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Persistent Urethritis/NSU
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Persistent Urethritis/NSU

Dear Dr,
I am a male in my thirties and have had an inflamed urethra for 12 weeks. The only definite symptom is a (sometimes more red and sometimes more blue) inflamed tip of my penis which has been constant for the 12 weeks and I have tested negative for clamydia (chlamydia), gonnerhea, hsv, hpv, hiv, syphilis, and a uti as well as positive for a uti and nsu over the 12 weeks.  The latest test last week showed no uti but showed ten wbc from a penis swab so obviously still inflammation present.  It hurts after masturbating and urinating but is only red and sore and the rest of the time I barely notice it. Over this time I have taken azithromizing one dose, metronidizole one dose, nitrofuaretoin low dose for 5 days, oxytetracycline 7 days and ofloxacin 7 days.

I have now been given (by a UK Dr) three courses to try (and he said there is little treatment left after this): Doxyclycline 100mg twice for 7 days, a longer course of Azithromycin for 5 days and a longer course of Metronidizole for 5 days.  He said I needed to take Metronidizole with one of them but it was up to me which!

1  I also bought fluconazole single dose to take in case it is thrush?

2 Would you suggest I take the Metrondzole with Azithromycin or Doxyclycline?  Is there any evidence on this and is there a synergy between drugs or do they all work in isolation to each other?

3 How much should I space out these treatments?

4 I want to retest, and maybe do online tests for mycoplasma and ureaplasma, but how how do I need to wait after my last does of Oxfloxacin?

Would be extremely grateful for your advice.
936016_tn?1332769204
Good Morning,

You've got yourself into a little bit of a pickle over this. First off I would stop looking at it - your description sounds of a normal urethral meatus - the hole you pee through. It will vary in colour at times so just relax about it.

In terms of all these antibiotics etc I would personally hesitate to take them because you don't actually seem to have a diagnosis of anything particular.

My strong advice would be to leave everything alone - stop staring at your penis and wait a few weeks and then go and see a doctor in a GU clinic and get a comprehensive set of tests done again including as you say mycoplasma, ureaplasma etc. These are most unlikely now given the antibiotics you have taken but its worth running just to put your mind at rest.

I suspect I'm afraid that you've become a little too obsessed with the symptoms and your penis.

very best wishes, Sean
5 Comments
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Avatar_m_tn
Thanks for your advice Dr but I need to clarify...I have been to several gum clinics and my gp and have been diagnosed with nsu three times since my symptoms started on 27 September. It is the first time in my life I have had urethriris. I am in a long term relationship so thought a uti was a more likely cause but tested negative for a uti after an initial positive two weeks ago but still had 10 white blood cells php field on a urethral swab.

With this in mind, please could you answer my questions above?

I am not too worried about long term harm to me or partner but I want to try the remaining antibiotics to try to get rid of my urethriris as my urethral is swollen and I thought the wbc on the swab implies infection? Or could it possibly be thrush that has lasted twelve weeks?

Also am I right that the online sti clinic in London offers reliable tests for mycoplasma and ureaplasma and is one of the best sti clinics in London for testing?

Thank you so much for your help...this is such a great website.

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Avatar_m_tn
I suspect that it is because of the holidays, but in case this has been missed, please could Dr Sean or Dr Jose answer the above questions?

Also an additional question if you don't mind, how many days after taking 5 days of azithromycin 500g would be safe to wait until having sex (assuming it clears the infection)?

Thank you again.
George.
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Avatar_m_tn
Dear doctors.  I would be v grateful for a reply as I do not know what to do next.
My questions 3 and 4 above still apply. That is how long should I wait between antibiotic regimes to avoid side effects or long term effects? I am worried as I have taken antibiotics for 33 of the last 103 days, 9 courses in total as some were together.  A Dr has given me doxy but not sure if he is just trying everything.  Also when are tests reliable after antibiotics?

I still have nsu in that I have 5 wbc in a swab. But the London online Sti clinic said I was clear on all stds including mycoplasma and this was 17 days after taking antibiotics. Should I believe the test?

Should I worry about other possible causes like staph or strep ?

I feel like your answer above did not give me the answers. I would be happy to pay again if you like as I really value your expert opponion on these difficult questions about my health...
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Avatar_m_tn
Do I need to re post and pay again for the above questions to be answered? Thanks.
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