Symptoms diagnosis/feedback

[seville2]

First some history.  Two years ago I had reason to believe I may be infected due to having unprotected sex and 7 days later developed some slight symptoms.  I had a mild, persistent pain in the urethra and had flu like symptoms for a week.  No discharge, external lesions, etc.   A series of tests were performed and Herpes 1 and 2 came back positive.  All other tests were negative and I never took any antibiotics.  However, there was no way to determine if the Herpes was contracted from the last encounter as I had never been tested previously.  

For the last 2 years I have had monogamous, protected sex.  No Herpes symptoms have occured and as far as I know, I have never had any true Herpes symptoms (lesions) even though I did test positive.

Two weeks ago I had protected sex but with a high-risk partner (foreign prostititute).  As far as I am aware the condom integrity was never breached, but due to my extreme intoxication, I could not be 100% certain.  7 days later I developed a mild, persistent pain (not just while urinating) of the urethra.  Mostly concentrated near the tip.  No discharge.  No external lesions.  However, I have now had the pain for more than a week.

Questions:
1.  Could this pain be a mild Herpes outbreak even though it is not accompanied by any other systems?
2.  What is the likliehood that I could have contracted another STD that would only be causing the stated symptoms?
3.  Could this really be pyschosomatic?
4.  Or is there another ailment not related to STD that could be causing it?
5.  Lastly, what are the chances of a false positive Herpes test?  I don't recall the name of the test, but the doctor did indicate it was the more reliable version.

I do not have easy, convenient access to a doctor so would like to get some feedback on risk/concerns before having to make the effort.

Thanks in advance.

[H. Hunter Handsfield, M.D.]

I was referring to your opening comment about possible symptoms 2 years ago, as well as the more recent encounter.

Condom rupture occurs no more often than an average of 1 time in 100.  If you don't remember it breaking, probably it did not.

[seville2]

Thanks.  Only clarification is that the last encounter of concern was 2 weeks ago, not 2 years ago.  And I can't guarantee that the condom remained intact.

But your comments make sense.

[H. Hunter Handsfield, M.D.]

Most likely none of the symptoms either 2 years ago or recently were due to herpes.  Although HSV can cause a range of symptoms, the mild sort of tingling or uncomfortable urination you describe almost certainly are not herpes.  If herpes causes symptoms at all, typical external blisters/sores are by far the most common ones; and when HSV causes urethritis (herpes inside the urine passage), typically it is very painful--even described by some men as the worst pain they ever experienced.

To the specific questions:

1) I doubt your symptoms are due to herpes.

2) Technically urethral discomfort could be due to urethritis, i.e. gonorrhea, chlamydia, or nongonococcal urethritis (NGU).  But usually there would be abnormal discharge.  In any case, you could not have acquired those through an intact condom, and those problems virtually always are self-cured long before 2 years.

3) An online provider cannot diagnose a psychosomatic problem or anything else.  But your symptoms certainly are typical for genitally focused anxiety.  And as I have said many times, whenever a person suspects his or her own symptoms have a psychological origin, usually s/he is right.

4)  I have no other speculation about possible causes.

5) Yes, false positive results are possible with the HSV blood tests, although it depends a bit on exactly what test was done.  The most commonly used modern test (Focus Diagnostics' HerpeSelect test) is especially prone to give false positive results for HSV-2 in people with HSV-1.  So it is possible you don't have HSV-2 at all.  Repeat testing might be a good idea.  This issue has been addressed frequently on this forum.  Enter "herpes diagnosis" or "HerpeSelect" into the search link to find multiple threads about it.

Good luck-- HHH, MD