Urethritis--What is this?

Dear Dr.

Thanks in advance for your help.  Please carefully review all of my posts ("Herpes/HIV" and "What next") plus the threads that followed with the STD doctors.  They have basically referred me to you because they say my condition is not STD related anymore.  

You may even want to go back to my first post from almost a year ago when I felt a pain in only one part of my urethra and testicular pain the morning after a sexual encounter.  The pain eventually went away in my urethra, but persisted in my left testicle.  I ended up being diagnosed with a spermatocele (spelling?) in September/October of '08. (testicular pain has been absent since that time thankfully)  I currently haven't experienced any testicular pain with my latest condition.  

To summarize about 9 weeks ago I had unprotected sex and caught chlamydia.  I was treated with many antibiotics, and my urethral pain went away, (at about 3 weeks) but returned after 1 week of finishing the antibiotics (cipro, 500mg 2/day, 14 days).  I have tried a number of other forms of therapy thereafter including Doxy, anti herpes meds, and natural remedies with no success.  I still have urethral burning and mild penile pain/aches.  Naproxen seems to be helping a bit lately with the pain.

What do you think is going on here?  A complication from chlamydia?  Abacterial prostatitis?  Should I wait it out?  My urologist here is suggesting a cystoscopy.  I really am not enthused about this!!  What possible results would that test show?  Is it worth doing?  

Please review my previous posts; summarize your assumptions about my situation so that I know we're on the same page; and provide your expert opinion on my next steps and conditions I should consider.  Thank you very much.

[Stephen Liroff, MD]

I have reviewed your previous posts and the superb, well thought out comments of Drs.  Handsfield and  Hook. I really cannot add anything to what they have said. Would I recommend a cystoscopy, no, except "to leave no stone unturned."
This forum has had many participants who have had affairs and  unprotected sex and then experienced many different and inexplicable symptoms. Search the archives. They have then started on a round of doctor’s visits to account for their symptoms. Multiple negative cultures and multiple visits later, often having had treatment for STI’s  without proven disease, they have come to this forum for the answer. In reality, the answer is anxiety based and the initial physician who stated that nothing could be found  in the workup and that the symptoms did not fit any known physical disease was correct. A second opinion is understandable. But, as the opinions mount that there is nothing physically wrong, you as well as the others, need to accept  the reality that has been explained in many ways and move on to obtaining the emotional care that you need to allow you to  move on and enjoy life.
A psychologist, psych social worker, or a psychiatrist who does counseling will help you work through your anxieties and possible relationship issues. These people can help greatly if you are motivated.
S.A.Liroff, M.D.

[jaybird791]

Any comments doctor?  I am eagerly awaiting your response.  Thank you.

[jaybird791]

I would really appreciate an answer shortly.  I need a second opinion on getting cystoscopy?  I am supposed to have one this coming Thursday?  Do you think that is the best course of action yet?  What other remedies do you suggest.  I have been taking saw palmetto and cranberry pills for a few weeks now.  The urethral pain seems to be getting slightly better.  I value your expert opinion.  Kindly write back soon.  Thank you.

[jaybird791]

You mentioned leaving no stone unturned.  What other things should I ask my doctor about before I getr the cystoscopy.  My urologists exact words were, "I don't know what causing the pain, that's why I have to take a look." (meaning he needs to do the cystoscopy)

Please outline what other treatment options I should explore.  I'm cancelled my last cystoscopy, but have now scheduled another one for next Tuesday because the pain is very bothersome.

I am having to urinate often. (which in reality I have always had this issue)
There is pain and burn during and after urination.
Urine seems to just "sit" inside my urethra.  I feel like I just need to "wring it out" or push harder when urinating, but nothing happens.

[Stephen Liroff, MD]

Your urologist is looking to see if he can find anything wrong, not that this person is looking for a specific problem. I cannot think of anything to ask ahead of time. Just know that you are certainly getting the last word in evaluations!
S.A.Liroff, M.D.