do, which looked like puss or some kind of discharge. They weeped a bit but didn’t become particularly moist. Neither they, nor my groin hurt. The nurse took a swab from the sores and suggested that if it were herpes, and given the number I had, I should be in some pain. She checked my ‘glands’ which weren’t swollen at the time. However, I think I might have got to the clinic before all the symptoms became evident. In the hours after I left the clinic and before the pills kicked in, the sores became a bit more uncomfortable and the glands became very swollen – visually and to touch.
The nurse also took a swab of the urethra and did a urine test. They gave me 4x 250mg Azithromycin to be taken together (for possible chlamydia?) and 25x 200mg Aciclovir to be taken over 5 days for possible herpes. The nurse didn’t really indicate what she thought it was at the time.
After taking the first 3 Aciclovir pills the sores have noticeably improved. They have formed a dark, dry scab and have reduced in size. So I guess they are working… which presumably means it is herpes...?
Regarding the other questions -
1) Do you think it’s probably my current partner because you’re more likely to get your first outbreak between 0-5 months after infection (i.e. since I’ve been with her), rather than 9 months or longer since initial infection (ie. from a previous partner)? I was under the impression that, sometimes, the first outbreak can take months or even years to happen after initial infection. I note your point about her needing a blood test if I do have it, thank you.
2) The query about NSU and fertility comes from a pamphlet they gave me at the clinic. It stated “having NSU will not affect the fertility of most men. If you have had NSU you will not normally be offered a fertility test unless you partner is having difficulty getting pregnant… you should not assume you are infertile”. Written by a sexual health charity – the FPA. I think it’s so vague as to be misleading… thanks for clarifying the facts!
3) Totally understand the link between chlamydia and epididymitis. I never follow the advice of unreliable websites but when I did a quick Google of the issue before asking you these questions, a number of broadsheet newspapers had articles from the last few years, such as www.timesonline.co.uk/tol/life_and_style/health/article2658732.ece mentioning studies that show a potential 3x increase in sperm damage for men carrying chlamydia. They also mention that antibiotic treatment can restore normality. Do you think these studies have any credibility? If so, and even if I did have asymptomatic chlamydia for a few years in the past, if I am now tested as being clear of the infection, can I be confident my sperm will now be normal (all other things being equal)?
Many thanks,
Ed
Thanks very much for your swift and comprehensive answer. Here are a few more details -
There were about 10 quite large bumps on my shaft and a number of smaller ones around them, with a few on the scrotum. I guess you could have described the larger ones as blisters… some had a bit of a white or clear top like a spot might do, which looked like puss or some kind of discharge. They weeped a bit but didn’t become particularly moist. Neither they, nor my groin hurt. The nurse took a swab from the sores and suggested that if it were herpes, and given the number I had, I should be in some pain. She checked my ‘glands’ which weren’t swollen at the time. However, I think I might have got to the clinic before all the symptoms became evident. In the hours after I left the clinic and before the pills kicked in, the sores became a bit more uncomfortable and the glands became very swollen – visually and to touch.
The nurse also took a swab of the urethra and did a urine test. They gave me 4x 250mg Azithromycin to be taken together (for possible chlamydia?) and 25x 200mg Aciclovir to be taken over 5 days for possible herpes. The nurse didn’t really indicate what she thought it was at the time.
After taking the first 3 Aciclovir pills the sores have noticeably improved. They have formed a dark, dry scab and have reduced in size. So I guess they are working… which presumably means it is herpes...?
Regarding the other questions -
1) Do you think it’s probably my current partner because you’re more likely to get your first outbreak between 0-5 months after infection (i.e. since I’ve been with her), rather than 9 months or longer since initial infection (ie. from a previous partner)? I was under the impression that, sometimes, the first outbreak can take months or even years to happen after initial infection. I note your point about her needing a blood test if I do have it, thank you.
2) The query about NSU and fertility comes from a pamphlet they gave me at the clinic. It stated “having NSU will not affect the fertility of most men. If you have had NSU you will not normally be offered a fertility test unless you partner is having difficulty getting pregnant… you should not assume you are infertile”. Written by a sexual health charity – the FPA. I think it’s so vague as to be misleading… thanks for clarifying the facts!
3) Totally understand the link between chlamydia and epididymitis. I never follow the advice of unreliable websites but when I did a quick Google of the issue before asking you these questions, a number of broadsheet newspapers had articles from the last few years, such as www.timesonline.co.uk/tol/life_and_style/health/article2658732.ece mentioning studies that show a potential 3x increase in sperm damage for men carrying chlamydia. They also mention that antibiotic treatment can restore normality. Do you think these studies have any credibility? If so, and even if I did have asymptomatic chlamydia for a few years in the past, if I am now tested as being clear of the infection, can I be confident my sperm will now be normal (all other things being equal)?
Many thanks,
Ed
MEDICAL PROFESSIONAL
This symptom also is strongly suggestive of herpes -- not of chlamydia or other STDs.
Ps. just to add... I also have swollen glands (? I'm not sure what they are..!) above my crotch area both right and left sides of my penis, which have a dull pain to touch...
Thanks,
Thanks,
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
