Possibility of Urethral Stricture, Prostatitis, or resistant infection?

[ThoroughlyConcerned]

On May 12th I had unprotected penis to vagina contact, which constituted my first sexual experience with any associated risks, as I am a virgin (24 yo).  The next day I experienced a strange, uncomfortable burning sensation on the tip of my penis, seemingly both on the exterior and in the end of the urethra.  Over the next week I developed the following symptoms.

1. Frequent Urination
2. Slightly weaker than usual stream.
3. Painful ejaculation
4. Rare slight pain in lower abdomen
5. Strange feeling in end of penis (fairly common)
6. Burning sensation on head of penis sometimes after urination
7. Slight burning sensation with urination
8. Sensation that urine is dripping from penis between urinating.

I was in Europe at the time, so it took a while to track down medical care.  On the 24th I saw a doctor and described the preceeding information, he tested my urine and said he found "no bacteria", but said he could prescribe some antibiotics if I wanted them.  So he ended up putting me on a 5-day course of cipro consisting of 250mg 2x a day.  

Lacking confidence in this treatment I flew home on the 26th and went to the ER.  After hearing the symptoms the doctor gave me a couple of antibiotics and said I would be "unequivocally" treated.  I don't know what the antibiotics were, but one was a intra-muscular shot in the arm and the other was a drink which was mixed from powder and water.  I believe the intent was to treat any possible Chlamydia/Gonnorhea infection(s).  I was advised to stop taking the cipro, so I stopped.

My symptoms seemed to improve somewhat, but I still was experiencing the following:
1. Frequent Urination
2. Weaker than usual stream
3. Painful ejaculation
     a. Symptoms 1, 2, 5 worse after ejaculation.
4. Rare slight pain in lower abdomen
5. Strange feeling in end of penis (fairly common)
7. Burning sensation on head of penis sometimes after urination.
8. Slight burning sensation with urination

I went back to the ER on the 31st, described my symptoms, and was given 2g of Flagyl.  Some of my symptoms quickly subsided, but I'm still experiencing the following to this day:

1. Frequent Urination
2. Weaker than usual stream.
3. Painful ejaculation
        a. Symptoms 1, 2, and 6 worse after ejaculation.
4. Rare pain between rectum and scrotum (shooting pain)
5. Rare slight pain in lower abdomen.
6. Strange feeling in end of penis (rare, most often after urination)

On June 6th I followed up with a nurse practitioner at a urologists office.  She decided to give put me on a month-long course of Doxycyline (100mg 2x daily).  If my symptoms have improved since then it hasn't been noticably so.  She told me to follow up six weeks later because I may have a stricture.

Could my current condition be due to residual inflammation from a previous, cured infection?  Could it be Trichomonal Prostatitas or would the Flagyl have taken care of that?  Could I have some sort of resistant infection?

What do you recommend I do?

Thank you.

[kami17]

A related discussion, Prostatitis was started.

[subby33]

I had these symptoms for months and nobody could figure out what it was.  Turns out it was appendicitis.  I had the same symptoms, but all of a sudden I had an attack and went to the ER.  They did a CT for Kidney Stones and it came back positive for appendicitis.

The surgeon said that my appendix was pushing up against my bladder/prostate and causing me to have a weak urine stream and discomfort in that area.

[ithurtsformetoo]

A month later I experienced a strange, uncomfortable burning sensation on the tip of my penis, seemingly both on the exterior and in the end of the urethra. Over the next month I developed the following symptoms similar to yours.

1. Frequent Urination
2. Slightly weaker than usual stream.
3. Painful ejaculation
4. Rare slight pain in lower abdomen
5. Strange feeling in end of penis (fairly common)
6. Burning sensation on head of penis sometimes after urination
7. Slight burning sensation with urination.
8. Painful and swollen prostrate.


I had been on cipro for 3 weeks, got alergic and then was changed to levaquin for 3 weeks. These medicines reduce symptoms but it doesnt seem to help clear things off. Please let me know if anything helped you. I will keep updated if anything helps me.

[ithurtsformetoo]

Hi Thoroughlyconcerned and whenwill,

On first week of May I had unprotected penis to mouth contact with a high risk partner.


A month later I experienced a strange, uncomfortable burning sensation on the tip of my penis, seemingly both on the exterior and in the end of the urethra. Over the next month I developed the following symptoms similar to yours.

1. Frequent Urination
2. Slightly weaker than usual stream.
3. Painful ejaculation
4. Rare slight pain in lower abdomen
5. Strange feeling in end of penis (fairly common)
6. Burning sensation on head of penis sometimes after urination
7. Slight burning sensation with urination.
8. Painful and swollen prostrate.


I had been on cipro for 3 weeks, got alergic and then was changed to levaquin for 3 weeks. These medicines reduce symptoms but it doesnt seem to help clear things off. Please let me know if anything helped you. I will keep updated if anything helps me.

[It sure hurts]

Well Guys,

I have had EXACTLY this for 1 year now. I've been on all the antibiotics and so forth.

I guess I will eventually go to the urologist like I should have, but I've always been positive that it would eventually clear itself.

I do have one last theory on all this, perhaps you guys can comment and see if it applies.

Hypothesis: That we have got some UTI that has affected and weakened the inside wall of the urethra, this includes the part closest to where the foreskin attaches to the head. Having sex etc keeps on tearing etc the inside and the urine etc keeps on creating the burn.

(Your urethra never gets a chance to heal I believe, and all the nerves around the tip are interrelated I think).

[whenwill]

Hi let me share my experience. Iam 28,Doctor work in  Emergency medicine in  the Uk .
  I was going out with my Ex-girl friend a few months and we started having unprotected sex. That is when my problems started and it has been a painful saga since.
        We were in switzerland  December when I first had unprotected sex in the next 3 days i noticed that my glans got inflammed and i developed a fungal type rash.  when I was back in the Uk, I had a proven UTI 2+ leucoyctes and nitrites I had painful micturition.
                 UTI in men is not a good thing.
              I took a 10 day course of ciprofloxacin and made an appointment for the STI clinic.
           My girlfriend and me were  checked for Chlamydia , Gonorrheoa , HIV  all negative  . My Full blood picture and my Urea aand electrolytes, PSA were all within normal range the specialist reffered me on to a Urologist, which in UK even working in the same hospital takes 5 weeks.
                Mean time i was paranoid so i took a 5 day course of Secnidazole (cousin of flagyl 1 dose is supposed to get rid of chlamydia it gives a mettalic taste and you are not supposed to drink alcohol as it has disulfiram like reaction). I took a 5 day course of Fluconazole(Antifungal) as what i had seemed to be candidial rash . I also applied local clotrimazole, still do .
                  My symptoms got better with the antifungal for a few days and we  thought  we had cracked the nut. we were happy and i started having unprotected sex  . I did not have pain during intercourse . After 2 weeks I used to pee every 20 minutes,had  dull aching pain close to my prostate region it felt like i had a tennis ball in my rectum,it was not painful peeing though and all my dipsticks / urine microscopy was negative.I Felt like peeing all the time constant urge.Discomfort SCORE 10/10
             I had an abdominal xray which showed no stones. An ultrasound of Kidneys and prostate all sizes were normal no hydronephrosis. I had a chest X-ray as well.
      The consultant urologist was a polish chap, nice guy! experienced. I told him all the story quickly, His first reaction was it is still an STI as it is acute in onset and he thought could be chlamydia . I told him  about all the courses of anti biotics we took. He wanted to do an Urethroscopy.Rectal examination was normal no enlarged prostate.
       3 days later i lay on the operating table got the urethroscopy under Lignocaine jelly ! bravo ! really brave!!as mostly only old men tolerate urethroscopy under local Anaesthesia. It was very Uncomfortable  he was quick no strictures nothing abnormal in bladder , no ulcers in urethra was a normal scope . AND I WILL NEVER GET ANOTHER SCOPE PUT INTO ME UNDER LOCAL ANAESTHESIA!
                     It has been 4 months since the scope my symptoms have improved discomfort score 4/10 but with a lot of medications.And i have used condoms since then.
1- I took Nystatin 5 day course ( it is hepato-toxic) without the knowledge of anyone.  
2- 28 day course of  Norfloxacin
3-14 days of ofloxacin
4- another 5 day course of secnidazole .


                NOW a lot of it was self treatment that i was not supposed to do but i was not a bad patient followed my GP/ STI specialist and Urologist but nothing helped .

         I have always enjoyed my work but now i find it difficult to give the best as i have to pee atleast once an hour.I have been off sick 2 weeks since december
I have episodes of discomfort EVERYDAY!
I dont have pain when i pee&All my Urine is clear on dipstick which i do almost twice a week.

                 I know iam not supposed to self diagnose but iam afraid what i Have is Prostatitis.I have learned to live with it . I do regular Sitz bath it helps.On examination when i have an erection i notice that my glans is not what it used to be before.

I think it is fungal induced inflammation that has not settled
or it has mounted some kind of immune response  or
I have not been able to clear the pathogen of my Urogenital tract .
I have a day off iam sitting in front of the computer and i have read SO much about STI and Prsotatitis



I have turned to alternative medicine
I take 1 Saw palmetto tablet /1Zinc tablet ( zinc is supposed to improve prostate health but I know that waht i take will not reach the prostate!)
I have made up my mind to stop all antibiotics which i have taken insanely .
         My only hope now is  Flucytosine . My GP is not going to prescribe that for me . But it is supposed to act against resistant candidial infection which i think is what i could have.I think i will get that shipped from somewhere as my GP hardly knows anything about candidial prostatitis.I dont even ask her questions anymore .
I spoke to the Urologist down the corridor the other day he asked me to come to his clinic. he wanted to test for Tuberculosis in my urine!

  NOW DO I THINK IT IS PYSCOLOGICAL I WILL TELL U WHAT I HAVE ALWAYS BEEN A HAPPY PERSON. I HAVE EXECERCISED 3 TIMES A WEEK I CAMP EVER SO OFTEN I CYCLE I HAVE A JOB I LOVE.
I DO NOT THINK IT IS PYSCOLOGICAL.

            i will keep u all posted about my further developments. Please note that all the medications i have taken was to help my discomfort after a proven UTI and possible candidial induced rash/sti
the rash has disappeared but it has left a permanent mark on my
prostate! wheni was out cycling in the park yesterday i realised how i need to deal with this problem. I think it is like angina and i have to learn to live with it But Iam just 28 ! why me ?
                    
      

[H. Hunter Handsfield, M.D.]

Be clear:  I do not think you acquired any infection whatsoever during the sexual encounter you describe.  Therefore, it probably isn't relevant what she was or was not tested for.  But the things you list are typical for routine STD testing, plus trichomonas.

HHH, MD

[jonline]

i've had a similar symptom since feb '06
saw a few doctors, took different antibiotics.
never got a cyctoscope done, though. a bit afraid.
not tested for stds as none of the (4) doctors thought it was necessary.
mostly my symptoms is ittitation of the urethra after urination. nothing else.

[ThoroughlyConcerned]

Thank you for assuaging my fears of a urethral stricture.  I'll try to take it easy, finish the course of antibiotics I'm currently on, and hopefully the symptoms will dissapear.  If they don't then I'll follow up with a urologist.  

Just a few more questions:

Is there any chance it can be prostatitis or cystitis?  I've seen them referred to as sequllae of Trichomoniasis.  

Also, I didn't mention this in my initial post, but the girl I had relations with said she'd been tested a few months prior to our encounter and the tests had all come back negative.  She made no mention of what she was tested for, but I would assume it would include Chlamydia, Gonnorhea, Syphillis, and HIV at the very least.  She also said she experienced no symptoms.  She made no mention of any sexual activity between when she was tested and our encounter, which I assume she would have had she been sexually active.  What could she have been carrying that would possibly be asymptomatic but cause the above decribed symptoms in me?  Could I have contracted it some other way?

[H. Hunter Handsfield, M.D.]

I am skeptical about the likelihood of a urethral stricture; your symptoms don't particularly suggest that diagnosis to me.  You might ask your urology provider how likely s/he thinks it is and whether you really need cystoscopy.  If you have a stricture, it isn't the result of an STD and or any other connection with the sexual exposure you describe.  Althought listed as a potential complication of urethritis, in 30+ years in a busy STD clinics, I haven't seen a single case of STD-related urethral stricture. It was once fairly common following gonorrhea, but only after being untreated for a couple of weeks or more--and many cases resulted not from gonorrhea itself but from irritating chemicals flushed into the urethra as treatment, in the pre-antibiotic era.  And stricture occurs extremely rare, if ever, following NGU.

Everybody with anxiety-related genital symptoms doubts that association, at least initially.  I can only judge the probabilities, not make any particular diagnosis. But anxiety, which truly can greatly magnify normal body sensations that are perceived as significant symptoms, is by far the most common likely explanation in men with stories like yours.  And few people would be sufficiently anxious to cut short a European trip for a second opinion in the circumstances you describe.  Ask your urologist's office about this possibility.  The odds are strong they have seen many such patients.

HHH, MD

[ThoroughlyConcerned]

Thanks for the help W87H, I have read about the cystoscope, or whatever it is called, and it sounds like its not too bad as long as they use a flexible tool rather than the hard/steel one.  As far as I know a retrograde urethrogram can also be used to diagnose strictures.

My other concern is that it is prostatitis, though I don't know how that is tested for.

[W87H]

You may want to request cystoscopy (looking in your penis with a small flexible camera) or an x-ray called a urethro-gram in order to rule out stricture as a possibility.  Both tets sound bad, but are pretty tolerable.

I suffered from recurrent urethral strictures for about 15 years and it can be a tough condition to manage - especially if your weakened stream slows to a dribble etc.

In any event, it is better to know earlier that you have a stricture so the urologist can explain the different treatment options.

In severe cases (like mine), the best and most-reliable long-term solution may be urethroplasty surgery.  I has mine at Duke University several years ago and have been symptom free since then.

In less-severe cases, the doctor may try to dilate (or stretch) the stricture to make it wider and increase your stream.  One possible side-effect of dilation is actually making the stricture worse.

From one patient to another, my advice to you is to request a test that will allow the urologist to visualize the urethra to determine if a stricture is present.

Good luck.

[ThoroughlyConcerned]

Upon my second visit to the ER I was told to follow up with a urologist, and that urologist actually told me to follow up with another urologist in 6 weeks.  Are you saying that I shouldn't?  The urologist (nurse practitioner) suggested a stricture could be the cause, is this not the case?

If you believe I'm psychosomatic I am skeptical of your claims, but I do consider it a possibility and would certainly not like to be dismissive.  Who do I see for that, and what, otherwise, can I do?

[H. Hunter Handsfield, M.D.]

You have seen several providers who didn't come up with anything; in that situation, no online source can come up with new answers.  You have already been overtreated, at your own insistance more than as a result of any diagnosis (and seemingly against your providers' best judgment), for symptoms that really do not suggest any STD and almost certainly are emotional in origin.  You can be 100% confident you have nothing that will ever threaten your health or that of future sex partners.  

My advice is that you just forget your symptoms as best you can and stop seeking a medical explanation.  If you can't stop dwelling on them, ask your providers for referral to a mental health professional to assess the possible emotional component.  I suggest it out of compassion, not criticism.

Good luck--  HHH, MD