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Swelling/Stinging at tip of penis
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Swelling/Stinging at tip of penis

After protected vaginal sex (& receiving unprotected oral sex) from a women with questionable background (let's call this "the incident") in 2004, I shortly after (5-10 days) developed a redness, stinging and small swelling around the urethral opening. This has gone down to almost nothing although I can still see a scar/structural abnormality at said point which was not there before the incident (timeframe for it to go from peak redness at about the 14-21 day mark to this small scar/abnormality was ~6 months). This is accompanied by itching at the point of the scar/abnormality and random itches across the glans (glands). Usually the first urine pass of the day will cause stinging at the spot, and so will soap when having a shower. Again, none of these symptoms were present before the incident.

Usual STD tests came back negative, visual inspection (including during the peak of the swelling) by 3  doctors at 3 GUM clinics have said that it isn't an STD. The frustrating thing is, it wasn't there before the incident so it must have been something that I picked up then, no? Neither Clorimitrazole or Hydrocortisone have an effect on it.

This has caused me extraordinary grief the last few years and I've avoided sexual relations in fear that I might be infectious "with something". I don't much care what it is if it's non-infectious since you can barely see it and it doesn't itch that much. I'm just worried about it being infectious. Is there anything I can do to reassure myself that I'm not going to infect the first girl I sleep with an unknown disease? What
Tags: penis, redness
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239123_tn?1267651214
OK, I won't jump to the genitally focused anxiety explanation.  But if you know that might be my response, it means you have read my responses to similar questions to know that no STD ever causes such symptoms.  And I only deal with STD issues.  In other words, I agree 100% with your GUM providers.

From time to time, every human being has unexplained symptoms somewhere in the body:  an ache here, a twinge there, unexplained abdominal pain, a sore joint. Some people have such problems on a repeated or continuing basis.  They should seek a provider's advice, but often there is no explanation.  Nothing bad ever comes of it, and people end up living with those symptoms, secure in the knowledge that they do not indicate a serious health problem.

The same can apply to the genitals.  Not every pain, twinge, tingle, etc means physical disease; or, if physical, that it is harmful. Our genitals have a special place in our psyches, but the principle is the same.  It is reasonable to check out various potentially harmful explanations, but not to continue to do so, and not to repeatedly try various antibiotics or other treatments, once both examination and treatment have made no difference.  You have done that; it is time to move on.

So whatever is going on, you can be certain you don't have anything that will ever harm you or a sex partner.  You're just going to have to learn to live with your symptoms.  Even if the symptoms themselves do not have a psychological origin (although they probably do), your reaction to them is clearly beyond reason, especially the apparent adverse effect on your sex life.  For that you clearly need counseling.  I suggest it out of compassion, not criticism.

Best wishes--  HHH, MD
5 Comments
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Avatar_n_tn
Doc,

Thanks for your answer. It really does help put my mind at ease and I commend yours and this boards service to the public. I agree about the councelling, the last couple of GUM clinics have suggested the same. If these truly are non-infectious symptoms that I have to live with then so be it, they are not life-disturbing (if I can get my head around the non-infectious part!). The only thing that bugs me is that they started shortly (days) after a risky sexual encounter, flared up bigtime within a couple of weeks (with visible swelling that was visible to GUM clinic doctors then) and to this day remains a small scar/stinging. It just boggles me that everyone says that the two incidents aren't linked.

As an aside and different problem, is prostatitis infectious by sex? I developed symptoms of prostatitis (urethral burning post passing urine) in 2003 (way before the above indicent) which have waxed and waned over time. STD/UTI tests came back negative. I recently had a good few months to a year of no pain but the symptoms have started coming back again. In 2003 (way before the experience I posted first about) I went on 6 weeks of cipro followed by 2 weeks of doxy which didn't seem to help much, suggesting non-bacterial chronic prostatitis. I haven't had any EPS analysis done so there potentially could still be a bacterial cause, although the fact that I was symptom free (and didn't respond particularly well to the anitbiotics) for about a year suggests a non-bacterial cause.

Thanks.
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Avatar_n_tn
Almost all prostatitis (at least 90%) is non-bacterial, and prostatitis it not known to be sexually acquired or transmitted.

That your symptoms followed a sexual exposure suggests the two events are related, not coincidental.  It doesn't prove it, but I have seen enough patients and heard enough stories to believe it isn't coincidence.  But that doesn't mean an infection is the cause.  Maybe some sort of physical or immunologic irritation that isn't understood.  Whatever the initial trigger, there is little doubt that emotion can then become part of the problem.  Research in people like you defintely shows high rates of anxiety, depression, and stress.  But there remains a chicken/egg problem:  are such persons symptomatic because of anxiety or anxious because of their symptoms?  Nobody really knows, and it is a mistake when I or my colleagues automatically blame emotion and psychology as the cause of the problem.  But cause or not, emotion clearly is part of the problem, in many if not all such persons.  And counseling can help that part, and can help people live with symptoms.

Equally important, human beings are very good at living comfortably with symptoms as long as they know that the symptoms do not mean something dire.  If you can get yourself to believe that, it truly is half or more of the battle.

HHH, MD  
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Avatar_n_tn
"Maybe some sort of physical or immunologic irritation that isn't understood".

Thankyou. You are the first doc to suggest this, even though I've suggested such a scenario/explanation to the GUM clinics who have basically said "impossible".

On a final note, on my last visit to a GUM clinic only a couple of weeks ago for another round of tests (yes, for the same encounter in 2004, yes, I know, insane), this time around they found a low concentration of white blood cells in my urine culture (15wbc/hpf), but no apparent microorganisms (and they tested for mycoplasma and ureaplasma as well as the rest of the usual tests). They gave my 1g of zithromax and sent me on my way. I'm guessing this is related to my more chronic prostatitis condition or a freak occurance, is there anything I need to follow up on (further tests etc)? What else could cause wbcs in the urine?

I also came back as positive for HSV-1 antibodies (I went the whole hog and got everthing tested). Statistically speaking this is most likely an oral infection that I probably picked up during childhood at school or universtity, especially considering I've never had a classic herpes blister either orally (that I can remember) or genitally, right?
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Avatar_n_tn
You are exhibiting the same behavior on this forum as you are at the GUM clinics.  If you take any 100 perfectly healthy people do daily tests like complete blood counts, liver function tess, or urinalysis for white blood cells, almost every person will have an abnormal result from time to time, without meaning anything.  The human body's physiology isn't regulated so precisely; these things vary.

I haven't a clue why your urine WBC happened to be on the high side at that moment.  But almost certainly it means nothing and the azithromycin did nothing except expose you to a potential risk of side effects.

It is time to stop.  This is my last comment on this thread.
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