What now?

[whatnow2]

This question revolves around something thats been going on in my life for the past 5 months. I began dating a girl in July, we got comfortable with eachother and began having unprotected sex. Late august early september I developed Urethritus(which i was given anti biotics for) and notified her to get an STD check. She was checked for a number of STDs and everything was negative. However she recieved her pab smear back with a high risk of cancer due to HPV.

Around the same time as her surgery I was tested for 7 STDs and tested negative for everything.(my only concern was I was on anti biotics and chlamydia and gonorhea were checked via a urine sample) We didn't have sex for awhile after she had her surgery, about 6 weeks after we began having sex again with a condom, then progresed to not using a condom again assuming everything was ok.

I'd like to add during this whole period I slept with one other girl unprotected I told her of my concerns and issues I had with the previous girl I slept with and took her to get tested. Again, negative for everything.

Here I am again with the same symptoms as last time except worse. My symptoms include lower back pain, urethritus, blurred vision, red sensitive penis hard to pull back foreskin(this did not start until my recent anti biotic treatment), Lots of fatigue, dark urine when i wake up, and dark circles under my eyes. My most painful symptom would be the lower back pain, i get shooting pains sometimes and my ribs feel sore. Another point I should make is her cheating on me is definatly out of the question. If we've both tested negative for STDs why would I be getting these symptoms? What should be my next course of action?

[H. Hunter Handsfield, M.D.]

It sounds like you acquired nongonococcal urethritis (NGU) from your partner.  Since you do not say she was treated, I assume she was not given antibiotics.  Even if her standard STD tests were negative, she should have been treated; there are several causes of NGU that do not show up on "standard" STD tests.  You don't say exactly what symptoms of urethritis you are having (most likely discharge, perhaps with some discomfort on urinating?)--but more likely than not, you simply caught the infection from her again because she was not treated.  If you are confident she hasn't had other partners, and you haven't either, this is by far the most likely explanation.

It also sounds like you have balanitis (infection of the head of the penis), perhaps due to a yeast infection that could have been triggered by your antibiotic treatment.  However, you partner's HPV infection has nothing to do with your symptoms.  And all your other symptoms are irrelevant (back pain, blurred vision, fatigue, dark circles, "shooting pains", etc).  They might be related to anxiety over all of this, but they are not caused by your recurrent NGU or any other STD.

Bottom line:  Both you and your partner need treatment with antibiotics active against NGU, such as azithromycin or doxycycline.  And to be really safe, you both should be retested for common STDs (chlamydia, gonorrhea); and a health care provider should examine your penis for possible balanitis.

Good luck--  HHH, MD

PS: A slim possibilty is Reiter's syndrome, a kind of arthritis that sometimes follows NGU and certain other infections.  Reiter's syndrome can cause back pain due to spinal arthritis, recurrent NGU, and perhaps rib soreness.  Reiter's isn't terribly common, so it's less likely than simple reinfection from your partner.  But if the back pain is severe or persists, you might ask your doctor about it.

[HHH,MD]

And I forgot to add that Reiter's syndrome sometimes includes balanitis and other kinds of skin rash.  If your own doctor doesn't know much about it, or if s/he thinks it is a possibility, you might ask about referral to an arthritis or infectious diseases specialist.  But don't jump to this conclusion too fast; if you indeed have recurrent NGU, you still need re-evaluation for common STDs and both you and your partner need antibiotic treatment.

HHH, MD