Urethritis, HSV-2 positive partner

[urethritis1234]

I am male and my female partner is confirmed HSV-2 positive, and I am HSV-1 positive. It was a one time encounter and she had an outbreak 3 weeks prior, then had her period, then waited an extra week before we had sex.

A condom was used, but I handled the condom after vaginal penetration with my finger, with the same finger I used for penetration if I remember correctly, so some of the vaginal liquid probably got on the condom.

The next day, approximately 12 hours after the encounter, I woke up with an obvious white, creamy, purulent discharge from my urethra. I went to the clinic later that day and started one week of doxycycline. The discharge improved but it returned a couple days after completing 7 days of doxy. Currently, I am 22 days post-encounter and 8 days into ciprofloxacin 500mg twice a day, with some improvement and no obvious purulent discharge at this moment.

Also, previously to this encounter, I did have oral sex performed on me 3-4 weeks prior from another person.

Could a new HSV2 infection present 12 hours post encounter with a creamy, purulent discharge? I have no obvious sores and it does not hurt during urination.

Since the discharge improved but came back, do you think this is bacterial, or a viral cycle of HSV2?

Gonorrhea and chlamydia were both negative on urine test 1 day post encounter and a urinalysis was performed 17 days post encounter, with HSV1/2 detection. Nothing was detected or grew in culture but my urine was very dilute because I was drinking a lot of water prior to that sample.

I also notice that the lumen of my urethra, when I spread the tip of my penis open, is a little more white compared to the more external part of my urethra. Is that normal?

And is my only option now to wait 12 weeks post encounter and get an IgG, or is there another way I can rule in and/or rule out a new HSV2 infection?

[Terri Warren]

The discharge that you had sounds absolutely nothing like herpes but does sound like an NGU infection of the urethra. And it sounds almost certainly bacterial.
I would suggest that you go to the CDC STI treatment guidelines online, download the printable version, go to page 63 for more on NGU, persistent. I think you need testing for mycoplasma genitalium and trich and you also need a different treatment. Cipro is not the recommended treatment (if you fail that treatment). You could try a course of azithromycin (which could be used as a first line tx for NGU instead if doxy). I would print this all out and take it with you to your doctor’s appointment.
This is not at all suggestive of HSV infection.
If you get a sore, have it swab tested. Otherwise, you’ll have to wait a while for another blood antibody test.

Terri

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