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urethra pain from unprotected oral sex- my doc's diagnosis?

Dr.,  I had sex worker in china perform oral w/ ejac. w/o a condom. No other sexual contact.2-3 days after the event I felt mild discomfort near the tip of the penis on the front side). This slight burning sensation also was felt down the urethra down to about midway on the penis. This sensation just seemed to be there all the time &  did not increase very much during urination if at all. Around the same time, maybe day 3-4, I also felt like I came down w/ a mild bug. I had light, runny nose, mild fever, & discomfort at the base of each ear, occasional diarrhea, & some fatigue. I have no other visual symptoms, lesions, sores, rash, no discharge, & the pain in the urethra area does not seem to increase much if at all during urination/ejaculation, but it is aggravated if I lightly squeeze or feel the urethra area.

On day 8, I saw my doctor.  Still had the lt/medium burning discomfort, but the other symptoms except for the occasional diarrhea resolving. The doctor did a swap for gonorrhea, Chlamydia &  blood sample for hsv1/2.  He suspected chlamydia at the time &  prescribed 1 gram azithromycin.

Days 9-11 the burning symptoms seemed to be clearing up but still mildly existed. I still had light nasal congestion/runny nose/diarrhea
Day 12 he called w/ test results. Gonorrhea test was negative, but HSV had mixed results. He said HGM test was pos. indicating a possible recent HSV infection, but that HGG test was negative & I would have to retest HGG in 6 weeks. Also lab failed to test for Chlamydia. He felt strongly I had recently acquired herpes & would follow up w/ 6 week blood test.

Day 12 -13, burning sensation in the urethra area that almost was gone returned.  I called my doc & he prescribed valtrex for urethra pain. I also asked about the Chlamydia test & he said they would run a urine test…

Should doc feel so strongly about herpes?  other STDS causing this pain?  Chlamydia even though I took the antibiotic & had some improvement ?
thx 4 help
11 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
It sounds likely that you caught a urethral infection from the oral sex event.  Urethritis is divided into gonococcal (i.e., gonorrhea) and nongonococcal urethritis, or NGU.  You probalby had NGU.  When acquired by oral sex, chlamydia is almost never the cause, because people don't carry chlamydia in the mouth or throat -- so it really doesn't matter that the lab apparently neglected to do that test.  Perhaps most important in your case, several percent of NGU cases from oral sex are due to viruses.  A viral infection would go along with the fact that your symptoms did not promptly clear up with azithromycin, because viruses do no respond to antibiortics.

There are two viruses that commonly cause NGU.  First is adenovirus, which is a common respiratory infection; it usually causes common colds.  The other symptoms go along with that idea, and the gradual improvement over about 10-14 days is very typical for adenoviral NGU.

The second common viral cause of NGU from oral sex is herpes (due only to HSV-1, not HSV-2).  Your doctor is obviously concerned about that possibility.  However, I doubt herpes in your case, because herpetic NGU usually includes typical herpes sores on the penis.  The IgM test doesn't mean much of anything.  In theory, a positive IgM test suggests early infection and can be positive before the standard (IgG) tests turn positive. Unfortunately, it usually doesn't work that way with herpes, and false positive IgM tests are very common.  (For more information, enter "IgM" into the MedHelp search window for many discussions about it in this forum.)   Also, even IgM tests don't usually turn postive so quickly.

It is possible your doc is right about herpes; at this point, it is impossible to know for sure.  However, my bet is against herpes and more in favor of adenovirus.  You'll probalby never know for sure about adenovirus; standard testing doesn't pick it up, and it's too late now to do the special tests that would be required.  But that infection doesn't matter; adenovirus doesn't persist or recur -- once it goes away, it's gone forever.

To be safe about herpes, I recommend you follow your doctor's advice about repeating an HSV-1 antibody (blood) test in a few weeks.  If still negative at 6 weeks, it will be even stronger evidence against herpes.  However, sometimes it takes 3-4 months for the HSV IgG antibody tests to become positive -- so your doctor might suggest yet another test if the 6 week test is negative.

Bottom line:  Probable viral NGU, most likely adenovirus, but herpes due to HSV-1 remains a slight possibility.  Follow-up blood tests for HSV-1 will sort it out.  

Final comment:  Some of this information might be new to your doctor.  But it sounds like he is a good physician who will not be turned off if you tactfully help him learn these things.  Consider printing out this reply for him.  If he is interested in more information about adenovirus and urethritis, he can look up a research paper from a couple years ago by Bradshaw and colleagues, in the Journal of Infectious Diseases.  (I wrote an editorial about it in the same issue of the journal.)  And for more information about IgM testing for HSV, he could look for papers written by Dr. Rhoda Morrow (and also by Rhoda Ashley -- her earlier publications are in her maiden name).

I hope this helps.  Best wishes--  HHH, MD
Avatar universal
Dr H, thx for the info. i never even heard about the adenovirus thing as a possibility for NGU.. Since i still have a few of the "cold" symptoms(runny nose, ear pressure, a little fatigue) along w/ the urethra pain, hopefully they will all disappear together...soon.

one more question, if it is HSV1, how long should a NGU from that last?? ( i am at about 12 days of ngu symptoms)

thanks again and keeping my fingers crossed

Shizzle
239123 tn?1267647614
MEDICAL PROFESSIONAL
Like adenovirus, HSV-1 also would be getting better on pretty much the same time frame as you are experiencing.

You can relax those fingers.  Most likely this won't turn out to be herpes.
Avatar universal
Dr H, Counting the days until i can knock out a 6 week test for more info, just want your thoughts if any on my symptoms as they have progressed.

by day 18 the uthrea pain subsided after some more flareups..hope it stays gone...loose stools clearing up , slowly

day 20 sore throat, increased nasal congestion and lt 99.1 fever?????, just as other symptoms clearing up??

hope this means nothing , but wanted your thoughts


thanks
shizz
239123 tn?1267647614
MEDICAL PROFESSIONAL
Sounds like your urethritis is getting better and that you caught a new cold.

You may not keep coming back here for questions that ought to be directed to your personal provider.  I will have no further comments.
Avatar universal
Dr. HHH...

would appreciate your intrepretation/help of my latest test results at 5.5 weeks...I am even more confused with these results after discussing them with the PA after the return of my bloodwork today.. The PA says i am positive because i just passed the threshold on the combo HGG test  (1.1).., but could not explain the 2 negative virus specific HGG tests..

IGM 1.52 (pos)

IGG hsv1 < .92  (neg)
IGG hsv2 < .92  (neg)

IGG combo(both hsv1 and hsv2)  1.1  (pos)    ( is this a different test?)

I have had no further symptoms than as discussed above in my earlier post. Any guidance or help would be very appreciated

thanks again for your time

shizz


239123 tn?1267647614
MEDICAL PROFESSIONAL
In theory, the weakly positive IgM result, and the weakly positive combined test result, could be due to a new infection with either HSV-1 or HSV-2.  However, IgM testing is extremely unreliable, as I said in my initial reply.  Therefore, I strongly emphasize "in theory".  You should review these results as negative, i.e. showing no evidence of prior or current HSV infection with either HSV-1 or HSV-2.

Even many sophisticated STD and infectious diseases specialists do not understand these details about interpreting HSV test results, so you shouldn't be critical of your PA for not being up to speed on this.  But the bottom line is that ONLY the type-specific IgG results count for anything, not the IgM or combo result.  In other words, at this point you can be around 90% certain that HSV did not explain your urethritis.  If the type-specific IgG results remain negative when you are tested once again at least 3 months after onset of symptoms, that will nail it down for sure.
Avatar universal
Dr. HHH...

Thanks for the info.. hopefully my doc will be in tomorrow and i can discuss the results w/ him, as well as go over your responses. btw in your opinion should i just wait for 3 month type specific IGG to be sure or should i consider a western blot

thanks again !!

shizz
239123 tn?1267647614
MEDICAL PROFESSIONAL
Just have a standard, commercial test at the 3 month mark.  WB is not recommended to confirm or resolve negative routine test results, only when the type-specific IgG test gives equivocal results.
Avatar universal
A related discussion, chlamydia antibodies was started.
Avatar universal
A related discussion, Cure was started.

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