worried and confused

Hello Doc
Thank you in advance for helping me out with a complicated situation. I'm a male 31 years old. Over 3 mos ago I had unprotected sex with a friend, who I trust. At the time I was a little paranoid, so I took 2 grams of azithromicin as a preventative.  3 mos later, right before I headed to Europe for vacation I started experiencing strange, tingling sensations at the tip of my penis. Never had any discharge, no fever, just increasing irritation. Started going to the bathroom a lot. Suspected it could be a UTI so I took a home test, which tested positive for WBC and Nitrates. Didn't have time to see a doctor because I was leaving the country, so I called and got a prescription for 250 mg of Cipro. Went to Paris, symptoms persisted after 4 days, so I went to a doctor there who told me that he couldn't test me because I was already on antibiotics, but it was most likely chlamydia. He gave me 100 mg of doxycycline for 15 days. I'm on day 10, and although the symptoms subsided a bit, they are back--a mildly irritating, faint burning sensation, anal discomfort, feeling like I have to go to the bathroom. I spoke to my friend who tells me she's sure it's nothing, she gets checked out every 6 mos, feels fine, etc. She has been in a monogamous relationship for years. So needless to say I have no idea what's going on, or if I should even be taking these antibiotics. When would it be good to go to a urologist?  Can a chlamydia infection show up after 3 mos? Could it be something else std related? This has been ongoing for weeks now, and it is extremely stressful, please help.

[H. Hunter Handsfield, M.D.]

No STD causes the symptoms you describe.  Even if you happened to have an STD, the treatments you have had would have cleared up every conceivable possibility.  You cannot have chlamydia after those treatments.

The only specific condition I can suggest is the possibility of the chronic pelvic pain syndrome; if you google that term, you'll find a number of useful online information sources.  You can start with the Wikipedia article, which is quite good.  You can also use the search link on this forum to see many other discussions of it (in addition to CPPS, also enter "male pelvic pain syndrome" and/or "prostatitis".)  CPPS used to be called chronic nonbacterial prostatits, but now it is known that the prostate gland may not be involved at all.  Genitally focused anxiety often is involved.  Happily, it is totally harmless, and you describe no symptoms that suggest any signficant threat to your health or that of a sex partner.  It is a diagnosis of exclusion--that is, if you visit a urologist, most likely nothing abnormal will be found--but that's a reasonable next step.

Good luck--  HHH, MD

[reason to worry?]

Thanks Doc..
One question about the appearance of chlamydia after 3 mos after taking a dose of 2 grams of azithromicin. Is that possible?

[H. Hunter Handsfield, M.D.]

See my reply above, paragraph 1, sentence 3.