Penile pain/irritation

[excursion]

My symptoms started in mid July.  One day at work the tip of my urethra started burning off and on throughout the day.  Urination did not bother me or increase the burning.  The weekend of the fourth of July I had unprotected sex with I girl in the back seat of a car.  I figured that I must have caught something from this encounter.  The burning got worse over the next few weeks, aggravated by any sexual activity and I noticed a clear discharge only in the morning when I woke up.  I noticed the right side of my urethra had a bluish/purple color to it as well.  I saw the doctor and told him about what was happening.  He said I probably contracted an STD which he though was NGU and prescribed me 10 days of Doxycycline.  I also got tested for Chlamydia, gonorrhea, herpes, syphilis, hepatitis B and C, and HIV which all came back negative.  The Doxy did not seem to help and the irritation at the tip of the urethra got worse to the effect walking around in cotton boxer briefs was unbearable.  The skin at the tip of the penis would even rub open on some occasions, kind of like a brush burn.  I saw the doc again and he prescribed me 5 days of Cipro and gave me some nystatin yeast cream (about 10 days worth).  I stopped taking the Cipro after 4 days because it was having some allergic reactions (extreme headaches, rashes, I didn’t notice any difference in these 4 days) and the yeast creams did not seem to help either.  I confirmed with the doc that all the soaps and detergents I was using not the cause.  He wasn’t sure what was going on and referred me to a urologist.  
The urologist gave me 14 days of doxycycline and 14 days of nystatin powder.  These had no effect.  The irritation at the tip of the urethra continued to get worse and a severe (9 out of 10) off and on pain developed on the right side of the glands.  It feels like a thumb tack is poking me from the inside out half an inch down from the opening, accept it is not quite as sharp.  In the mean time I got a urine culture, Pelvic CT scan, and penile sonogram and all of these diagnostics came out “perfectly fine”.  He told me to give another month or so to see if it worked it self out, but nothing changed symptom wise.  Since the symptoms started I have not experience any change or problems with urinary or sexual function; however the symptoms get much worse after any sexual activity.
I went back to the urologist who told me that the only other procedure left he could do was a cystoscopy.  I wanted to get some other opinions before I get an invasive surgical procedure performed.  The urologist stated that he didn’t think he would see anything and I am skeptical because I am only 23 and have never had any prior urination problems.  Given that things stared a week and a half after my risky sexual encounter, I wanted to be completely sure that this isn’t related to the encounter I had a few months back. Do you have any advice on what is going on and what I should do next?

[Kevin Pho, MD]

You have had a pretty comprehensive workup for infection.  

I would agree that the cystoscopy is the next step.  It can look for anatomical abnormalities, such as a urethral polyp or stricture, that can lead to the burning.

You can also consider a prostatic exam - since cases of chronic prostatitis can lead to some of your symptoms.  This can include a digital rectal exam and prostatic massage.  Any fluid that is expressed through this can be sent for analysis and culture.  A transrectal ultrasound can be considered as well.

These options can be discussed with your personal physician or in conjunction with another urological opinion.

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.
kevinmd_b

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[caringwife]

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