Chronic Urethra Irritation, please help

[Androsynth]

Please someone help me diagnose a chronic issue I've been having.

Male in 30's.

Symptoms:
* dull, usually very mild, but near-constant stinging sensation felt in urethra, near penis tip
* often is worse before and/or after urinating, but sometimes seemingly not related to urination
* occasional random twinges of pain or discomfort in the urethra
* somewhat increased urinary urgency and frequency, esp. in morning
* no visual signs, except occasional slight puffiness of meatus area
* dermatographia & itchiness of neck and trunk of body which requires cetirizine to control
* these symptoms have lasted for several months - they were worst shortly after onset, tapered, but have seemingly reached a "plateau" where it doesn't seem to be getting any better overall

Workup thus far:
* gon & chlam tested shortly after onset, both neg.
* Cipro 14 day course given shortly after onset, little or no change to symptoms.
* STD panel (gon, chlam, hsv, hiv, syphilis) 45 days after onset, all neg.
* standard blood panel, including blood sugar, liver and kidney function, all normal (GP says "excellent").
* Bladder-kidney ultrasound reveals nothing.
* Cystoscopy reveals nothing in bladder, "possibly a little irritation" in urethra, doxycycline 7 day course given afterwards, no change to symptoms.
* Several urinalyses were performed, some with attempted culture of bacteria, none ever detected bacteria or elevated WBC. Those performed shortly after onset indicated microhematuria which persisted for a couple of months, while the recent ones ones have not had hematuria.
* Urine pH has been "on the acidic side" (pH of 5) but diet changes and taking baking soda have not affected symptoms.
* Azithromycin 5-day course given for an unrelated issue - this produces temporary relief of urethral issues.
* Two digital rectal exams, one shortly after onset, the other months later, both revealed nothing
* Urologist has noted that the urethra is very sensitive to contact, but reassures that I have "nothing infectious or serious".
* No discharge, odor, or lesions were ever observed.

So the only actual clinical findings were:
* microhematuria which is now gone
* urethra sensitive to contact
* urethra "may have had a little irritation" (uro's words)
* dermatographia

So I'm at my wit's end. My uro is a nice guy but it seems that he is out of ideas and has been toying with garbage diagnoses such as interstitial cystitis. Any suggestions would be greatly appreciated. I'm thinking that it must be some sub-clinical infection or something rare which most doctors wouldn't be aware of.  Any ideas?

[Bear2018]

Any answers buddy? I had the same thing and was told it was the dermatographia in the urethra and scrotum causing the ache. They put me on Zyrtec twice a day with some improvement but the burning after urination continued. Another urologist tested me positive for HPV in my semen. He thinks it’s a viral HPV caused event. Says that I’ll have to let the HPV clear over the next few years. Lesson learned. Condoms with everyone. I dated my girl for 1 year and had no issues. But I guess HPV can flare just like herpes. So i dipped in unprotected during a flare of her HPV and it ****** me up

[Androsynth]

Well, another uro visit, another negative urinalysis, and more reassurance.  The doc is not inclined to prescribe any further medications without any evidence of an infection.  He seems to be leaning toward a largely psychological cause, and pointed out that while women often experience bladder symptoms due to anxiety, depression, etc., in men this can be expressed in the urethra.  I would love to believe that this is the case but I have my doubts.  And a psychiatrist visit and/or anti-depression meds are unfortunately off the table at this point.

[Androsynth]

No answers yet and not likely anytime soon I'm afraid.  Unfortunately OTC NSAIDs don't seem to make much difference.

Next appt I may ask for diflucan just in case of yeast and tinidazole in case of trich, even though these are unlikely since I've not had any probable exposure to these and since these would usually present with at least some WBC in urinalysis I believe.

I can see on the net that there are many cases like ours with negative test results and no answers.

[sporque]

I'm having roughly the same problem..Been going on for about a month now..I haven't had as many tests as you..My urine culture was negative..Started out a intense urge to urinate when sitting, tingling feeling in bladder region..Last for 2 weeks, was given Cipro 3 days..Seemed to help, but symptoms came back and are now similar to what you describe..Occult blood was also noted in my urine.
Had CT scan today to look for kidney issues..Will have results Monday..Have you found any answers yet?

[John_Volks]

I've had all the same tests and they came back negative, but my itch persists.

Azithromycin also has anti-inflammatory properties. If you felt a little better, perhaps ask your doctor for some NSAIDs, or pop aspirin daily for a couple weeks, and if it works then switch to daily dose-aspirin.

I'm doing that, and also taking probiotic pills twice a day, just in case it's yeast related.

If these things work for you, try to remember to come back and update!

[Androsynth]

So I'm out of luck then?  Could this be a parasite of some sort?  Trich?  Bacterial Biofilm? Can it be chronic NGU despite multiple negative urinalyses?  it is not psychogenic or imaginary.  There must be some kind of test that the docs have missed and I need to find out what's going on.

I should mention that these urinalyses and cultures were always "first-catch" but not always with the day's first urine.