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STDs (Expert Forum)
Urethra Irritation Even After Meds....Please Help
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which 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.
Urethra Irritation Even After Meds....Please Help
by WhatIsIt1977, Sep 08, 2009 11:57AM
Hello and thanks in advance for your help....I am very concerned and worried.
On Sunday, August 23rd I received unprotected oral sex for about 3 minutes from a female street prostitute. I immediately ejaculated and urinated 15 minutes later. Within the next 48 hours I began to have an irritation and unnatural feeling in the shaft of my penis. No discharge.
Went to the doctor and he tested me for Chlamydia (negative result) on Tuesday August 25th and prescribed me Azithromycin (1-time two-pill dosage). The irritation subsided but a week or so later came back.
Very concerned, I went back and on Friday, September 4th, (13 days after exposure) the doctor gave me an injection of Rocephin and I have been on doxycycline two pills a day since Friday, September 4th (4 days ago). I do not have any discharge or sores, bumps, red spots, blisters, etc., just a constant, bad irritation in my urethra and it is driving me crazy that I cannot even think anymore.
- I am worried about Herpes since this has not cleared up even after the meds my doctor gave me. Should this be a worry even though there is no visible sign on my penis?
- What could be causing this irritation? Is it an STD? It does not burn when I urinate.
- If it were NGU (urethritis), wouldn't the irritation have gone away after my meds?
- What do you recommmend doing next? Testing? Medication? etc.?
Without getting all moral, I feel aweful about my actions. The risk and guilt I feel is just not worth it and I feel like less of a man for even being so stupid.
Thank you all for your help and understanding.
On Sunday, August 23rd I received unprotected oral sex for about 3 minutes from a female street prostitute. I immediately ejaculated and urinated 15 minutes later. Within the next 48 hours I began to have an irritation and unnatural feeling in the shaft of my penis. No discharge.
Went to the doctor and he tested me for Chlamydia (negative result) on Tuesday August 25th and prescribed me Azithromycin (1-time two-pill dosage). The irritation subsided but a week or so later came back.
Very concerned, I went back and on Friday, September 4th, (13 days after exposure) the doctor gave me an injection of Rocephin and I have been on doxycycline two pills a day since Friday, September 4th (4 days ago). I do not have any discharge or sores, bumps, red spots, blisters, etc., just a constant, bad irritation in my urethra and it is driving me crazy that I cannot even think anymore.
- I am worried about Herpes since this has not cleared up even after the meds my doctor gave me. Should this be a worry even though there is no visible sign on my penis?
- What could be causing this irritation? Is it an STD? It does not burn when I urinate.
- If it were NGU (urethritis), wouldn't the irritation have gone away after my meds?
- What do you recommmend doing next? Testing? Medication? etc.?
Without getting all moral, I feel aweful about my actions. The risk and guilt I feel is just not worth it and I feel like less of a man for even being so stupid.
Thank you all for your help and understanding.
Doctor's Answer
by H. Hunter Handsfield, M.D., Sep 08, 2009 12:24PM
, Sep 08, 2009 12:24PM
Welcome back to the STD forum.
I'm not sure whether or not you ever had a urethral infection. Two days is really too soon for onset of NGU, and if it had been gonorrhea it would have been easily diagnosed. Some sort of physical or chemical irritation seems more likely. But that's not definite, and NGU (but not chlamydia) can be acquired through oral sex.
NGU symptoms often persist or recur after treatment, sometimes because the bacteria causing it are resistant to the antibiotic; sometimes because of inflammation not due to an infection; and sometimes because the infection is caused by a virus. In your case, you can be pretty sure you do not have a continuing bacterial infection, i.e. no gonorrhea, chlamydia, or the other bacteria that can cause NGU; if you did, the combination of antibiotics you have had definitely would have cleared it up.
My guess is that your NGU was due to a virus. The two viruses most likely to be responsible are herpes, specifically HSV type 1; or adenovirus, a common respiratory virus that accounts for 2-5% of NGU cases. In your case, adenovirus is more likely than HSV, because herpes usually causes obvious blisters/sores on the penile skin. Also, herpes urethritis usually is more severe than you describe, often with excrutiating pain when urinating.
If the problem is a virus like adenovirus, the symptoms will clear up on their own. It usually takes a couple of weeks, so my bet is that things will start to improve soon. A much less likely possibility is that you have a bacterial urinary tract infection (not sexually acquired), but UTIs are uncommon in men under age 40-50 and most UTIs would respond well to the antibiotics you received, especially the doxycycline or ceftriaxone (Rocephin). And as I said, the whole thing might be some sort of chemical irritation related to the oral sex -- in which case it also will clear up on its own.
Bottom line: Probably nothing serious is going on, i.e. nothing that will threaten your health in a serious way or that could be dangerous to another sex partner. But return to your doctor if the symptoms persist more than several more days.
Regards-- HHH, MD
I'm not sure whether or not you ever had a urethral infection. Two days is really too soon for onset of NGU, and if it had been gonorrhea it would have been easily diagnosed. Some sort of physical or chemical irritation seems more likely. But that's not definite, and NGU (but not chlamydia) can be acquired through oral sex.
NGU symptoms often persist or recur after treatment, sometimes because the bacteria causing it are resistant to the antibiotic; sometimes because of inflammation not due to an infection; and sometimes because the infection is caused by a virus. In your case, you can be pretty sure you do not have a continuing bacterial infection, i.e. no gonorrhea, chlamydia, or the other bacteria that can cause NGU; if you did, the combination of antibiotics you have had definitely would have cleared it up.
My guess is that your NGU was due to a virus. The two viruses most likely to be responsible are herpes, specifically HSV type 1; or adenovirus, a common respiratory virus that accounts for 2-5% of NGU cases. In your case, adenovirus is more likely than HSV, because herpes usually causes obvious blisters/sores on the penile skin. Also, herpes urethritis usually is more severe than you describe, often with excrutiating pain when urinating.
If the problem is a virus like adenovirus, the symptoms will clear up on their own. It usually takes a couple of weeks, so my bet is that things will start to improve soon. A much less likely possibility is that you have a bacterial urinary tract infection (not sexually acquired), but UTIs are uncommon in men under age 40-50 and most UTIs would respond well to the antibiotics you received, especially the doxycycline or ceftriaxone (Rocephin). And as I said, the whole thing might be some sort of chemical irritation related to the oral sex -- in which case it also will clear up on its own.
Bottom line: Probably nothing serious is going on, i.e. nothing that will threaten your health in a serious way or that could be dangerous to another sex partner. But return to your doctor if the symptoms persist more than several more days.
Regards-- HHH, MD
-Just so I have this correct, if it were genital herpes, I would have shown signs of it by now? 16 days after possible exposure.
-I have a follow-up with my PCP on Thursday. What things should I ask him or tests to take?
Do not request specific tests. Just tell your doctor what you told me, and perhaps tell him my opinion (you could print out my reply) -- then follow his recommendations.
I failed to mention that I have Celiac Disease. Would that have any bearing on any of this?
Sorry for not mentioning this above.
Thank you.
Let's hold off on additional comments unless you have more to say after you return to your physician.
I went to my PCP today and he inspected my genitals and said there is no sign that I have genital herpes. I also told him what you posted above. He said that by this point, since I have had this irritation in my urethra this long, that if it were genital herpes I would have had a bad rash by now and would've by this point KNOWN whether or not I had herpes. He said that within days, I would broken out in a rash and it would have escalated from there. He wouldn't even order me a Herpes test.
He is at a loss for what may be causing the irritation and is sending me to a urologist.
Can I rest assure at this point that I do not have genital herpes?
Thank you for your help.
I will post what the urologist says once I have the appointment.
I wanted to follow-up with what my urologist said. He examined me and said that there was no sign of herpes on my penis at 3.5 after exposure.
I had an HIV, HSV 1 & 2 blood tests conducted at 2 weeks and again 3.5 weeks after exposure. Both tests came back negative for HIV, negative for genital herpes and both said at some point have had contact with oral herpes, that I at some point had a cold sore (although I have never noticed a cold sore).
Up unto inspection at 3.5 weeks, there was some irritation on the outside of the head of my penis which he said looked like a yeast infection and prescribed Nystatin cream. I used that and the external irritation went away but the urethral irritation is back. It does not burn when I urinate, but just a steady burning/tingling irritation in my shaft. I went back and saw the urologist and he examined my penis 5.5 weeks after possible exposure and said he sees no signs of genital herpes.
What on earth could this be? Do this sound like a concern for herpes or HIV? I am incredibly worried about this irritation in my urethra and just do not know what it could be.
My concerns are both HIV and/or Genital Herpes.
Would I have had an outbreak by now if I had herpes?
Thank you for your help.
If you need to to resubmit and extra payment I will.
Thank you.