Herpes or someother STD?

[Ole_fool]

I contacted Chlamydia during a trip to Dubai back in January of this year; I was treated and think I was cured.  I am married and confessed my sin to my wife and she was treated as well.  There were no further medical issues.  I had my annual physical in July and my Doctor informed me that I had contacted Herpes at some point in my life, but not sure when.  I do recall when I had Chlamydia symptoms back in January that my penis was very red with minor blisters.  It also took a while for the drainage to stop.  It went away and I did not have a recurrence until yesterday.  The tip of my penis is very red at the opening and I do have some small amounts of puss coming out, but no blisters or soreness.  I read a lot on line about Herpes and have not seen that listed as a symptom?  So I’m really confused, I did not have sex with anyone other than my wife since the episode in Dubai and my wife was treated as well for Chlamydia.  Other current symptoms are muscle pain in back, stomach upset and sore throat (Flu like symptoms).  Is this Herpes or another STD?

[H. Hunter Handsfield, M.D.]

Well, it sounds like you don't have herpes; it is true that a positive IgM blood test is generally meaningless.  Also, absence of visible herpes blisters/sores is good evidence your pain wasn't from herpes.  Finally, if you had herpes, you can be sure the symptoms would have cleared up dramatically within 2-3 days of taking Valtrex

I also doubt you have any other STD, especially in view of the negative tests for gonorrhea and chlamydia.  All I can suggest at this time is to follow your doctor's advice about possible other diagnostic tests or treatments.  If your own doc doesn't seem to be on top of things, you could ask for referral to an infectious diseases specialist.  Beyond that, I'm afraid this forum can't help further.

[Ole_fool]

I followed your advice and went to an Urgent Health provider in the area last Saturday, 11/1.   There was no visible drainage at the time, but based off of me telling her I had Herpes she assumed I have a recurrence and prescribed 1000 mg of Valtrix twice daily for 2 days and told me to see my Family Doctor on Monday.  I followed the prescription and also went to see my Family Doctor.  He said that he agreed that it was probably a Herpes recurrence since I tested positive in July, but there was no drainage or pain on urination, only a tingling at the tip of penis and slightly red urethras.  He took urine samples and blood test for STD’s.  He also prescribed Valtrix but only 500 mg twice a day for five days then 500 mg once a day as suppression.  On Friday, 11/7 the Doctor’s office called (Nurse) and said that my urine test for Chlamydia and gonorrhea are negative and also my blood test for Herpes indicated that there was no Herpes detected.  I said how can that be, the Doctor told me in July that I had herpes.  I asked her what type of test was taken and she stated it was imG.  I read on your forum that test is worthless; I’m not sure what is wrong.  I also have no idea what test he used last July during my physical.  The tingling in my urethra was almost gone, but it started back up last night again and there was also a small amount of drainage today. Still, no pain when urinating, but It feels like it’s coming back already.  I am going back to my Doctor tomorrow again and will ask for a consultation to a professional that can figure this out, but not sure what to ask or what test he will do next.  Any suggestions?

Thank you,

[Ole_fool]

Thank you.  I'll try to do that now, thank you again for the fast response and guidance.  

[H. Hunter Handsfield, M.D.]

This gets a bit too complex, given your wife's Valtrex for herpes zoster (shingles).  Shingles does not recur and is not a valid use for ongoing anti-herpes therapy; and 500 mg is much too low a dose to treat or prevent shingles anyway.  This smacks of someone who might actually have genital herpes that was confused at one time with shingles.

It might turn out that you should also take ongoing treatment with Valtrex or other antiherpes drug, but definitely don't start doing it on your own.  Wait for a clear diagnosis and the advice of your own doctor.

Getting an accurate diagnosis is sufficiently important that it probably is worth the inconvenience to do it today if possible.  I suggest you phone your doctor's office and see whether the answering service will put you in touch with your doctor or someone who is covering for him or her over the weekend, and explain the circumstances.  If s/he cannot see you personally, s/he might recommend a walk-in clinic or local emergency department.  You could even refer him or her to this thread to make the case.

[Ole_fool]

Thank you for the fast response Doctor.  My initial test for Chlamydia was done with urine sample and came back positive.  I've had all kinds of tests taken back in Feb and then again in July.   After the July physical is when I was told I had herpes, I assume as well that it's GH and I contacted it in Dubai in Jan.  I'll go back and see him on Monday.  I asked my wife if she had any relations with anyone else and she did not.  I believe her as we are married for 25 years.  Based on your response I'm sure it’s Herpes, is there anything that I can take for it?  My wife has Valtrex 500 mg that she takes for shingles.  Not sure I can find a doctor office open today unless its an emergency.  

[H. Hunter Handsfield, M.D.]

I'll try to help sort this out, but some additional information would be helpful.  If you have more information about the test that showed herpes "at some point", please provide it.  Most likely it was a blood test, and probably it was positive for herpes simplex virus type 2 (HSV-2).  Your doctor probably can tell you the numerical results for both HSV-1 and HSV-2.

Also, you don't say the basis for the diagnosis of chlamydia.  Was that just a clinician's judgment or was a test done?  However, these details may not matter much.  If you had chlamydia, and if it was properly treated and you and your wife took your antibiotics as directed, the chlamyia probably is a done deal and no longer a signficant health issue for either of you.

While awaiting information about your HSV test, I'm quite certain you have genital herpes.  The initial infection probably occurred in January; "penis was very red with minor blisters" is an excellent description of an initial genital herpes infection.  About a third of men with initial genital herpes have HSV in the urethra (penile opening) as well as the skin, causing discharge and often painful urination -- just like chlamydia.  (The biggest uncertainty about that initial infection is whether you had only herpes or both herpes and chlamydia.)

I suspect your initial infection was due to HSV-2 and that your current symptoms are due to recurrent herpes.  It is possible that it is a seprate problem altogether, such as a new chlamydial infection, gonorrhea, or nonchlamydial nongonococcal urethritis (NGU).  However, the previous history plus the "very red" appearance of your urethral opening suggest herpes.

Please see a health care provider immediately, preferably today even though it is a weekend.  Examination by an experienced clinician might be able to tell immediately whether recurrent herpes is likely.  More important, a test for HSV could be collected from the inflamed area, but such tests are accurate only in the first 2-3 days after onset.  And if the clinician doesn't suspect herpes, you will need prompt treatment for gonorrhea, chlamydia, and/or NGU.

In addition, your wife needs to be examined and have a blood test for HSV.  That will tell whether or not she is already infected with HSV-2.  If not, you and she then can take precautions to avoid transmitting genital herpes to her.  It would be a good idea for the two of you to see a provider together so she also can be examined and have the HSV blood test.  In the meantime, you need to definitely avoid sex with her for the next couple of weeks, until your current urethral infection is diagnosed and has cleared up.

I hope this helps.  I look forward to helping further if you can provide the missing information about your previous test results.

Best wishes--  HHH, MD