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Cause of bleeding from the penile urethra? Prostatitis?
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Cause of bleeding from the penile urethra? Prostatitis?

Hi Doctor,

I am a 28 yr old male. My problems started 4 months ago when i begun to experience lower pelvic pain,scrotal pain and tightening, clear penile secretions after urination and a reddish inflamed penile tip around the urethral opening. My urination flow is fine and it doesnt burn. Over the last 4 months i have recieved 5 batchs of full STD checks and UTI checks, all of which were negative. I have had scrotal, pelvic, prostate and kidney ultrasounds. I have a had a pelvic CT scan, all of which showed no abnormalities. I have visited a urologist who could not identify a problem. He suggested that i possibly had prostatitis and a mild case of NSU but this wasnt definate. I had a PSA test of 2.5. To cover all bases, I am on noroxin, naproxen, zoloft, doxycycline and keflex. I have been on noroxin for 2 weeks and i am beginning to improve. My concern is that I had sex with my partner the other day with a condom on and i started to bleed out of the urethra. It wasnt due to ejaculation as i hadnt ejaculated at that time. In fact when i ejaculated later, there was no blood in the semen. It seemed more due to trauma to the urethra from friction and rough sex. I have not bled since, and there is no trace in the urine. I am aware that naproxen and zoloft can make you bleed easier, so i thought that might be the cause. So my first question is, does my problem as a whole sound like prostatitis? and secondly do you have any insight on this on the blood coming from the urethra? I spoke with my GP about it, and he assumed it would be minor trauma due to sex.

Any advice would be appreciated.

Regards
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First, a PSA of 2.5 in a 28 year old is a bit high and needs to be repeated after not having had an ejaculation for 3-4 days. Then, if it is at that level or greater, I recommend repeating it at least yearly to observe it’s speed of rise.
The blood per urethra may be due to rough sex, given that nothing else has be positive. Just see if it recurs and when.
As to your scrotal/perineal discomfort, I would first consider anxiety as a factor. This is not prostatitis.
S.A.Liroff, M.D.
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I should also add that I have had a pelvic xray, urinalysis and blood work done for kidney and liver function. All were normal. Strictures, ulcers or warts seem unlikely as my urine flow has always and still is fine and pain free. To add to this, i have changed partners but have not engaged in unprotected sex for many years. My current partner has been tested and is clear also. I get tested each year for STDS and they have always been negative.
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Further information for you. I had a urine test and urethral swab done this week. They came back negative for stds and uti's. No blood was detected in the urine. Occasional gram stain positive cocci & and occasional gram stain positive bacilli were found. However i was told that these were normal bacteria. I have an appointment in two weeks with a dermatologist and a urologist again. Look foward to your reply on this.
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Apologies, my PSA was 2.3, not 2.5. Both my GP and urologist do not seem concerned about that figure as it still falls below the normal range of <2.5 for my age bracket. They also indicated that as there were no abnormalities  in the ultrasound, CT scan and xrays that the cause for concern is low.
As for the blood in the urethra, i have had sex a few times since this and it has not happened again.
Also i have seen a dermatologist and he indicated that the redness around the penile tip is seborrhoeic dermatitis.
In terms of infections, i have had numerous tests and they have all been negative. Herpes simplex tests have all been negative over the past 5 months as have HIV. However as i am still feeling symptoms (intermittent clear penile discharge and penile tenderness), my GP prescribed me a 1g dose of azithromycin and a 2g dose of Tinidazole. This on top of the antibiotics that i have previously taken such as doxycycline, keflex and noroxin should well and truly cover any undiagnosed infection. Is that correct? I did have a positive ANA test (Titre: 640 Homogenous) on two occasions so i do wonder if its a autoimmune problem causing my symptoms. Is that a possibility? I had a negative rhematoid factor test and a normal c-reactive protein test. Kidney and liver function is fine. However Bilirubin is consistantly high. My GP believes that is due to Gilberts Syndrome. Is there any light that you can shed on this situation?
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