Hypochondria or herpes?

[Door23]

I’m a 36 gay male who had an unprotected encounter on May 6. Encounter consisted of mutual masturbation, frottage, and some docking (he was uncut). Five days later I had vague pain in my penis. My doctor ordered ua culture and chlamydia and gonorrhea. I was given 1 gram azithromycin, and 500 mg cipro bid. All tests negative. Stopped cipro and saw my doctor the next week. Exam unremarkable. There have never been any visible lesions, itching, burning, or redness. Had a moderately painful urethritis (no pain with urination or ejaculation though). She said to take ibuprofen. I also felt under the weather that week as well. No change with NSAIDs. Only relief was hot bath and some alprazolam.

Next week Went to urgent care, no lesions seen, no fever, no lymphadenopathy. Repeated ua and culture. Ua showed increased rbc and some casts. Was given doxy 100 mg bid and told to finish cipro. Went back to urgent care the following week was given diflucan for three days. Saw urologist on June 11 who said “no lesions, no std’s”. Prostate exam normal. Told me to get an ultrasound and recheck a ua. Throughout the five weeks urethritis waxed and waned. Other symptoms were anorexia, nausea, tingling lips, pu/pd, and dry mouth. I suspect most of those were anxiety.
Saw doctor on June 19 had CBC, ua, culture, tsh, hiv, and hsv 1&2 IgG and IgM tests run. Heard from doctor June 25th everything was “normal”. Waiting to get copy of test results.

Currently I have pu/pd and some dysuria, no pain though. I intermittently feel like there is sand in my urethra, mainly a few hours post ejaculation. Also I get random tingling in the head/tip of penis. Sometimes it’s a couple times during the day, sometimes it lasts for a couple of hours. These symptoms have been persistent since May 10. Starting this week I had two days where I was feeling back to normal, then tingling today. Still no lesions.

Questions:
How risky was my encounter in terms of herpes transmission?
Do these symptoms sound like herpes? I’m mainly concerned because onset of signs was five days post encounter. Hoping these are pyschsomatic signs, but I realize I will need to retest in sept to be certain it’s not Hsv. Doctor gave me script for antivirals wonder if I should try them? Thank you for your help.

[Terri Warren]

I’m not clear about pu/pd?
The contact was average risk of getting herpes. But it doesn’t sound like herpes to me. You need to be looking for lesions. I would NOT take antivirals without a diagnosis if you plan to do any further testing to rule out herpes here. Please look at the IgG results only for herpes, ignore the IgM as it tends to have many false positives.
I’m unclear why you stopped the cipro – there are other things that can cause urethritis beside gonorrhea and chlamydia. The azithro will help with some for sure but herpes not all.

Terri

[Door23]

Hey Terri I just wanted to give some follow up.

Im a single male in the health care field. At the beginning of May I had a sexual encounter with a stranger that only involved oral and mutual touching and docking. Pretty low risk all things considered. Five days later awoke with vague genital pain, burning etc..

Went to Doctor tested for common sti’s treated with doxy and cipro. All tests were negative. Spent the next 6 months in and out of primary care doctors office, three urologists, and Four er visits. Had 4 herpes igg tests all negative in fact all testing was always negative. I suffered from severe urethritis, vague genial pain that felt like static electricity, tingling in my butt cheek, red inflamed urethra. To say the pain was crippling is putting it mildly. I was diagnosed with everything from atypical herpes, to interstitial cystitis, to bladder cancer causing referred pain. At one point I was started on antipsychotics doctors thought it was in my head. After a negative cystoscopy was told I could go to a pain clinic or see a physical therapist.

Physical therapy has saved my life. I just wanted to make you aware of a condition called male pelvic floor dysfunction. It’s common in men 20-50 years old with high stress. Men involuntarily clench their pelvic floor muscles and secondarily pinch nerves, mainly the pudendal nerve which innervates the genitalia. Pain can look like penis pain, testicular, rectal etc… Most of these stories seem to occur after infidelities or sketchy sexual encounters causing stress and increased anxiety.

My physical therapist said some men come to her for treatment after suffering for 3-7 years. They are told its prostate problems, disc problems, or mental. She knew within five minutes of meeting me what was wrong. She massages muscles at the insertion of the pelvis and the lower back. I’m 6 weeks into therapy and probably 90% better. hopefully my story can help someone. You need a male pelvic floor physical therapist.

[Terri Warren]

Thank you so much for sharing this with me. Though I’ve heard of this in the past, vaguely, I don’t think I’ve ever had contact with someone who actually had this diagnosis. Wow, this is a very common thing for me to hear from men who have these kinds of complaints and strongly believe they have herpes though they have negative testing for HSV. From now on, I will ask that men who have this complaint to be evaluated for male pelvic floor dysfunction. How very gracious of you to send me this note and make others aware of this. And I feel like more than a bit of a ditz for now knowing more about this. Ninety percent better? That is so wonderful, I’m happy for you.

Terri

[Enigmatic_one]

Hi Door23,

Thank you for letting me know about pelvic floor dysfunction and the book recommendation. How are you doing these days? Have your symptoms recurred, or have you been able to keep them at bay since going through physical therapy/massage? I’m just curious about your experience in case this is what I end up having and so that I have some idea what I might be looking at in the long run. Thanks man, I hope you are doing well!

[Door23]

Hey Enigmatic

I’m all better. It took 3 months of physical therapy. I do occasionally get flaresxwhen I’m stressed but at least I know what it is. It was the unknown that escalated the anxiety.
Good luck with everything.

[Enigmatic_one]

Door23,

I’m happy to hear your are all better. I cannot wait to say the same about my situation. What a nightmare the last twelve weeks have been. I feel like I’m getting somewhere now. Thanks again!

[Terri Warren]

OK everybody, glad for the good news.

Terri

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