Factitious Urethritis

[deeplyconcerned881]

Doctor, I'm sorry for posting again. 9 days ago I went to a Uro complaining of still discharge after urination, burning sensation after ejaculation when I presume ‘prostatic’ fluid is coming out, occasional tingling/stinging sensation in urethra, and LLQ abdominal pain. After telling my story, he did a DRE/prostate massage to get a specimen and told my prostate was boggy.He had difficulty getting a sample and milked my penis and got a drop of fluid.A g/s, c/s, and chlamydia test(urine).All came out (-) except for the g/s or culture(i could not remember which result) which showed pus cells ~10-15hpf. I was also dx with varicocele.He prescribed nitrofurantoin 100mg bid/10days and said I  have factitious urethritis from consistently checking/masturbating. Now he said if sx persist he may think it may be prostatitits if discharge continues.
My questions:
1 Is the drop of whatever fluid he obtained suffice in the g/s or c/s result or it may be skewed? Can I believe the results that the pus cells are not due to a persisting STD?
2. Given the dx, is my UTI transmissible if i have unprotected sex with my partner? Or is the prostatic fluid infectious given if it was bacterial prostatitits considering that some STDs causes it?
4. On risk assessment, prior to dx of GU or NGU and drinking meds, there was an encounter with my gf where she gave me a handjob, the only contact with my fluid I guess is when I came and wiped it with tissue. i do not remember if she washed her hands afterwards but did not touch her privates, i only kissed her breast. Is there a possibility I have infected her?Several weeks postmeds, I fingered her and kissed her privates could i still be infectious?I have oral thrush
5. I was tested 66 days VDRL and 69 days HIV rapid test (-),can I put this behind me?
6. I frequently pee at the PM, can this be prostatitis?
6. Can I conclude based on these results to leave the post STI behind me and move on? Or is this a sequelae(?) of the previous infection?

[Edward W Hook, MD]

Your anxiety is getting the best of you.  Strainght to our questons:

1.  No, this is not persistent NGU.
2.  Are you asking if you could transmit your oral thrush- if so, this would be unusual.  Thrust is very rarely transmittted.
3.  Yoiu need to STOP repeatedly examining yourself.  It owuld probably not hurt to take some time off from masturbation either.
4.  I answered this quesstion before.  Bacterial prostatits is not an STD- your partner is not at risk, even if you have prostatitis, which is not clear.
5.  Yes, you should stop worrying and move on.

EWH

[deeplyconcerned881]

To the good doctor, thank you as it was a big sigh of relief, as this symptoms have been persisting for almost three months and i have been to several doctors only the latest doctor (uro) that i have been to totally hit the spot with the diagnosis of varicocele (as others claimed it was muscle spasm) and i thought it was a lingering std. He took up his residency in London, he is a very knowledgable doctor. Actually the diagnosis of UTI is the reason for my worries particularly the discharge and the urethral stinging and pain which is quite bothersome since i never know when will it subside/or infection persist which causes great anxiety since according to the uro i have taken everything and wonders why i still have sx.
So for the last set of questions/clarifications before i move on with my life.
1. Could this be what I have read in your previous posts of persisting NGU?
2. I had oral thrush and it worries me if i was the one who have infected her? Is that a possibility?
3. So decreasing masturbation and overtly looking at my urethra may decrease this stinging and other sx? So would you recommend anything that would less aggravate the urethritis? If it persist do you suggest I return to the Uro again? Or do you think it would increase the likelihood of prostatitis?
4. Sometimes it just bothers me that after ejaculation, 20 minutes or so i still see discharge after urination and occasional stinging/itchiness or when i wake up from a night that i ejaculated there is discharge before i pee. It really bothers me, and i really could not tell what is normal discharge form the other.I want to believe i am cured but symptoms persist.That is why upon talking with the Uro, if it persist he said it could be a sign of prostatitis since he claimed i had a 'boggy' prostate and where could the fluid be coming from when all tests are (-).This is what really worries me. So I can rest assured if indeed it was bacterial prostatitis, the secretions is not infective and not cause any harm to my gf? I am just scared it might be trich or something that wasnt caught by the meds.
5. Presently, there is stinginess and sometimes i feel that a discharge is coming out in the urethra, can i just not worry about it not being std anymore and assume it was just irritated? I just want to move on.
I will believe them and remove any doubts at all that these persisting symptoms are unrelated to the episode almost 3 months ago. It was a hell of a 3 months. Thank you for your time

[Edward W Hook, MD]

Welcome back to the Forum. In preparing to answer your question I reviewed your earlier interaction with Dr. Handsfield and agree with all that he has said to you.  The idea that you could have a persisting STD following all of the treatment you have received (or took yourself) is most unlikely.  On the other hand, increased genital awareness and self examination is famous for causing irritation and mimicking  persistent STD - this is, I suspect what he was referring to as factitious urethritis.

The evaluation your urologist performed was precisely what I had done, as were the tests that performed were right on target as well. he sounds like a good doctor.  

Let's work through your specific questions:

1 Is the drop of whatever fluid he obtained suffice in the g/s or c/s result or it may be skewed? Can I believe the results that the pus cells are not due to a persisting STD?

Yes, this is good specimen for evaluation.  The fact that there was not more fluid suggests that there is not a lot of inflammation either - with more inflammation, there tends to be more easily expressed fluid (this is a good thing).  

2. Given the dx, is my UTI transmissible if i have unprotected sex with my partner? Or is the prostatic fluid infectious given if it was bacterial prostatitits considering that some STDs causes it?

There is no reason for you to worry about unprotected sex with your partner.  Bacterial prostatitis, if that is what you have, is not an STD.  Are you sure he felt you had that?  

4. On risk assessment, prior to dx of GU or NGU and drinking meds, there was an encounter with my gf where she gave me a handjob, the only contact with my fluid I guess is when I came and wiped it with tissue. i do not remember if she washed her hands afterwards but did not touch her privates, i only kissed her breast. Is there a possibility I have infected her?Several weeks postmeds, I fingered her and kissed her privates could i still be infectious?I have oral thrush

No STDs are not transmitted by masturbation, even when there are genital secretions on a partner's fingers.  Similarly there is no risk from having kissed her genitals.  Your thrush was because of the antibiotics you have taken- no surprise there.

5. I was tested 66 days VDRL and 69 days HIV rapid test (-),can I put this behind me?

Yes, as Dr. Handsfield has already told you, these results are definitive- believe them.  

6. I frequently pee at the PM, can this be prostatitis?

Urinary frequency MAY be a sign of prostatitis but it is also a sign of anxiety.  

6. Can I conclude based on these results to leave the post STI behind me and move on? Or is this a sequelae(?) of the previous infection?

Yes, you can and should forget about the possibility of a lingering STD.  It is time for you to move forward, not to get trapped in this cycle of self-doubt and anxiety.  

I hope you find these answers helpful. Your urologist sounds like he is doing a quality job.  Believe him.  EWH