Aa
Urethritis/Prostatitis?
Dear Dr,
Could use ur opinion.
March 2010 Am physician in 30s made mistake at massage place in Bangkok. Girl 1-unprotected oral sex for 5 mins, put condom on then intercourse for 5 mins. Girl 2-removed condom, put new one and gave oral sex for 5 mins, then intercourse for 5 mins. 20 mins of fun for lifetime of probs.
2 wks aftr, dysuria, freq, burning, urgency. Took Suprax, Azithro, Flagyl. 1 wk later symptoms persisted, mild clear discharge. Saw urologist (End Mar.), swab neg. for chlamydia, gc, HIV/HSV(Herpeselect IG 1 2). Put on Cipro 7 days. Symptoms went, returned 2 wks later. Put on Doxy 7 days, severe pain with pee x 2 days at meatus, left side swollen. Noted milky discharge at tip while defecating. Symptoms went for 2 wks, returned. Took Cipro and Doxy bid x 4 wks. Symptoms slowly went, did prostate exam, and next day symptoms gone. Prostate exam ok.
Normal, met girl of dreams got engaged, no sex.
4 months ltr (Aug 2010), symptoms recurred! Burning after pee for 1 hr. Ejaculation, w/ burning 4 hrs after. Put on Cipro, no help, tingling tip of penis, left meatus inflamed. Cysto (Sept) neg. Dx: prostatdyonia. Had unprotected sex w/ wife for 10 secs, still scared.
End of Sept, 2 lesions meatus. 1st bx eczema, 2nd genital wart. Went into depression and suicidal. Had anesth/laser surg (Nov 2010), no warts. Given steroid oint. to put in urethra.
(End of Nov 2010) Using ointment, rash inner thighs, attached pic. No pruritus or pain. White flaking, if scratched revealed red flat scaly lesion. Clotrimazole 3 days, resolved. At time, urethral burning, tingling felt better to pee. Did seminal fluid cx: rare enterococcus/ 5-10 wbcs. Put on Ampi, 80% better, IF no ejac.
1) Despite negative HSV tests at 1 wk, 4 wks, and 7 months, could I still have HSV urethritis, what test should I get done? WB?
2) Can HPV cause symptoms like I had? Can HPV/HSV cause prostatitis?
3) Is Enterococcus sexually acquired?
Thanks
MEDICAL PROFESSIONAL
Recurrence of genital warts is exceedingly common and generally is not evidence of immunodeficiency.
As a physician, you undoubtedly recognize your wife's symptoms as typical for a garden variety UTI. There is no reason to suppose that event has anything at all to do with your HPV infection or any other STD.
That will have to end this thread. You're going to have to work with your personal health care providers to work out any remaining problems or questions. Good luck.
As a physician, you undoubtedly recognize your wife's symptoms as typical for a garden variety UTI. There is no reason to suppose that event has anything at all to do with your HPV infection or any other STD.
That will have to end this thread. You're going to have to work with your personal health care providers to work out any remaining problems or questions. Good luck.
Dr. Handsfield,
Sorry to bother again, but I need advice... I had a recurrence of my warts on the outside and in the urethra, so I got them surgically removed today, in the urethra next week.. probably go back to surgery. I'm curious, should I be concerned of immunodeficiency here? I mean, CBC with diff have been ok, absolute lymphocyte counts ok and HIV negative on several occasions. What gives? This *****! I'm in pain and my wife wants a divorce. Its not fair! Man, god is definitely punishing me after that day in Thailand..
Also my wife has been experiencing dysuria/frequency/little blood in urine, back pain, burning that was severe a few weeks ago it went away after about 5 days, but I was scared and treated her with Levaquin after she refused to go to ER. We have been having protected intercourse, I'm still concerned about HSV, any other way I can get a good confirmatory diagnosis for that?
Thanks again
Sorry to bother again, but I need advice... I had a recurrence of my warts on the outside and in the urethra, so I got them surgically removed today, in the urethra next week.. probably go back to surgery. I'm curious, should I be concerned of immunodeficiency here? I mean, CBC with diff have been ok, absolute lymphocyte counts ok and HIV negative on several occasions. What gives? This *****! I'm in pain and my wife wants a divorce. Its not fair! Man, god is definitely punishing me after that day in Thailand..
Also my wife has been experiencing dysuria/frequency/little blood in urine, back pain, burning that was severe a few weeks ago it went away after about 5 days, but I was scared and treated her with Levaquin after she refused to go to ER. We have been having protected intercourse, I'm still concerned about HSV, any other way I can get a good confirmatory diagnosis for that?
Thanks again
Thanks again Dr. Handsfield (apologies for the incorrect spelling previously). I'm overall lucky I didn't get stevens johnsons with all the abx I was on.... yet.. phew.
Take care.
Take care.
MEDICAL PROFESSIONAL
That several clinicians know you have genital warts should not be at all embarrassing. Somewhere in the range of 15-25% of all people have genital warts at one time or another.
As far as is known, neither chlamydia nor gonorrhea infects the prostate gland at all; if so, it is rare. But yes, it is possible to have either infection asymptomatically without WBC showing up on routine urinalysis.
You are working very hard to convince yourself, and me (and probably your own doctors) that you have an STD (other than your warts) despite overwhelming evidence to the contrary. You may or may not have prostatitis or CPPS, as noted above, but no STD. I suggest you simply dismiss that possibility. Work with your urologist(s) on the prostate issue, but forget STD.
That's as far as my advice can go. Best wishes.
As far as is known, neither chlamydia nor gonorrhea infects the prostate gland at all; if so, it is rare. But yes, it is possible to have either infection asymptomatically without WBC showing up on routine urinalysis.
You are working very hard to convince yourself, and me (and probably your own doctors) that you have an STD (other than your warts) despite overwhelming evidence to the contrary. You may or may not have prostatitis or CPPS, as noted above, but no STD. I suggest you simply dismiss that possibility. Work with your urologist(s) on the prostate issue, but forget STD.
That's as far as my advice can go. Best wishes.
Dear Dr. Hansfield, thank you so much for taking the time to write all the above, it's very encouraging.
Its been a rough road. Almost the 1 year anniv. of this happening, and many physicians in the community have seen my privates (3 urologists and 1 dermatologist) and know I have condyloma... embarassing.
Just need to reassure myself. Is it possible to have something like N. Gonorrhea, Chlamyadia in prostate with no WBCs on U/A? The more I think, the more I know the prostate is problem (if go #2, I feel a lot better for example, internal prostate massage). Still have burning after ejaculation for a few hours, urinating better.
I guess, what I'm asking do you think any further cx would help with my problem (e.g. pre/post prostatic massage, hour glass, PCR for above on prostate fluid?). How bout multi-drug resistant gonnorrhea, I did receive oral sex? Lastly, how often do condoms fail?
I have appointment with university hosp. as the urologists here didn't know what was prob. back when this started. I plan on keeping that appointment. I'm a worrier, and now scared that I'll get prostate ca down the road.. like I have sealed my fate.
Thanks again for everything! What a great forum!
Its been a rough road. Almost the 1 year anniv. of this happening, and many physicians in the community have seen my privates (3 urologists and 1 dermatologist) and know I have condyloma... embarassing.
Just need to reassure myself. Is it possible to have something like N. Gonorrhea, Chlamyadia in prostate with no WBCs on U/A? The more I think, the more I know the prostate is problem (if go #2, I feel a lot better for example, internal prostate massage). Still have burning after ejaculation for a few hours, urinating better.
I guess, what I'm asking do you think any further cx would help with my problem (e.g. pre/post prostatic massage, hour glass, PCR for above on prostate fluid?). How bout multi-drug resistant gonnorrhea, I did receive oral sex? Lastly, how often do condoms fail?
I have appointment with university hosp. as the urologists here didn't know what was prob. back when this started. I plan on keeping that appointment. I'm a worrier, and now scared that I'll get prostate ca down the road.. like I have sealed my fate.
Thanks again for everything! What a great forum!
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help. Bottom lines: HPV is obviously sexually acquired, but you probably didn't get it from the sexual exposures in Bangkok. Other than the wart, it is extremely unlikely you have herpetic urethritis or any other STD.
First, you can dismiss any bacterial urethritis, which could not develop or persist after the antibiotics you took.
Urethral discharge with defecation is a fairly common symptom, resulting from valsalva plus the movement of feces over the prostate -- an internal prostate massage. In and of itself, it's not abnormal unless it occurs with unusual frequency. I don't know if it's more common in men with prostatitis; that's a reasonable assumption, but I'm unaware of any data. Your urologist probably is more up to speed on this than I am.
The HSV serological tests are very good, although not perfect. But herpetic urethritis is unlikely on clinical grounds. It occurs rarely in the absence of overt external herpetic lesions; it usually is very painful; and since your Thailand exposure was by fellatio, it would have to be HSV-1 -- but genital HSV-1 infections recur infrequently if at all. Herpetic urethritis due to either HSV-1 or 2 would not persist or recur as frequently as your symptoms have done. Combining the clinical picture plus the serology, you can dismiss herpes as a cause of any of your symptoms.
I'm inclined to agree with the "prostadynia" diagnosis. The more current terminology (as recommended by the American Urological Association) is chronic pelvic pain syndrome; you could look up the term on Medline, or just google it and start your reading with the excellent Wikipedia article and the information from the Stanford Univ. Dept of Urology, both of which should be near the top of the google hits. Or you might have nonbacterial prostatitis. My inclincation is to dismiss the enterococcus, given the apparent small numbers on culture -- but that's a judgment call that I cannot make from this distance, especially since you had symptomatic improvement after presumptive treatment for it. All these issue are better addressed by your urologist. For sure enterococcus isn't sexually transmitted; as you know, it's a component of normal fecal flora and therefore is a common pathogen in a variety of urogenital infections.
Your genital area skin rash isn't consistent with any STD. Eczema sounds plausible, especially in view of one of the biopsy results.
Which brings us to your meatal wart. As I hope you have learned by now, your initial reaction to it was way out of proportion. Genital warts are an inconvenience, not a serious health threat -- and they clear up on their own. From population-based studies in Scandinavia, it's a fair bet that 20-25% of all persons experience genital warts at one time or another. It really shouldn't be such a big deal for you or, for that matter, for your wife. In any case, HPV is not known to cause any of the other symptoms you describe and to my knowledge has not been associated with prostatitis.
My opinion is that except for the HPV/wart problem, none of your symptoms has anything at all to do with your Bangkok adventures last March. And even the HPV infection that caused you wart probably was unrelated. HPV is rarely if ever acquired by oral sex. And recent research shows the incubation period for visible warts is longer than previously believed -- typically 6-18 months, although sometimes as short as 2 months. So your HPV infection probably was from some other sexual exposure, and could even have been acquired from your regular sexual partner(s).
I hope this helps put these issues into perspective. The main thing is to understand that you have no problem that presents any serious risk of long term health impact for either you or your wife or other sex partners.
Regards-- HHH, MD
First, you can dismiss any bacterial urethritis, which could not develop or persist after the antibiotics you took.
Urethral discharge with defecation is a fairly common symptom, resulting from valsalva plus the movement of feces over the prostate -- an internal prostate massage. In and of itself, it's not abnormal unless it occurs with unusual frequency. I don't know if it's more common in men with prostatitis; that's a reasonable assumption, but I'm unaware of any data. Your urologist probably is more up to speed on this than I am.
The HSV serological tests are very good, although not perfect. But herpetic urethritis is unlikely on clinical grounds. It occurs rarely in the absence of overt external herpetic lesions; it usually is very painful; and since your Thailand exposure was by fellatio, it would have to be HSV-1 -- but genital HSV-1 infections recur infrequently if at all. Herpetic urethritis due to either HSV-1 or 2 would not persist or recur as frequently as your symptoms have done. Combining the clinical picture plus the serology, you can dismiss herpes as a cause of any of your symptoms.
I'm inclined to agree with the "prostadynia" diagnosis. The more current terminology (as recommended by the American Urological Association) is chronic pelvic pain syndrome; you could look up the term on Medline, or just google it and start your reading with the excellent Wikipedia article and the information from the Stanford Univ. Dept of Urology, both of which should be near the top of the google hits. Or you might have nonbacterial prostatitis. My inclincation is to dismiss the enterococcus, given the apparent small numbers on culture -- but that's a judgment call that I cannot make from this distance, especially since you had symptomatic improvement after presumptive treatment for it. All these issue are better addressed by your urologist. For sure enterococcus isn't sexually transmitted; as you know, it's a component of normal fecal flora and therefore is a common pathogen in a variety of urogenital infections.
Your genital area skin rash isn't consistent with any STD. Eczema sounds plausible, especially in view of one of the biopsy results.
Which brings us to your meatal wart. As I hope you have learned by now, your initial reaction to it was way out of proportion. Genital warts are an inconvenience, not a serious health threat -- and they clear up on their own. From population-based studies in Scandinavia, it's a fair bet that 20-25% of all persons experience genital warts at one time or another. It really shouldn't be such a big deal for you or, for that matter, for your wife. In any case, HPV is not known to cause any of the other symptoms you describe and to my knowledge has not been associated with prostatitis.
My opinion is that except for the HPV/wart problem, none of your symptoms has anything at all to do with your Bangkok adventures last March. And even the HPV infection that caused you wart probably was unrelated. HPV is rarely if ever acquired by oral sex. And recent research shows the incubation period for visible warts is longer than previously believed -- typically 6-18 months, although sometimes as short as 2 months. So your HPV infection probably was from some other sexual exposure, and could even have been acquired from your regular sexual partner(s).
I hope this helps put these issues into perspective. The main thing is to understand that you have no problem that presents any serious risk of long term health impact for either you or your wife or other sex partners.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
