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Urology (Expert Forum)
Urethritis ???
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Urethritis ???
by DJH, Apr 02, 2003 12:00AM
I am a 30 y/o male, sexually active, having a urethral (?) irritation for about 3 mos. Symptoms include slight burn/tingle internal irritation, primarily near tip, no pain or freq of urination; groin/anal/thighs area feeling of dry skin,tenderness, with random tingle/tickle sensation; NO RASH/BLISTERS; some intermittent slight redness tip of penis and scrotum; some achiness of/around left testicle. Also, abnormal bowel movements during same time frame, formed, but not normal. All of these are low grade irritations. Nothing is causing high level pain. Just very annoying and distracting.
Have been to GP and URO; multiple urinalysis negative; no growth in culture; no evidence of internal urinary tract infection. Have taken Doxcy and Cipro 10 day courses with no relief. Have used various lotions on skin irritation, with no relief.
Questions:
What could this be and what would be treatment?
Could this be a Mycoplasma infect; if so what is the preferred antibiotic tx; how can these be tested for dx'd; uro seems to want to rule out bacteria after two courses. However, I have read that mycos may not be sensitive to the antibiotics I used; maybe azithro or erthro or levofloxacin?
Yeast (partner gets these infects)without the rash, what tx could I utilize?
Viral?
Stricture?
How can I get to the bottom of this and get it resolved?
Thank you for your help.
Have been to GP and URO; multiple urinalysis negative; no growth in culture; no evidence of internal urinary tract infection. Have taken Doxcy and Cipro 10 day courses with no relief. Have used various lotions on skin irritation, with no relief.
Questions:
What could this be and what would be treatment?
Could this be a Mycoplasma infect; if so what is the preferred antibiotic tx; how can these be tested for dx'd; uro seems to want to rule out bacteria after two courses. However, I have read that mycos may not be sensitive to the antibiotics I used; maybe azithro or erthro or levofloxacin?
Yeast (partner gets these infects)without the rash, what tx could I utilize?
Viral?
Stricture?
How can I get to the bottom of this and get it resolved?
Thank you for your help.
Doctor's Answer
by Kevin Pho, MD, Apr 03, 2003 12:00AM
, Apr 03, 2003 12:00AM
Hello - thanks for asking your question.
You are describing a urethral syndrome. Multiple U/A's negative, culture negative. Treated with doxy and cipro.
Chlamydia is the most common cause of urethal syndrome. Other causes can include Ureaplasma urealyticum, Mycoplasma genitalium, and Trichomonas.
It could be that the Chalmydia is resistant to the doxy/cipro and require another antibiotic. It is also possible (as you suggested) that Mycoplasma or Ureaplasma may be responsible. Other antibiotics that you may want to consider is Metronidazole (2 grams in a single dose) and Azithromycin (1 gram single dose).
If yeast infection is a concern, this can be treated with fluconazole.
Other causes for your symptoms may be urethral strictures or urethral polyps. These can be evaluated with a cystoscopy.
I would consider getting tested for Chalymdia (via culture or nucleic acid amplification tests). I would also consider trying other antibiotics (i.e. flagyl or azithromycin). If all is negative, a cystoscopy to evaluate for anatomical abnormalities would be reasonable.
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.
You are describing a urethral syndrome. Multiple U/A's negative, culture negative. Treated with doxy and cipro.
Chlamydia is the most common cause of urethal syndrome. Other causes can include Ureaplasma urealyticum, Mycoplasma genitalium, and Trichomonas.
It could be that the Chalmydia is resistant to the doxy/cipro and require another antibiotic. It is also possible (as you suggested) that Mycoplasma or Ureaplasma may be responsible. Other antibiotics that you may want to consider is Metronidazole (2 grams in a single dose) and Azithromycin (1 gram single dose).
If yeast infection is a concern, this can be treated with fluconazole.
Other causes for your symptoms may be urethral strictures or urethral polyps. These can be evaluated with a cystoscopy.
I would consider getting tested for Chalymdia (via culture or nucleic acid amplification tests). I would also consider trying other antibiotics (i.e. flagyl or azithromycin). If all is negative, a cystoscopy to evaluate for anatomical abnormalities would be reasonable.
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.
Member Comments (4)
by DJH, Apr 03, 2003 12:00AM
To: Urinary Tract Infections
0
by kevinmd, Apr 03, 2003 12:00AM
To: Urinary Tract Infections
0
by gsr, Apr 03, 2003 12:00AM
To: Urinary Tract Infections
0
by jui, Apr 10, 2003 12:00AM
To: Urinary Tract Infections
0
by Miguel567, Mar 18, 2008 06:42PM
A related discussion, Possible Urethritis/ Pain in Urethra was started.
