So first - let's address your genital symptoms, then your tongue.
When I first read your symptoms, and that you had some white blood cells, I thought NGU, which is an infection in your urethra. This can be caused by normal mouth bacteria entering the urethra. Azithromycin and doxy should cure it, though. Has anyone taken a swab of your urethra and cultured it to see if bacteria grows?
My other thought was prostate, and your enlarged prostate could explain it. Are they doing any further testing, like a PSA or ultrasound to rule out cancer or BPH? https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087
Nothing you describe about your tongue would be from an STD. It wouldn't be a surprise if you got oral yeast (thrush) from taking all the antibiotics, though. If you use your toothbrush, or a tongue scraper, are you able to remove any of this whiteness?
I think you should stick with the urologist. Get some continuity of care.
Thanks for the reply auntiejessi. I considered NGU as well after reading many posts on here but saw that the treatment was azithromycin and doxy so figured since they didn't help it would have ruled NGU out. No swab of the urethra has been taken. The NP at the urologist office did mention the possibility of a cystoscopy if there is no improvement in two months. My PSA is normal. Nobody has suggested an ultrasound.
As I mentioned in my original post, her last theory was perhaps HPV based on a very tiny bump. She prescribed podofilox and stated that if the bump went away after using this it would confirm the diagnosis. I just picked it up today but have not started using it. Any thoughts about this? What are the odds of getting HPV from receiving maybe two minutes of unprotected oral?
I'm glad to hear you don't think what's going on with my tongue and mouth is related to an STD. The whiteness doesn't really come off with a toothbrush. It's not the cottage cheese-like appearance that I've seen in some pictures. More just a general whiteness over most of my tongue. Saw my regular PCP today. He suggested another round of Nystatin liquid but this time twice per day for two weeks (instead of 4x/day like I did before). So I will give that another shot. He also prescribed ketoconazole 2% cream to apply to the redness on my shaft.
Thanks again for your expertise!
A urine screen isn't a true test for NGU, really you should have a sample taken from inside your urethra looked at under a microscope for white blood cells. It's pretty quick and easy. The doxy and azithro should clear NGU, but there are some infections that have become resistant. But if your symptoms have subsided after the meds you're most likely fine.
I thought I would provide an update. It has now been over 4 months that I've been having this issue. While it is better than the first few weeks, it still persists. The main symptoms over the last couple of weeks has been burning on either side of the frenulum, redness along that underside part of the shaft and burning on certain parts of my scrotum. These symptoms come and go although the redness is there most of the time. I am also still having the white on my tongue and occasional sore gums and lips.
Thinking this still might be a persistent fungal infection I have been using the ketaconozole cream on my penis for more than 6 weeks without improvement. I have also been on clotrimazole lozenges for about 10 days- prescribed by my PCP who referred me to an ENT but can't get an appt until January. I have also tried following the candida diet. I was strict with it for two weeks but have since eased up some. I still avoid sugar for the most part. I have also tried using coconut oil- a home remedy I read about online.
I also have an appointment with a dermatologist in two weeks. Given all of the antifungals I've tried I'm not convinced it is a fungal infection. But not sure what else it could be? I've read about burning scrotum syndrome. Another thread on here said burning can be a symptom of prostatitis. Seems like there should be some kind of test that could definitively diagnose this.
Had the standard STD testing early on and all came back negative. Any reason to think this could be some kind of an STD? Open to any and all input!