Irritation of urethra

[DougA]

For about 5 months now my glans penis is itchy all the time inside the urethra. The outside of the glans is ultra sensitive when brushing up against my clothing. Sometimes my right testicle is sore as well as my right buttock area. Occasionally while urinating I will get a tingle in my bladder  but never any burning. I also have had a tiny white spot at the tip of my penis inside the urethra which a dermatologist looked at and didn't know what it was. He did find oxalate crystals in my urine. I don't get up at night to void, or urinate excessively. My bowel movements are normal but generally I feel very tired a lot and don't have much get up and go. No fevers, I just feel under the weather a lot.

I've been tested for HIV, Syphilis and chlamydia, all negative. A 24 hour urinalysis was negative. Ultrasounds of the penis and right kidney area and lower abdomen were negative and I'm waiting for the results of a PSA test. My urologist has also performed at least four digital rectal exams of the prostate and found nothing. I believe my next test will be a cyctoscopy.

In September I was taking Trimethoprim for blastocystis hominis found in a stool sample. This was before I had my current problem and wasn't feeling up to par for about a month. I continued on the Trimethoprim for a total of 10 days.

After 5 days on the Trimethoprim my current symptoms began. Two weeks later I took Ciprofloxacin for 5 days. Three weeks later I took Cefixime 1 day and Doxycycline for 7 days, then a few weeks later Ketoderm 2% for 7 days. All of these were prescribed by my family doctor. I was then referred to a urologist who ordered the ultrasounds, 24 hour urinalysis and PSA tests but hasn't prescribed anything yet so I haven't had any treatment for 3 months.

I've been in a monogamous relationship for 7 years so I don't think the problem is sex related.

Any suggestions. Thanks.

[Kevin Pho, MD]

Another possibility would be prostatitis.  There are some difficult cases that require an extended period of antibiotics to treat.  A digital rectal exam with culture of the prostatic secretions can be done to evaluate this.  

Prostate imaging can also be considered - with either a transrectal ultrasound or prostatic MRI.  

If those tests are negative, then the cystoscopy would be the next reasonable test.  This can evaluate for any anatomical abnormalities (i.e. a urethral stricture or polyp) that can be causing your symptoms.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.