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confusing symptoms

Mr. HH: About 3 years ago, I began to have trouble urinating and needed to go several times in a span of a few hours with urges more frequent and some pain in the back of scrotum, ejaculation pain.   A week or so later I experienced what I thought was, 2 prodromal symptoms feeling.  I tested for Herpes, Chlamydia, and PSA.  The HSV-2 test came back positive (2.1 combined HSV1/2).  Dr. said I have HSV-2.  The PSA was 3.4. Three months later, I went in the hospital with aseptic meningitis, and rec’d a lot of antibiotics (vancomyecin, etc.).  Blood work showed positive for Coxsackie’s virus. No HSV tests done in the hospital.  After the hospital stay another test showed PSA to be 1.2, and my symptoms of prostatitis were gone.  I decided to get tested for STDs as I was still feeling some discomfort when I ejaculate. I tested Negative for:  HIV, Hepatitis B, Chlamydia, Gonorrhea, and Syphilis. And, surprising to me, the HSV 1/2 tests were also negative and the Doctor said I do not have, and never had Herpes, and no STDs.  The IgG was 0.16 and IgM was 0.35. It was a HSV1/2 combined Ab screen type of test.  My sex drive, and erections were excellent, but since the hospital stay, my sex drive dropped dramatically, and suddenly.  Erections are poor.  There is some pain ejaculating.  And, I have very little preseminal fluid (I used to have too much).  I went for more blood work to check for LowT, and C-reactive protein, and other tests.  All was normal except I have a 260 choleterol which I always have had so this is not new.  C-reactive protein is 0.79, and Testosterone is 580 ng/dl and 18.7 pg/ml free direct. PSA at 1.3 (I am 50).  I have conflicting HSV-2 tests.  Should I go for another? Could the prostatitis have altered the first HSV-2 test? Does a IgG 0.16 and IgM 0.35 indicate I do not have HSV 1 or 2?   Or could I have some sort of chronic prostatitis causing this, yeast infection?  What caused the prodromal feeling?  This all started with a positive HSV-2.
1 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the STD forum.  You have asked questions about some aspects of your symptoms on the STD/HIV/herpes community forums a few times over the past year or so.  The replies there were accurate:  there was nothing in your symptoms or your risk history that suggested any STD.  And that remains true now.

The only STD issue in all your diagnostic tests is the apparently conflicting test results for HSV-2.  The HSV 1/2 combo tests often give false results -- which is exactly why weakly positive results (like yours, with a value of 2.1) are routinely repeated with truly type-specific antibody tests.  Those are the ones that give true results and yours are definitely negative.

Undoubtedly the diagnosis of aseptic meningitis was correct, and coxsackievirus is a potential cause.  But otherwise nothing abnmoral has been found after very extensive testing.  (I have no comment about the results of tests for non-infectious problems, like testosterone, PSA, etc.)  The low (i.e. normal) CRP result is strong evidence against any infection or systemic inflammation of any kind.

No STD is a likely cause of "trouble urinating and needed to go several times in a span of a few hours with urges more frequent and some pain in the back of scrotum, ejaculation pain" and for sure herpes cannot cause such problems.  I don't know what you mean by "prodromal feeling".  Some symptoms could indeed be due to prostatitis -- or, more likely, the chronic pelvic pain syndrome (which used to be considered a form of prostatitis) -- but those problems are not caused by STD and probably not due to any infection at all.  (If you have not done so, you should google CPPS [spell it out] and start your reading with the excellent Wikipedia article and the information you will find from the Stanford University Department of Urology.)

From the information provided here, almost certainly no infection explains any of your symptoms and for sure there is no STD problem here.  Your statement "This all started with a positive HSV-2" is an important clue that suggests the problem may be primarily psychological.  That initial positive result was definitely false, as the subsequent testing showed.  You do not have and never had HSV-2, and therefore it is not a possible cause of anything you are feeling.  

If your symptoms continue or you otherwise remain concerned, continue to work with your doctor(s) about the cause.  But stop looking to herpes or any other STD as a factor here.

Regards--  HHH, MD
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