Symptom Help?

[Buckwheat1776]

Dr(s), OK here's the deal. I have unprotected, insertive, oral sex with a woman outside of my relationship about two weeks ago. I'm 40yrs old. Really dumb one time thing to do, but it is what it is. Anywho, I got some blood testing done couple days ago. HIV-, Syp-,Chlam-, Gonn-, HSV2-, HSV1 >5.00 IGG.

I have had cold sores and blisters around my mouth since I was a child through adulhood and wouldn't think I could build antibodies that magnitude that quick? Been HIV tested regularly but never for HSV before.

At any rate, my symptoms are a stinging/burning sensation from tip of penis to around 1in inside ureatha.Penis/scrotal area seems to be more sensation than before like heated or something. Pain is constant, dull, burn in uretha about 2 to 3 on a 10 scale and urination doesn't seem to highten sensation. I see no outward sores or blisters (or inward as far as I can exam). I have constant dull ache/pain in bladder area/lower ab associated with this from start.

My doc put me on Cipro and Doxy for about 2 weeks which I've been on for a week with little improvement. I've been studying my delimma and think possible Mycoplasma Gentalium for same symptoms that are only treatable with Avelox or Arithromyacin. Thoughts on any of this?      

[Edward W Hook, MD]

?? We went through this above.  As I said above- "There is a good description of the CPPS in Wikipedia. "  Thier defintion is far better and more inclusive than I could provide.  

Time for this thread to come to an end.  EWH

[Buckwheat1776]

what is CPPS dr?

[Edward W Hook, MD]

My advice would be to continue to work with your doctor.  In some cases prostate infections require prolonged antibiotics.  In other cases, there is a need for the CPPS.   I would not worry about M. genitalium.  EWH

[Buckwheat1776]

Dr. Hook,

Well, still fighting this matter. Urologist put me on Doxy for two weeks and has had me on 1000MG of Cipro daily for a month. Four days ago, (after the meds ended and I got roughly 70% better eventually) some of the symptoms have come back. I have a considerable amount of dull pain in pelvic/lower abdominal area. Urine tests twice over past couple weeks @ his office have been "crystal clear" in his analysis. I have no discharge or outward signs of STD. Maybe this could be bug that Doxy and Cipro wouldn't do much to but surpress like MG? Kinda at wits end with this thing ...  

[Edward W Hook, MD]

Thanks for the follow-up.  Certainly your exam findngs sound like prostatitis.  I hope all goes well form here.  EWH

[Buckwheat1776]

FYI. I explained all the circumstances to my Dr. that I've explained to you and he said much of the same things you said upon examination and discussion on HSV. No visible lesions @ +10 days past, no discharge coupled with prostatitis he thinks that's where my tingeling/burning urethral sensation is comming from. Just never had this before and was kinda weird feeling.

[Buckwheat1776]

Dr. Hook,

Followed your advice and went to see urologist today. He did the ole finger check and almost hit the floor and wanted to cry like little GURLLL! Dr. said acute prostatitis. Still going to get rechecked in a few weeks for all standard STD's and stay on Doxy and Cipro for a month. Thanks for your help Dr. Hook. I think we've found our culprit.

[Edward W Hook, MD]

I think you are spending too much time on the internet an not enough time with health care professionals.  If you have NGU you should have it diagnosed, not just guess what might be going on.  I would suggest you go and get a swab test taken to find out if you have NGU or not.  

You have cold sores due to HSV-1.  Your HSV-1 will not spread to other parts of your body and there is no reason to be worried about HSV-2 from what you describe.  

[Buckwheat1776]

It is possible I've acquired nongonococcal urethritis (NGU) due to my new partner's normal oral bacteria that would/could be foriegn to the uretha? If so, what can be done about it? Some other med to erradicate the bacteria? FYI. I've had NO such problems in my life such as CPPS or Prostate before the sexual event described. I figure cause/effect in some form???    

[Buckwheat1776]

Re: Clhyamida and Gonn test were urine, the rest were blood. I've read several places where folks misdiagnose hsv with Myco ...or another bacterium. What I have seen from other men with Myco (or similar bacterial std) seem to follow a very specific pattern. (1) A few days after unprotected, insertive, oral (only) sex with new partner. (2) Dull burning in uretha with no other, visible, signs of std ...i.e sores or lesions  with urethral sensations not in direct association with urination discomfort (3) Hightened sensations/burning/cooling or penis/genital region due to Myco attack of nerve cells in area.(4) Dull, constant, pelvic, internal pain. Myco seems to VERY difficult to catch in testing outside of DNA testing.    

I read where Dr. HHH stated that "there was a lot unknown about passage of non-viral, STD , bacteria from oral to gential" in these cases.

That said, what is your opinion of this?

Based on your comments and professional opinion ...  "On the other hand, your IgG result of >5.0 for HSV-1 validates that your cold sores are due to HSV-1, virtually ruling out the your genital discomfort could be due to HSV-1.  As for HSV2, the fact that there are no lesions and the distribution of your discomfort is not compatible with genital herpes.   I doubt that herpes is causing your difficulties." Do you think it possible or even likely I have aquired HSV2 or HSV1 genitally via oral without presenting any visible signs of HSV?

With my current symptoms in mind, and the testing that has been done, what would be your professional opinion of a resolution plan ... additional, possible, meds, testing, etc? I have planned follow up in a month of all afoementioned testing blood and urine. Doesn't seem like HUGE issue but bothersome and worrisome. Thanks.    



  

[Edward W Hook, MD]

'Welcome to the Forum.  Your post is a bit hard to follow.  

Did you have blood tests for gonorrhea and chlamydia?  If so, I would think they are unlikely to be reliable in any way.  On the other hand, urine tests are excellent for these organisms and quite reliable.   What sort of test was peformed?

Your HSV test results are too early to detect a recently acquired infection.  On the other hand, your IgG result of >5.0 for HSV-1 validates that your cold sores are due to HSV-1, virtually ruling out the your genital discomfort could be due to HSV-1.  As for HSV2, the fact that there are no lesions and the distribution of your discomfort is not compatible with genital herpes.   I doubt that herpes is causing your difficulties.  

The characteristics of the pain you describe do not suggest a typical presentation of any STD.  On the other hand, they are compatible with the Chronic Pelvic Pain Syndrome (CPPS) which is a poorly described process that is likely to be caused by more than one thing.  There is a good description of the CPPS in Wikipedia. Take a look and see if this fits.

Hope these comments help.  I presume you'll provide some clarification as to what sort of tests you had for gonorrhea and chlamydia although I doubt that these are part of your present problem.

Hope this is some help. EWH