Two months tip pain and urinary frequency

I am a healthy, 34-year old, circumcised male with these symptoms for 60+ days: pain and discomfort in tip of penis, in and around opening and underneath; frequent urge to urinate, and drippy feel after urination; difficulty gaining erections, poor erectile strength and discomfort after ejaculation.  Just inside the opening there are small purple dots, or discolored, irritated skin.  Not aware of any discharge.  Urge to urinate itself feels like it originates in the tip of the penis, not bladder.  Worst time is 5-9 AM when pain can go to a 4.  I live overseas where STDs and HIV are abundant.  Sexually active with 3-4 women in the past few months, using condoms for vaginal sex but unprotected oral.  
First consulted GP and dermatologist.  Blood, urine and physical examination showed nothing.  I convinced one to give me a prescription for doxycycline, which made no difference. On return to US, I visited GUM clinic, where I gave blood again and had a urethral swab taken and a physical exam.  Negative.  Next visited urologist, who put me on Cippro and Flagyl, no effect.  Also did cytoscopy and ultrasound and checked prostate, said everything looked healthy.  Next dermatologist, who had treated me for molluscum, examined and thought the appearance was normal.  
So with real discomfort and after 5 doctors, 4 antibiotics (Zithromax too), creams (clotrimazole, cortisone, plain old Neosporin) and no diagnosis, I turn to you.  Urge to urinate has decreased a bit, but discomfort still there, focused on the tip and opening.  Erectile challenges continue as erection is weak and orgasm small and fast.  Urologist says wait six weeks with no more tests, no more drugs, and no more worrying, and that this should simply go away on its own.  
Much anxiety here.  Does anyone have ideas on what might cause this or how to resolve?  Thanks in advance.

[H. Hunter Handsfield, M.D.]

I hope you don't seriously expect that any online searching or advice, including mine, can come up with answers that have not been made clear after visits to 5 providers, including experts like urologists or GUM professionals.

Your symptoms are not those of any STD, and STDs have all been ruled out by testing and treatment.  The urologist is right.  My guess is you have the male pelvic pain syndrome, which probably is primarily a manifestation of genitally focused anxiety.  For more information, see  http://www.pelvicpainhelp.com/  and http://en.wikipedia.org/wiki/Prostatitis#Category_III:_CP.2FCPPS.2C_pelvic_myoneuropathy

This forum only deals with STD, which clealry is not the problem, so I will have no other advice or comments.

Good luck---  HHH, MD

[edave]

Well, I am not a doctor but but I would suggest trying a few things.

drink cranberry juice: recommended by a urologist since it flushes bacteria out of the urethra,

shake your penis  dont squeeeze when your finished peeing

no tea it makes you have a rusty zipper (leakage after you pee)

no self medications or creams. (hydrocordizone might be ok if it is pure but neosporin can make one heck of an allergic reaction if it has sulfa in it which I am allergic to, maybe your are too.

Anxiety always makes me worse. Relax a little.

Since you had Cippro it should have cleared out any infection already.

Oh ya most important keep soaps away from the tip of your penis. Soap can cause allergic reaction down there and inside if it makes it up. Perhaps baby shampoo for cleaning that area.

Try using condoms if your going to worry so much.

[H. Hunter Handsfield, M.D.]

Most likely edave's advice won't help much, but it won't hurt--so feel free to give those things a try.  But most likely you're going to just live with your symptoms, which probably will fade with time.  You can be 100% certain you have nothing that will ever harm you or a future sex partner.  Perhaps just knowing that will help things settle down.

[edave]

Found this in my travels - Non Specific Urethritis which could be post infection, heres more:

Sometimes NSU is very hard to get rid of. It can return or recur, and since the cause is unknown, the solution can be hard to find.

Urethral irritation may also be set up by:

repeated squeezing or milking of the urethra

very frequent or vigorous masturbation or sexual activity

concentrated urine caused by dehydration

caffeine and/or alcohol, some medications

general illness

allergies

soap or cosmetic entering the end of the urethra.

[H. Hunter Handsfield, M.D.]

The problem, edave, is that "nervous" doesn't have "urethral irritation".  His anxiety is magnifying otherwise normal body sensations.  Nothing else is wrong.

Time to end this thread.  I cut 'em off when we get beyond science into hope, hype and magic.

[Prof.Jason]

There are many, many conditions which have been discovered in the last 100 years which didn’t exist before. Many new bacteria, fungi and parasites have been discovered in the last decade alone which also didn’t exist before, this should be acknowledged by Doctors.

It is not helpful to attribute symptoms to a psycho somatic response because there is an unknown cause. A simple 'I don’t know' is better than 'its all in your head' because when you read a medical journal next week and find that a doctor in Australia has discovered X is the cause of Y, and you've been telling 100's of patients that its ‘all in their head’ for the past 30 years, how will you explain this arrogance to them?

I am not a hypochondriac, I understand the power of the mind and how it can cause real symptoms in some people.

I had had 30+ partners before the following partner and never with any issues.

The woman was not a prostitute or of ill repute, I had known this woman for a year or so.

She was on the pill, so we had unprotected sex. We were both keen as it was the first time.  We synchronized the climax and I ejaculated while inside-(totally normal for me, many ‘FG’ on pill). I would describe what happened as like ‘a mild tingling fluid was being forced 2 – 4mm down my urethra, this sensation was in time with ejaculation, between each pulse and seemed to go further  with each pulse, like my penis was sucking as well as blowing.

It was not a sensation I had ever felt before BUT I was not concerned at all, a quick rub seemed to make the sensation subside and there were other distractions. Around 5-10 minutes later I went to the toilet to urinate. Urination was accompanied by the same sensation encountered during ejaculation but seemed to be more pins and needles like.
Again a bit of a rub seemed to make the sensation subside. I had sex with this same woman many times after this and although the sensation was less noticeable as went on, it was still evident during ejaculation and urination.

The sexual relationship with this woman ended some months later.

The problem was that the sensation continued, urination was more often than not, accompanied by the slight/mild tingling/P&N sensation in the last cm of the penis

I did not accept that the problem was an actual problem and expected my body to fight off whatever it was and it would go away with time.

I started another sexual relationship and we had unprotected sex, she was also on the pill, now this is when the concern starts.

During the first sexual encounter, she reported a ‘nice’ tingling sensation during/as a result of my ejaculation. I also felt the now familiar mild tingling/P&N sensation. “It’s not an unpleasant sensation”, she reported, but the fact that she was actually mentioning it was curious and of some concern, in that I could have passed something on, however harmless it is, that fact that I could be the origin of someone’s condition is concerning.

I went to the doctors and explained the symptoms and circumstances and he did a urine test, he reported that there was nothing unusual, a little ‘crap’ in there, but nothing to worry about, and that it was most likely anxiety. The Dr had explained that there was nothing which caused the symptoms reported, there was nothing to treat. I accepted this without question.

I had a series of events occur; my Dr. told me it was in my head, this didn’t explain the fact that a new partner had reported similar symptoms after sex with me, even though I had never mentioned any such symptom to her.

The relationship with this woman ended after around 6 months, and I started a relationship with a woman which I’d had a relationship with several years before.

Almost the same thing occurred, after sex, she mentioned that there was a ‘good’ tingling sensation, and ‘itch’.

Again, I had never mentioned my issue to her but she reported a new / unfamiliar sensation.

I am still with this woman and we both seem to be healthy but there is the re-occurring tingling sensation.

As anxiety can cause symptoms, the mind can mask symptoms also.

There is one another symptom which may be related or not, (cant be 100% discounted.
Around a few days after the initial ‘tingling’ sensation, I had a nostril infection of some kind, the nostrils got red, but did not swell, a thin layer of thick white/yellowish mucus discharge and irritation of the nostril membrane was apparent for some days, drying occurred and some cracks formed due to the excessive nose blowing and wiping going on. The fractures took several months to heal properly. I’ve had to be very vigilant with nose blowing and through clean in the shower, else after a few days, a lot of buildup occurs.

The reason I mention the additional symptom, is that the second woman who reported the ‘tingling’ sensation also had almost exactly the same symptoms with her nostrils, enflamed, cracking/fractures where the membrane meets the external skin, a white/yellowish mucus, this has been ongoing for her for several years now.


I’ve written this because I know these are real symptoms of something that does exist but may not yet be identifiable.

[H. Hunter Handsfield, M.D.]

I stand by the science, not personal testimony.  This thread is over.