Is this HSV urethritis?

[gari]

I am a male and had sex with a new female partner two weeks ago which included both unprotected oral followed by protected vaginal sex. There was no discomfort/pain during sex. I didn’t see any visible lesions on my partner. Approximately 4 days after that, I started getting slight discomfort inside the glans of the penis and the distal shaft. It feels like a slight soreness and stinging that worsens when I squeeze on the area, or have an erection or masturbate (which I’ve been minimizing). It isn’t associated with any other symptoms nor signs including skin changes, dysuria, fevers, adenopathy. I looked inside the urethral meatus and don’t see any clear ulcers or redness. Three days after the symptoms started, I got an online telemedicine service that prescribed me empirically flagyl x one dose, cefexime x one dose and doxycycline x 7 days. I finished everything including the last dose of doxycycline today.

I also got another online service to prescribe me valcyte 500 mg which i’ve been taken twice daily for the last 2 days.

There still have been no other new signs nor symptoms since this started but I still have what feels like mild soreness and irritation of the distal urethra and sensitivity/discomfort of the urethral meatus with erections and when it rubs against my underwear. This comes and goes throughout the day.

I am not certain if this is an atypical presentation of gHSV1 from the oral sex. I would think HSV2 would be less likely since the head of my penis was covered with a condom the whole time.

Questions

1) What do you think the likelihood that this is a HSV infection?
2) What are your thoughts on continuing valcyte either to complete a 5 day treatment course or continuing 500 mg daily as prophylactic until my final testing is back?
3) If you have gHSV1 urethritis with no lesions, where do you asymptomatically shed from after the acute phase?
4) What do you think about early IgG testing at 4 weeks?

[gari]

I should also add that after masturbation earlier today, I developed discomfort along the perineum that lasts for hours along what feels like the course of the urethra. I still had no actual dysuria or other signs with it.

[gari]

It’s been a week and a half since I asked my question. Your website says it may take 3-4 days. Is this website still active?

[Terri Warren]

1) What do you think the likelihood that this is a HSV infection?
Without external genital lesions, I think HSV being the cause of the pain is highly unlikely

2) What are your thoughts on continuing valcyte either to complete a 5 day treatment course or continuing 500 mg daily as prophylactic until my final testing is back?
I would say no as longer courses of antivirals can cause false negatives on herpes antibody tests.

3) If you have gHSV1 urethritis with no lesions, where do you asymptomatically shed from after the acute phase?
The shaft of the penis and possibly anus.

4) What do you think about early IgG testing at 4 weeks?
I would say it could give you a baseline but would not be useful indetermining whether you are infected or not.
I would recommend a prostate evaluation for you.

Terri

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