Persistent irritation of meatus and urethra

[endofwits]

Thank you very much for your help.  This forum is an invaluable resource for people like me.

Here is a brief summary of my problem:

almost 4 months ago I most probably (stupid drunk and can't remember) had unprotected vaginal sex with a sex worker in China.  7 days later I had vague itching at the tip of my penis which developed into unbearable stinging over the next week (there was no discharge).  My GP diagnosed a chlamydial infection (without test) and prescribed a 10 day course of ofloxacin.  The symptoms seemed to clear up but there was some residual irritation.  I developed swollen axillary glands and had swollen glands (which lasted 9 weeks) in the neck accompanied by loss of appetite so had myself tested for HIV (negative at 30 days and subsequently negative after 3 months, Hepatitis B, C and Syphillis all also negative thank God - interestingly I tested positive for Hepatitis A antibodies but doc said this could have been in childhood.  The doctor prescribed an anti-fungal cream against the irritation.

This didn't work so I had second course of Oflaxacin.  The symptoms still didn't completely disappear and the doc said it was probably psychosomatic so he would do a urine culture to put my mind at ease.  Before the results came back (negative) I was in severe pain - stinging glans, red meatus, urethral pain, urgency and frequency of urination but still no discharge.  This time he diagnosed chronic cystitis and prescribed 10 days floxacin.  The urethral pain reduced and urgency disappeared but glans pain and constant stinging/itching meatus remains.  

Afterwards I was referred to a urologist who did prostate massage, urethral swab and urine test.  I am waiting for the results should be here in next two days.  He said he would be testing for HPV as this could be a cause.

I have been on many forums and have read that there is no HPV test for men.  Here are my questions:

1. Can he test for HPV and could it be the cause?
2. Could the redness at the tip of my penis be a meatal wart (or would he have seen this during the urethral swab?
3. I could not find any pictures on web and the meatus is red and more raised than usual - would a genital wart itch and sting constantly.
4. Could HSV be a cause (no ulcers) and cause contiuous irritation and stinging for over three months (I've read that it comes and goes)?

The uncertainty and discomfort are driving me crazy as I am afraid a) infecting my wife (we have been having protected sex since April because of unusual UTI!) and b) of losing my family.

Despite my fears I can't believe this is psychsomatic as my meatus is the colour of a baboon's backside and the irritation is constant.

Thank you again for your forum.
Endofwits

[gmoncel2]

A related discussion, Genital warts/ itch was started.

[endofwits]

Dear Doctor,

have followed my GPs advice to get on with my life - big mistake!  Had unprotected sex with my wife and am now in constant agony with urethral pain.  I called the doc and asked to be retested by the urologist as I fear I must have infected my wife before symptoms appeared.  As the urologist is on vacation he has prescribed me Sunamed Zithromax and said if it clears and comes back then my wife needs to go to get checked.  Can this be a sensible course of action?

Thanks

[endofwits]

Hi Doc,

I received my results yesterday and the urologist did check for HPV using a PCR test.  I thought this didn't work for men?  All results were negative.  He did not check for trichomoniasis as he said he ruled this out as there has been no discharge and no positive urine culture.  He says that its all in my head and the sooner I stop worrying about things the quicker the pain will go away.  

Is he right about ruling out trichomoniasis as a possibe cause?

Thanks,
endofwits

[H. Hunter Handsfield, M.D.]

I can't comment further, except to say that doctors who actually have examined someone are in a better position than I am to know what is going.  At least you can be confident that, whatever it is, no serious harm will come to you or any future sex partners.

HHH, MD

[endofwits]

Hi Dr.

just got a call from my GP to say that the urologist called to say all tests were negative and he has no explanation for my symptoms. When I asked him specifically what had been tested he answered, "fungal, bacterial, mycoplasma - everything" and says that he still believes it to be psycho-organic.  The urologist will send him a complete report in a couple of days with the details of all the tests. I will check off the list the things you suggested be tested and post a comment.  Unfortunately being told that something is pyschosomatic when I have physical pain is not much of a help!

I am now in desperation.
endofwits

[H. Hunter Handsfield, M.D.]

I agree with your conclusion, that anxiety alone or a psychosomatic problem cannot explain visible erythema (redness) of the meatus.  So I believe you have real inflammation.  The most likely explanation is nonchlamydial nongonococcal urethritis (NGU); chlamydial infection wouldn't cause persistent symptoms or come back after treatment with ofloxacin, but other causes might do so.  (As you seem to know, no healthcare provider can diagnose chlamydia by visual inspection; a chlamydia lab test is necessary.  You probably didn't have chlamydia.)  You could have had gonorrhea, indicated by the fairly severe initial symptoms.  Trichomoniasis is another possibility; an infrequent cause of NGU, but more of a possibility in atypical cases like yours.

Or it could have been a viral infection, especially adenovirus or herpes.  However, adenovirus--which is normally not sexually transmitted but sometimes can be-- would have cleared up by now and doesn't recur.  I can't be certain from your story whether you're having p *persistent* symptoms or *recurrent* ones.  If the problem largely went away then came back, then herpes is a reasonable possibility.  On the other hand, most herpetic urethritis is accompanied by overt herpes lesions on the outside of the penis--so if it is herpes, it is atypical.  And your last statement "the irritation is constant" is against that infection.

Genital warts/HPV is not a likely explanation.  Neither is "cystitis", regardless of what one healthcare provider said, or prostate gland infection.  And you need not worry about HIV.

On balance, the best bet is nonchlamydial NGU.  The treatment of choice is doxycycline (or other antibiotic in the same class, such as minocycline or tetracycline); or azithromycin.  Given the persistent/recurrent nature, it would be reasonable to try metronidazole (active against trichomoniasis) in additino to doxy or azithromycin.  You should discuss these options with your healthcare providers.  In the meantime, it is a good idea to continue to avoid unprotected intercourse with your wife, until things are sorted out.

Whew--long answer!  To finish with replies to your specific questions:  1) Your doctor is right, there is no test for HPV; but HPV is not likely to be the problem. 2&3) Usually a wart looks like a wart; not just redness.  And warts are not painful. 4) As I said above, HSV may be possible but is unlikely.  But it wouldn't be a bad idea to be tested for it.

Good luck--  HHH, MD