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Could this be a HSV infection?
Hello Doctors,
I recently became sexually active with a new partner who later informed me she tested positive for HSV-2 in March 2013 after a possible date rape (type of test unknown). I previously tested negative for HSV-1/2. She does not recall any outbreaks.
The sexual encounters began on or about October 27 and lasted until I was informed of her HSV status on December 24. We engaged in sex on average 2-3/weekly for the 8 weeks. Condoms were used every time but lambskin condoms were used 3 times. She performed oral many times and never with protection. There were times my penis touched her vagina unprotected during foreplay (and her anus on one occasion).
Dysuria, frequent urge to urinate and soreness in my urethra began sometime in mid-November. Symptoms were moderate, annoying but not severe. First doctor visit was Dec. 5. Urine came back negative for blood, chlamydia, gonorrhea with slightly elevated white blood count. Prescribed doxycycline 100mg 7 days. Dysuria subsided but other symptoms not fully resolved. Abstained from sex for approximately two weeks then started again. I cannot recall if the other symptoms every went away. After being informed of her HSV status on Dec. 24, I went back to GP on December 26 and informed him of her HSV status and my symptoms. Digital rectal exam was performed, nothing abnormal. Given doxycycline for 10 days 100mg with one dose of Suprax 400mg.
The dysuria is resolved but the almost constant urge to urinate and the feeling of never emptying my bladder persists and is affecting my ability to sleep and stay asleep. Back to GP on Jan. 9. Prescribed doxycycline 100mg once daily for 30 days and Vesicare 5mg once daily 30 days.
I don't recall any other symptoms other than a sense of malaise (and a lack of quality sleep).
Do my symptoms indicate a HSV infection? Any thoughts on the persistent bladder symptoms?
I recently became sexually active with a new partner who later informed me she tested positive for HSV-2 in March 2013 after a possible date rape (type of test unknown). I previously tested negative for HSV-1/2. She does not recall any outbreaks.
The sexual encounters began on or about October 27 and lasted until I was informed of her HSV status on December 24. We engaged in sex on average 2-3/weekly for the 8 weeks. Condoms were used every time but lambskin condoms were used 3 times. She performed oral many times and never with protection. There were times my penis touched her vagina unprotected during foreplay (and her anus on one occasion).
Dysuria, frequent urge to urinate and soreness in my urethra began sometime in mid-November. Symptoms were moderate, annoying but not severe. First doctor visit was Dec. 5. Urine came back negative for blood, chlamydia, gonorrhea with slightly elevated white blood count. Prescribed doxycycline 100mg 7 days. Dysuria subsided but other symptoms not fully resolved. Abstained from sex for approximately two weeks then started again. I cannot recall if the other symptoms every went away. After being informed of her HSV status on Dec. 24, I went back to GP on December 26 and informed him of her HSV status and my symptoms. Digital rectal exam was performed, nothing abnormal. Given doxycycline for 10 days 100mg with one dose of Suprax 400mg.
The dysuria is resolved but the almost constant urge to urinate and the feeling of never emptying my bladder persists and is affecting my ability to sleep and stay asleep. Back to GP on Jan. 9. Prescribed doxycycline 100mg once daily for 30 days and Vesicare 5mg once daily 30 days.
I don't recall any other symptoms other than a sense of malaise (and a lack of quality sleep).
Do my symptoms indicate a HSV infection? Any thoughts on the persistent bladder symptoms?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
The bottom line is that almost certainly you do not have genital herpes.
When one person in a relationship has chronic, longstanding HSV-2, the average transmission risk is probably around once for every 1,000 sexual exposures. (In monogamous couples in this situation, after 10 years only about half the partners catch HSV-2.) And that's for unprotected sex; with only several exposures and consistent condom use, your risk was near zero. Although natural membrane condoms in theory might be a little less effective than latex, the difference is small and any barrier is highly effective in STD prevention, including herpes.
Second, your symptoms are not typical for genital herpes. The symptoms themselves (bladder, urethra, etc) are wrong, and so is the duration. Herpes outbreak symptoms never last more than 1-2 weeks, not the several weeks you seem to imply.
It is obvious your urologist suspects prostatitis, which is not an STD. Based on your symptoms, that seems a good bet. However, I would be even more suspicious that you only have genitally focused anxiety and/or the chronic pelvic pain sydrome. I suggest you google that term; there is an excellent Wikipedia article, and I would also direct you to information provided by the Stanford University Dept of Urology (which probably will be near the top of the google hits). As you will see, CPPS and prostatitis overlap with one another. You might speak with your urolgist about it -- and also don't get your hopes up that the doxycycline will help very much. Such antibiotics are often tried in situations like yours, but have no benefit it no infection is present. (Perhaps the Vesicare will help a bit, however.)
Having said all that, as the former partner of a person with HSV-2, it would be reasonable to have a blood test for it. You can expect negative results, which would confirm for sure that your symptoms are not due to herpes.
I hope this has helped. Best wishes-- HHH, MD
The bottom line is that almost certainly you do not have genital herpes.
When one person in a relationship has chronic, longstanding HSV-2, the average transmission risk is probably around once for every 1,000 sexual exposures. (In monogamous couples in this situation, after 10 years only about half the partners catch HSV-2.) And that's for unprotected sex; with only several exposures and consistent condom use, your risk was near zero. Although natural membrane condoms in theory might be a little less effective than latex, the difference is small and any barrier is highly effective in STD prevention, including herpes.
Second, your symptoms are not typical for genital herpes. The symptoms themselves (bladder, urethra, etc) are wrong, and so is the duration. Herpes outbreak symptoms never last more than 1-2 weeks, not the several weeks you seem to imply.
It is obvious your urologist suspects prostatitis, which is not an STD. Based on your symptoms, that seems a good bet. However, I would be even more suspicious that you only have genitally focused anxiety and/or the chronic pelvic pain sydrome. I suggest you google that term; there is an excellent Wikipedia article, and I would also direct you to information provided by the Stanford University Dept of Urology (which probably will be near the top of the google hits). As you will see, CPPS and prostatitis overlap with one another. You might speak with your urolgist about it -- and also don't get your hopes up that the doxycycline will help very much. Such antibiotics are often tried in situations like yours, but have no benefit it no infection is present. (Perhaps the Vesicare will help a bit, however.)
Having said all that, as the former partner of a person with HSV-2, it would be reasonable to have a blood test for it. You can expect negative results, which would confirm for sure that your symptoms are not due to herpes.
I hope this has helped. Best wishes-- HHH, MD
Doctor,
Thank you for answering my somewhat delayed follow-up question.
Your explanations are succinct yet very informative.
Thank you for answering my somewhat delayed follow-up question.
Your explanations are succinct yet very informative.
MEDICAL PROFESSIONAL
Welcome back.
As I said above, your symptoms are typical for CPPS -- which are idential to those that can be caused by prostate problems and overactive bladder. "Reaction to bacteria in your partner's mouth" implies nongonococcal urethritis (NGU), but the main symtpom that is discharge, not urethral discomfort of the sort you describe; and you've already been treated with the best drugs for it. And you can continue to ignore your thoughts about herpes, which never does anything like this.
If your symptoms continue, it's something to take up with your urologist. But many men just learn to live with such symptoms. Once you understand (and truly believe) that it's nothing harmful either for you or any future sex partner, they may fade away. In any case, for sure you have no STD, so I can't help further. Best of luck with it.
As I said above, your symptoms are typical for CPPS -- which are idential to those that can be caused by prostate problems and overactive bladder. "Reaction to bacteria in your partner's mouth" implies nongonococcal urethritis (NGU), but the main symtpom that is discharge, not urethral discomfort of the sort you describe; and you've already been treated with the best drugs for it. And you can continue to ignore your thoughts about herpes, which never does anything like this.
If your symptoms continue, it's something to take up with your urologist. But many men just learn to live with such symptoms. Once you understand (and truly believe) that it's nothing harmful either for you or any future sex partner, they may fade away. In any case, for sure you have no STD, so I can't help further. Best of luck with it.
Dear Doctor,
I am hoping I may follow-up on my question from January. I followed-up with a urologist who conducted a DRL, ordered a bladder ultrasound with voiding test and a cystoscopy. In summary, results of tests were a slightly enlarged prostate and in his opinion, an overactive bladder to be treated with Enablex. He did not seem concerned with my prostate.
Here's my problem. I am still having general urethra discomfort and persistent need to urinate but often without the ability to urinate. This has been going on ever since my initial UTI symptoms in mid-November and it's driving me crazy.
I did suspect HSV but you put that to rest. Could my symptoms be caused by the oral sex I am receiving from the same partner I wrote about in January? I read that some people have reactions to the bacteria found in your partner's mouth. Any other ideas on the diagnosis or what questions I should be asking my general doctor or urologist?
As you can tell, I am frustrated and trying to figure out what could be causing my persistent symptoms and what I can do to help alleviate them.
Thanks again.
I am hoping I may follow-up on my question from January. I followed-up with a urologist who conducted a DRL, ordered a bladder ultrasound with voiding test and a cystoscopy. In summary, results of tests were a slightly enlarged prostate and in his opinion, an overactive bladder to be treated with Enablex. He did not seem concerned with my prostate.
Here's my problem. I am still having general urethra discomfort and persistent need to urinate but often without the ability to urinate. This has been going on ever since my initial UTI symptoms in mid-November and it's driving me crazy.
I did suspect HSV but you put that to rest. Could my symptoms be caused by the oral sex I am receiving from the same partner I wrote about in January? I read that some people have reactions to the bacteria found in your partner's mouth. Any other ideas on the diagnosis or what questions I should be asking my general doctor or urologist?
As you can tell, I am frustrated and trying to figure out what could be causing my persistent symptoms and what I can do to help alleviate them.
Thanks again.
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.
