What do I have??

[advicemonger]

Hi Dr,

I have had symptoms of NGU for a month now. Please see the timeline of events:

Recvd unprotected oral sex on 7/12 by a CSW.  I did have 2 minor nicks (1-2mm in length) from shaving 24 hours before.  

7/14  -  constant burning sensation in the tip of my penis and also started to feel "wet" but  no discharge.

7/15 - started taking Cipro 500mg twice/day

7/18 – Went to GP, got HIV/Syphillis blood test, Urine sample for Gon/Clmyda/Bacterial Culture which all came back negative.  Also I received TDAP vaccine that day as well.  I stopped taking Cipro.

7/21 –Returned to my GP for the followup.  All tests were negative but got a shot of 250mg Ceftriaxone and 1g of azithromycin.  

7/22 – L back pain which subsided the next day.

7/25 –got an ache in my right testicle. Felt as if someone was constantly pulling down on my testis.  Felt shooting pains from my testicle area up to my lower abdomen.  Took pain killers and started taking Cipro.

7/26 – Went to GP and submitted another urine test which was negative for gon/chlmyda/bacteria and also no elevated WBC on UA.

7/28 – GP performed DRE. Was OK tho I had burning feeling when prostate was pushed. Got 2nd 250mg Ceftriaxone and 10 days of Doxy 100mg.

8/5 –Testicle pain came back.  Had shooting pains in my perineum area.  I started taking Cipro along with doxy.

8/8 – Took Flagyl 2g to eliminate trich possib.

8/12 – GP followup that showed all my test have been negative.

Currently, I am still taking cipro. Due to the length of the symptoms, can this all be caused by a virus infection which I may spread to future partners?  Only visual symptom is a slightly swollen/darker meatus that is not painful to touch.  I noticed that Cipro seemed to be the most effective drug and that seemed odd because cipro is not the recommended treatment against NGU infections.  Should I take a herpes blood test and if so how long should I wait?  Or could this be some other kind of infection or virus?

[H. Hunter Handsfield, M.D.]

Herpes is not a plausible explanation for continuing symptoms like yours.  If you test positive, it will mean you have an asymptomatic HSV infection plus another cause -- whatever it might be -- for your symptoms.  But if you insist, just make sure you have a type-specific HSV antibody test.  If you're in the US and your doctor or clinic uses either of the two main national laboratories (Quest, Labcorp) then accurate testing will be done.  They use HerpeSelect (by Focus labs) and the Captia HSV test (by Trinity Biotech), respectively.

[advicemonger]

Thanks for the reply doc.  If i do decide to do a full test a few months down the road, what is the recommended test for herpes (I've read there are a few different tests)?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

I do not believe you ever had NGU.  The main symptom of NGU is urethral discharge, generally with little or no pain on urination.  And if indeed NGU explained some of your early symptoms, you have been more than adequately treated for all known causes of NGU.  Many people with symptoms like yours are primarily suffering from the chronic pelvic pain syndrome, which overlaps with chronic noninfectious prostatitis; or genitally focused anxiety.  I doubt you have anything that will ever harm you or any current or future sex partners.  I really wouldn't worry about it; I believe your symptoms will gradually fade with time.  I recommend against any further diagnostic testing or treatment.

Regards--  HHH, MD