Burning during urination

[NiceGuyNick]

I received unprotected oral sex from a woman on March 2nd 2007.  A few weeks later, I noticed a burning while urinating.  I became concerned and went to a local STD clinic.  They did the swab test, and took blood, and a urine sample.  I tested negative for chlamydia, gonorrhea, syphilis, and HIV.  I have no abnormal lesions or sores.  The burning still did not go away, so I went to a doctor.  He tested my urine for a bladder infection and that came back negative as well.  He told me I have urethritis and I should just wait it out.  So I waited for a few weeks, and called him telling him it did not go away, he prescribed me cipro for 10 days.  That did nothing.  I went to a urologist on 4/23 and he did a prostate exam and said my prostate was inflamed, and then did a test where they inserted some sort of scope into my urethra and looked into my bladder, and filled it with water.  He said that he did see some inflammation in the urethra and everything else looked normal.  So he prescribed me Doxycycline 100mg 2 times a day for 2 weeks.  I got done with that and nothing happened.  So I called him, and he prescribed me Phenazopyridine 200mg 3 times a day for 10 days.  This did nothing except turn my urine orange.  After reading through numerous posts on here, it looks like I have some sort of urethritis, maybe NGU?.  I am not sure what I have but I do not have any discharge and it only hurts when I pee right at the tip.  When for instance I pee in the morning, it does not really hurt, or say if I have been drinking alot of water and have to pee really bad, it does not hurt when I go.  But regular intervals during the day, it burns.  My urologist wants me to come back in, but he is booked up until June, and I really want to heal so I can go on with life.  I have no idea what I have .  Is there any way I could have one of the viruses listed above still even while taking that Doxycycline?  I read that Zithromax is a good alternative if Doxy does not work?  What would you prescribe to me due to my symptoms if I was a patient in your office?  I have no problem going back to the urologist to get well, but this burning is really concerning me.  What other options do I have to get rid of whatever I contracted?  Please help, I can't remember what it's like to pee and not have it hurt.    

P.S. Not sure if it's my nerves or what but my testicles are sore for a minute then it goes away.  Not sure if it's related to my problem, but this only started happening within the past week.      

[H. Hunter Handsfield, M.D.]

Whatever is going on, it isn't an STD.  I cannot comment on the diagnosis of prostatitis, but that condition is not sexually acquired.  From the negative tests you have had and the lack of response to antibiotic therapy, you can be 100% certain you don't have any infection that will ever harm you, and nothing that can be passed to or harm a sex partner.  Your prostatitis may indeed be responsible, but most cases of prostate inflammation like this do not improve on antibiotics and probably are not due to infection at all.

If you were my patient, my advice--assuming I confirmed the previous evaluation by your urologist and the various test results and treatment--would be to follow up with your urologist, as he suggested.  But if his further evaluation comes up with no more specific information, you might just have to learn to live with your symptoms, knowing they mean nothing physically important.  Somewhere along the line, I might also suggest a mental health evaluation--not because I think you are wacko or because I necessarily believe your symptoms have a psychological origin, but to help decide whether or not emotion is affecting your perception of their severity.  (I'm not a believer in pschology creating symptoms out of the blue, but there is no doubt that such factors can powerfully affect how the symptom feels and its severity.)

Not all genital pain, tingling, or other such symptoms means an infection.  Psychology often is partly responsible, but this really isn't known well.  But it is clear that no harm ever comes from cases like yours.  All humans get various aches and pains from time to time, and some people have them all the time:  an aching back, unexplained headaches, abdominal discomfort, tingling down a leg, etc, etc.  Most people just learn to live with such problems, and most are perfectly capable of doing so, once they become convinced the symptom doesn't mean anything dangerous.  Why should the genitals be exempt?  Our genitals have a special place in our psyches, but the principle is the same.

This is a common problem in men; you can see several other questions essentially identical to yours.  Use the search link to look for 'STD symptoms' and 'STD anxiety'.

Bottom line:  Whatever is going on definitely isn't an STD, and that is the limit of my expertise, so I won't be able to offer more comment or advice aside from this response.

Good luck-- HHH, MD

[NiceGuyNick]

After writing this, the pain in my left testicle went to both and I was in serious pain.  Went to the urologist and he did a prostate exam, and the left side of my prostate was inflammed, and the right was fine.  He said it is common in men my age...29.  Said that I need to sit in a hot tub for 15 minutes a day to get heat in that area, take 600 mg of ibuprofen 3 times a day for the inflammation and 500mg of Levaquin for 10 days and the option to refill if needed.  Said that would cause burning during urination.  So hopefully this works.  Never even heard of prostaitis until now.