Persistent burning for 2 weeks

Very regrettably, I had unprotected extramarital oral and vaginal sex with the same woman on August 15 and 22. Exactly 2 weeks after the second encounter, I began to experience a burning sensation at the tip of my penis which lasted an entire day. This then transformed into a less discomforting irritated feeling localized on the meatus.

After a few days, I went to the doctor. He saw a tiny lesion on the meatus -- a raised red lump on the left side. He took a swab test, urine sample and gave me 7 days of doxycycline 100mg x 2. I also went to a private clinic for an HSV blood test -- they said it was highly accurate and "would separate out any false positives/negatives". Both doctors said it did not look at all like herpes, but that if so it was most likely not the primary outbreak.

The irritated feeling began to subside, but then I drank a beer and urinated. Immediately afterward the burning sensation on the tip of my penis (in the general area) returned, quite intensely. It faded in a few hours, but I have felt it on and off since. When I feel the need to urinate, this feeling seems to displace the burning -- almost pleasant in comparison.  The burning is real and not just in my head. Subsequent drinking of alcohol has not worsened it. For the past three days I have also noticed a bright red rash on one part of the inside of my foreskin (I am uncircumcised). There is no discharge, itching or other symptoms. I have spoken to the woman and she is experiencing no symptoms.

Yesterday, my tests for chlamydia, gonohrrea, HIV and the herpes swab test all came back negative. The HSV blood test may not come for another 1-2 weeks. As for the urine, my doctor said "there was nothing growing in it. Your urine is sterile". He suggested I see a dermatologist.

(1) Do you have any idea what I might have?; (2) Do you think it is safe to resume unprotected sex with my wife, or am I possibly contagious?

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help. There are several possibilities of which an STD is among the most unlikely.  Of the possible STDs which you might have gotten from this encounter, NGU (non-gonococcal urethritis) is the most likely and as I said above, I doubt this is your problem.  I say this for a number of reasons including:
1.  Your doctors saw no problem
2. Your chlamydia test was negative, as was your urine test.
3. Discomfort at the urethral meatus is not a typical symptom of urethritis.
4. Recommended therapy for NGU is doxycycline, you are still symptomatic after recommended therapy.  

I find myself wondering if this might be a fungal/yeast infection.  Certainly such infection can cause inflammation at the tip of the penis and the red rash you have noted could be a fungal infection (FYI, fungal infections get worse after taking antibiotics so the fact that your rash became noticeable after the doxycycline is suggestive as well.  

As I said above, this is unlikely to be an STD.  Seeing a dermatologist is a reasonable suggestion, particularly with your recent rash.  In the meantime I see no reason to abstain from unprotected sex with your wife.  

I hope these comments are helpful. EWH

[concernedidiot]

Dear Dr. Hook -- I just wanted to thank you for your excellent advice. Armed with your information, I went to another doctor, who easily diagnosed my condition as balanitis. She prescribed a corticosteroid and anti-fungal cream. After only two days of using the creams, my symptoms have almost disappeared. I feel much, much better. You were spot on -- thank you.

[Edward W Hook, MD]

Great, glad I could help.  EWH