Nonchlamydial/nongonococcal urethritis

[ct2733]

I woke up last Wednsday with a severe burning sensation in my penis during urination. I went to the ER that night because it hurt so bad. I thought it was a UTI. However that test came back negative. The nurse practitioner thought I had chlamydia/gonorrhea and prescribed me one pill of Cipro and one dose(four pills) of Zithromax. I took both that night. I then heard two days later that my chlamydia/gonorrhea tests were negative, which was good news. Friday night I was drinking plenty of water and juice and my symptoms started to fee better if not almost gone. I thought I was getting better. Then Saturday I woke up and the burning was back. So I went to urgent care where they prescribed me doxycycline. Today is Monday and I still have burning during urination. It seems a little more tolerable than when I first had it, but I don't know if I'm just used to it or better hydrated now.Last night I was drinking plenty of water etc again and the symptoms cleared then , but are back again today. I would have thought the burning woud be gone by now if the antibiotics I was prescribed were the right ones. After reading some studies online the cause could be mycoplasmas and ureaplasmas. Before I get to my questions here is my history. Five days before I came down with my symptoms I had unprotected sex with a coworker. She has tested negative for everything. However she has a history of bacterial vaginosis secondary to being on prednisone, which she is on currently and has been for several years. She also states that a week and a half prior to us having sex she was having some irritation in her vagina and she went to the Dr. and got tested. Eveything came back negative. So we were thinking maybe she has an imbalance of the normal flora that passed on to me causing the urethritis. So my questions are.........what pathogen do you believe it could be? What antibiotic should I be on? How long does it take before the burning goes away? Thanks for the advice..............

[H. Hunter Handsfield, M.D.]

The severity of your symptoms is atypical for all the bacterial causes of urethritis, except for gonorrhea.  It is rare that chlamydia or that NGU cause pain as the primary symptom; and even with gonorrhea, the discharge usually is more prominent than pain.  Trichomonas, an occasional cause of symptomatic urethritis in men, also tends to be mild (usually asymptomatic).  Further, aside from trich, all bacterial causes would normally respond to the antibiotics you have had.

So if an infection is the cause, I suspect it is viral.  Herpes is possible and typically causes the severe sort of symptoms you describe.  However, most cases of herpetic urethritis are associated with other evidence of a new HSV infection, i.e. blisters/sores on the penis.  Up to 5% of NGU cases are caused by certain strains of adenovirus, usually associated with respiratory infection.  Adenovirus would be especially likely if you or your partner also have other signs of a sore throat or cold, especially if accompanied by conjunctivitis (pinkeye).  It isn't associated with BV or other vaginal infection.

If it's herpes, anti-herpes therapy might help, but it might be to late to make a difference.  If adenovirus, there is no treatment.  Despite the up and down course, it sounds like things are getting better overall. I sugggest you discuss these possibilities with your personal health care provider.  But if it isn't herpes and if the symptoms continue to improve, most likely you can chalk it up as unknown but not harmful in the long run.

I hope this helps.  Best wishes--  HHH, MD