Remaining cautious

[awaitingresults]

Hello.  Although heavily under the influence of alcohol, I believe my only STD exposure risk was recieving protected fellatio .  At 6 days post-exposure, I had a chlam/gono urine test done.  Results: negative.  Around 2 weeks post-exposure, started to experiance slight burning only at the completion of urination.  This period was filled with anxiety, and admittedly, plentiful over-checking and over-thinking of symptoms.  At 28 days, full screening test done.  Results: negative for HIV, syphillis, chlam/gono, and HSV1.  I am aware this was likely a bit too early on the HIV and syphillis fronts, and way too early for herpes.  Although I do not know for sure (until I get a hard copy of the results today), the fact the doctor specified HSV1, makes me believe he ran a type specific IgG test.  Is my thinking correct here? Regarding test types, I strongly believe my chlam/gono tests were both NAAT's, because both of the doctor's administering them mentioned PCR.  At the 28-day testing, the doctor also ordered a culture and microscopic examinination of the mid-stream urine to look for evidence od WBC or bacteria (as I understand it).  This also came back clean.  My main concern here is that I am still experencing the burning sensation after urination or ejaculation.  I am now at 7.5 weeks post-exposure.   I am wondering what your opinion is on a few things regarding my situation.  First, for both sets of urine analysis (6 and 28 days), the time since my last urination was pretty much exactly 2 hours.  Does this compromise your confidence in my results?  I do not think I have experienced any abnormal discharge to have culutred, and I have monitored this very closely (small amounts of fluid released from the urethra for 10-20 minutes after ejaculation are normal, correct?).  My predominant lines of thought boil down to this: I am a bit of a paranoid individual by nature and I am letting my imagination run very wild here OR I have an undiagnosed case of nonchlamydial NGU.  

[Edward W Hook, MD]

this is not herpes.  Whether or not it is an early fungal infection, I cannot comment.  You need to be examined by a health care provider who can look and see what's going on.  We do not guess on diagnoses over the net.  It is not fair to you or appropriate for us.  EWH

[awaitingresults]

To add to my previous comment, the irritation/rash/tiny,tiny bumps have responded well to an anti-fungal cream.  Just wanted to know if this influences your opinion.

[awaitingresults]

Hello Doctor.  Thank you very much for your previous replies.  I have another question revolving around a recently discovered issue.  Yesterday I noticed some irritation under my foreskin, and what appeared to be 1-3 pin-tip sized blisters.  I cannot conclusively say that they are blisters though, since they are so small.  I will be trying to get into a local clinic tomorrow to get them checked.  Considering the exposure I described above, the testing which I have already done (IgG at 4 weeks), and the time frame for these symptoms to occur (about 10-11 weeks post-exposure), could you fairly confidently rule out herpes (related to that exposure specifically)?  What could be other potential sources of this problem?  Absolutely any thoughts you have on the matter would be greatly appreciated.  You should know that I obsessively checked for lesions for the first 7-8 weeks after the exposure, and can confidently say that I did not see any.

[Edward W Hook, MD]

I feel as though your questions were answered.  You are not at risk.  To give you direct answers to your questions as posed above:

1.  No
2.  I don't understand the question about normal urethral secretions 10-20 minutes after ejaculation
3.  No (once again)

EWH

[awaitingresults]

While I appreciate your rapid response and reassurance Dr., I remain unclear and concerned with a few issues, and want to provide a little more relevant info.  In terms of info, the woman performing fellatio was a stripper, and like I said, I am not 100% positive that this was all that happened or that I was protected the entire time (although I am fairly certain).  Second, I now have confirmation that the chlam/gono test at 28 days post-exposure was a NAAT.  Third, the herpes test was IgG EIA, and all the hardcopy of my results says is: Nonreactive/no evidence of past exposure.  Now to deal with my remaining uncertainties.  You did not directly answer a few of my questions, although I admit they could have been posed more directly at the end of my initial post.  Does the fact I only waited exactly 2 hours from my last urination compromise any of my urinary results (chlam/gono or culture) at 6 or 28 days?  The only reason I directly ask is that I found a post on this forum from a guy who was in a damn near exact situation, with clear urine tests and the same symptoms, who turned out to have nonchlamydial NGU upon testing with a deep urethral swab.  I also inquired if urethral secretions were normal for 10-20 minutes after ejaculation, so I was wondering if you might firmly confirm this.  Finally, considering my symptoms (burning/stinging with urination or ejaculation, no lesions, no discharge), the time frame for my testing thus far (6 and 28 days post exposure) and the lack of certainty regarding my exposure risk, would you recomend further testing?

[Edward W Hook, MD]

You may be awaiting results but I'm not.  I know you did not get an STD from the exposure you describe.  Why?-
1.  First and foremost, you were protected
2.  Second, the chances of getting an STD if you only received fellatio are very, very low
3.  You've been tested twice, the tests (even cultures) are VERY good.

As far as alternative explanations, you've already acknowledged that you're nervous about this. If anything at all is going on, that will increase the risk.  If not, this is something that you should work through with a physician who can examine you  I would recommend a urologist or dermatologist.

hope this helps.  EWH

[awaitingresults]

Continuing above post (due to character limit):

From the posts of others, I have gathered that the lack of blisters thus far and continuous nature of the symptoms (burning/stinging sensation) for roughly 5 weeks, pretty much rules out herpetic urethritis (although I plan to have the blood test again at 3 months).  I am also aware that the NGU is usually associated with abnormal discharge, which I have not seen.  Yet, despite the enormous emotional and mental relief that came with the results from 28-days, the burning/stinging after urination or ejaculation persists.  The only other possibility which I have seen raised in this forum is mechanical or chemical irritation of the urethra.  I am not confident in this diagnosis for a number of reasons.  First, the persistance of the symptoms, in terms of elapsed time, and the fact I only wash the my penis with a very gentle soap (recomended by derm's for senstitve skin).   Please offer any additonal insight.