Idiopathic URETHRITIS

Dear Doctor,

maybe you can give me some advice because I am loosing hope.
I am not asking to diagnose or to cure my disease. I would
appreciate any, idea what it can be.

I am a gay male. I practice sex. I use a condom for anal intercourse only.
I do not use a condom for anything else. I am sexually active and was sexually active
at the moment of exposure.

I was infected with Herpes I in June 2006. I had a few very short and very mild
outbreaks. I am on acyclovir daily. I seem to be managing the virus well. How
ever there is another infection I acquired with HSV1. I have PERSISTENT ARTHRITIS

It's been there for almost 6 months. I do not have any pain, occasionally I feel a slight
burning in the area. The physical symptom I have is red irritated opening on my penis
where urine comes out. I have no other redness just my pea whole is red. It doesn't
spread and it doesn't go away either. The area is very red with respect to the color
of surrounding tissue. It is not very big just limited to the pee whole. I went to doctor
after my first outbreak was over and got tested second time for gonorrhea, chlamydia, and syphilis.
All tests were negative. My doctor ordered the these test a few times. I completed a course of
Cipro and two courses of Doxy. I also took Cipro for additional 30 days. I used Neosporin, Hydrocortisone 2.5mg,
Ketoconazole, Desononid creams as topical remedies. Nothing helps. I talked to my doctors about other
antibiotics like Zithromax and Bactrim but my doctor told me that the antibiotics that  I had taken are much stronger
than these I just had taken. She told me that if I had Mycoplasma or E.Coli. Although there are no
commercial test available for Mycoplazma or E.Coli such a hard core attack by Doxy and Cipro would have cured it.

I was refereed to an urologist.  The urologist ordered fungal and viral tests on urine. All came negative.
I underwent a cystoscopy which revealed that the redness does not extend into my urethra
and just limited to the very tip of my penis. This means that I do not have Herpes lesions in my urethra
as it was hypothesized before. I also underwent a course of Valtrex.
The doctor calls my case idiopathic and not sure what to do next. The likely step we are going
to take next is biopsy which I will
probably do next.

1. I would appreciate any idea of what it might be.
2. Maybe you can recommend any test or alternative treatments.
3. Maybe there are antibiotics that my doctors are not aware of.
4. I am in a committed relationship right now. My partner is aware of
my disorder. We practice anal sex with a condom and oral sex without.
It's been like this for a few month now. He has HSV-1 but not genital.
5. Should I worried about my partner re-contracting HSV-1 from me?



Thank you in advance for your help.
Paul

[H. Hunter Handsfield, M.D.]

No online source can provide answers when direct evaluation by several provieders and consultants have not been able to solve an atypical health problem.  What I can do, however, is assure you that you obviously have nothing that will ever significantly harm your health or that of a future sex partner.  My guess is that the residual redness doesn't mean anything is wrong, and that you actually do not have continuing inflammatory urethritis.  (Redness alone is not in itself evidence of urethritis.)  You may just have to live with the symptoms--just as some people live with headaches, or joint pain, or other symptoms that are bothersome but not dangerous.  I suggest just forgetting about it and continuing with life.

Best wishes--  HHH, MD

[Paulrain]

Dear doctor, I appreciate your advice. Could you express your opinion regarding a biopsy procedure. Namely, given all the data would you advice against the procedure especially considering the sensitivity of the area. In general does a place of biopsy heal well and scarless?

Sincere thanks,
Paul

[H. Hunter Handsfield, M.D.]

From your description of the problem, it is hard for me to imagine any condition that could be detected that would explain your symptoms or require treatment.  But you need to discuss this with your provider; if s/he recommends a biopsy, there may be factors that I am not considering.  On the other hand, if a biopsy is under consideration because you talked him or her into it--i.e., because of the level of concern you express--then consider lowering the rhetoric.  Make it clear that you don't want a biopsy unless there is a realistic possibility it would show something important.

HHH, MD