Returning Questions about UTI/NGU/Prostatits/HSV?

[joeaccount]

Hello Dr. Hook/Handsfield

I had a previous post with Dr. Hook regarding my concerns with HSV2 from an infected ex girlfriend.  I have had a negative Western Blot a year after that relationship ended for HSV2 (I am positive for type1 since childhood).  Dr Hook assured me irritation on my glans was very unlikely to be HSV, and my PCR test did indeed come back negative.  However shortly after I had all of the classic, uncomfortable symptoms of an NGU or Prostatitis (constant, significant penile and some anal discharge, some pain starting my stream, not feeling like I've emptied, needing to return to urinate).  I went to an urgent care and had a urinalysis done.  It showed a significant bacterial infection (I believe it was Ecoli).  I have not had any sexual relationships in two years (since my ex), so bacterial STDs were not a factor.
This is where things are a bit murky.  I went to an Urgent Care and a Urologist.  I had a bad experience with the Urologist, who acted like he didn't have time to see me.  They did a full STD screen on my urine including HPV (which I thought wasn't even able to be tested for) but it did NOT include a herpes test of the urine.  So my fears of HSV somehow causing a bacteria infection were not addressed. However, my Urgent Care Doctor did a PCR swab of my penile discharge which was negative for HSV.  A two week course of antibiotics helped very quickly, although I'm not sure if I'm being hyper sensitive or if there is some lingering discomfort sometimes with urinating or sitting long hours.

So my questions are mostly how a 32 year old man could get a non-STD related UTI/NGU/Prostatis? Could herpes be the cause after all?  Everything I read online says these things are STD related in younger men.  

[Edward W Hook, MD]

You are taking advantage of this Forum.  I worked hard to address your concerns over a 17 exchange thread which I had to end and now you are back, asking essentially the same sorts of questions in a question which exceeds the requested length of questions on the Forum.  My responses will be limited and then, as per Forum policy, I will ask you not to post again until after January 2014.  

First your specific questions:
1 and 2.  As I tried so say more gently before, you need to put your fears that this is HSV aside.  You have negative tests for HSV and symptoms whose time course and manifestations are not suggestive of HSV.  

3.  This is not a hygiene problem.  It may be an OCD/anxiety problem, compounded by side effects of your Zoloft which is well known to cause a number of genitourinary symptoms.  If you wish further evaluation, more trips to urgent care are most unlikely to be helpful in dealing with the complexities of your problem.  Further, just because you had an unfulfilling interaction with one urologist does not mean that all urologists cannot help you.  Sometimes it takes a bit of trial and error to find a health care provider who is on the same wavelength as you are.  The fact that there were E. coli in your earlier urine test suggests this is more of a urological problem than an STI problem (i.e. possibly prostatitis).

I hope this helps.  If you continue to fixate of HSV, the chance of resolving these problems is small.  EWH

[joeaccount]

A few more specific questions....


1.  Since my urine was not tested for herpes, all I have to go on is my negative PCR from penile discharge.  How should I feel about this test?  Does testing discharge yield HSV results as readily or in the same effect as urine testing or is one preferable over the other?

2.  Is herpes a potential cause for me?

3.  How does this come about in an otherwise healthy young man, after what I've read online is that this is highly unusual?  I do suffer a bit from depression and take zoloft generic which impacts my ability to be hard and ejaculate.  Sometimes I let my hygiene slip from depression and I had been sweating for many hours in a very hot car trip when this all came about... still seems unlikely