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Morning Penile Discharge
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Morning Penile Discharge

I am a 30 year-old male average ht/wt and in Jan 2005 I started having white/clear discharge and an uncomfortable sensation in my urethra.  Also painful urination. In Nov 2004 I started having intercourse with a new partner and a month later started having the above symptoms. The doctor tested for chlamydia and did a bacterial culture which came back negative but prescribed one gram of azythromycin anyways.  About three weeks later the symptoms came back and he said there was nothing he could do.  My partner was also tested by her gyno for everything and her doctor said that it is not anything to do with her(I was there to hear it).  

In March I went to a different doctor and was tested for everything, chlamydia, gonorrhea, ureaplasma, herpes, culture and urinalysis.  On this day a swab done first thing in the morning revealing many white cells so I was prescribed doxycycline 2X day for a week.  All of the above tests came back neagative except I am still having the following symptoms.  Slight discharge upon awakening, periodic frequency of urination and on April 2 there was dried blood at the tip of the penis(One time only).  I have no discharge throughout the day and there are periods throughout the day where my urethra feels uncomfortable.  On April 2 I went for another culture and urinalysis that also came back negative.

My current doctor said he can't treat anything that he cannot determine so he said to wait two more weeks and if the symptoms persist to come see him again. In Canada The wait for a urologist is 4-6 months.

I have not had any sexual contact since before the doxycycline and currently have slight discharge or the penis glued shut in the morning only.  I have been tested for everything and nothing is showing up.  There has to be something wrong as there was a small amount of blood once and I have no pain in prostate area or lower back, and occasional urinary frequency. I also feel 100% otherwise.

In January when this started I was having discharge during the day but the azythromycin cleared that up.  For example I was fine yesterday morning and around 2:00 I had an uncomfortable urethra feeling most of the day.  Today when I woke up the penis was glued shut and occasional frequency of urination(little volume).  

Any ideas as an STD is ruled out and the mid-stream urinalysis and culture are negative. Is the first thing in the morning mid stream sample removing everything from the urethra and that is why the test is negative.  Why would there be puss in the urethra from the swab with no infection present upon testing? Should I get a second opinion.  Any input would be great.

Help in Canada

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You've had a pretty good evaluation for STDs and already have been treated with antibiotics.

One consider would be prostatitis.  Diseases affecting the prostate can lead to the symptoms you describe and can be very difficult to treat.  

I would consider a thorough digital rectal exam, or a transrectal ultrasound to image the prostate.  If there is presence of an abcess (abscess), this cannot be appropriately treated with antibiotics.  Any prostatic secretions that is expressed via massage should be sent for analysis and culture.

A second opinion wouldn't be a bad idea - but the urology referral is really what you need.

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.

Kevin, M.D.
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