Urethritis but urinalysis negative

[dummy76]

Three weeks ago I had unprotected oral from a stripper.  About ten days later I began experiencing an increased urgency to urinate.  I went to my PCP on day 15 and tested negative for gonnorrea and chlamydia.  My urinalysis was also normal.  He setup a referral to a urologist for later this week.

Yesterday I began experiencing a burning sensation almost always at the tip of the penis with pain following urination or ejaculation.  The need to frequently urinate has gone - it is really more of a slight pain sensation.  

I went back to PCP and the urinalysis was negative again.  From reading this board I suspected NGU but the PCP said he wold have seen results in the urine.

What's your advise?  The PCP was suggesting psychosomatic pain but it hurts!

[Edward W Hook, MD]

For a male, the main STD risk associated with receipt of oral sex is acquiring gonorrhea, non-chlamydial NGU, or herpes due to HSV type 1.  You do not have lesions and if your pain was associated with herpes you would have lesions.  If you had gonorrhea, most likely the symptoms would be obvious and if your urine was tested for gonorrhea would have likely yielded a positive test result.  That leaves non-chlamydial NGU which would be diagnosed by the presence of white blood cells which are usually seen on urinalysis and would almost certainly be seen if a urethral swab were taken for Gram stain.  In persons with little inflammation, it is important that the swab (or urinalysis for that matter) be collected after one has not voided for at least 2 hours (voiding flushes the inflammation away).  

If, after collection of the specimens mentioned above, there is still no definitive evidence of infection, then I would side with your PCP.  We find it not at all unusual that when a person's anxieties about possible STDs are raised, they tend to turn their attention towards their genitals and in doing so tend to notice things (sensations, bumps, secretions, etc) that are totally normal but in other settings unnoticed.  If you have had all or most of the tests noted above, then it is time to stop testing and worrying and move on.

Hope this is helpful.  EWH

[dummy76]

I asked for a Gram stain at the second visit and the PCP said a urinalysis was adequate.  I did void approximately 90 minutes prior to the second test and 45 minutes prior to the first test.  With the first test I was trying to drink enough water to flush out anything that may be causing issues.

Thank you for your help.  I will continue to ask my PCP for a Gram stain.