Avatar universal

Undiagnosed penis tip pain

So, I posted in men's health, but found this section and thought I might have some luck.

I have been experiencing pain at the tip of my urethra, and on the top of my penis head, for about 2 months now. It feels more like a constant sting rather than a burning, and there is no discharge, or visible symptoms.

When I touch the top of my penis head, it is extremely sensitive, and sometimes the skin looks a little cracked, but other times it looks completely normal. It feels like a chaffing effect, but I only wear breathable cotton boxers, and have not caused any chaffing. There are no lesions or bumps, and while I keep the area clean, I do not use any soaps or irritants directly on it.

I am in a happy monogamous relationship, and have abstained from sex for a very long time (years before these symptoms began). I have completely normal urine flow, and it looks clear/yellow, and has been tested at nauseam.

I think it is important to add that I am HIV-1 positive and have been for about 3 years. I have been on ART medication and am/have remained undetectable since treatment right after diagnosis. I started by taking Tivicay and Descovy, and then when Biktarvy came out, I was switched to the single pill regiment. There was no complication with the switch and this seems to be unrelated to the medication, but given my technically suppressed immune system, I thought it was important to add.

I went to my doctor multiple times, and went to a urologist. This is what has been done with unsuccessful results:

Urgent Care Facility (Doctor Unavailable)
1) First urine test, to test for UTI- no leukocytes and negative
2) Second urine test, to test for gonorrhea/chlamydia- both negative
3) Diagnosed with bacterial prostatitis and put on 3 weeks of levofloxacin- no help

General Physician (2 Visits)
4) Third urine test, to microscopically test for stones- no blood or any evidence
5) Given oral anti-fungal in case of yeast infection from 3 weeks of antibiotics- test revealed no yeast infection, and oral anti-fungal did nothing

6) Fourth urine test- completely normal results
7) Gave me a prostate exam- completely normal results, but told me this could be lingering pain from chronic prostatitis

General Physician
8) Fifth urine test to check for c-reactive protein and any bacteria- both negative
9) Tested for Diabetes- negative

I have noticed the pain is usually isolated to the left side of the meatus. Urine flow is somewhat restricted, and there is a frequent urge to go.

Looking forward to hearing back, and maybe even getting some resolve. Thanks in advance.
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Avatar universal
To my limited urological knowledge, restriction of flow + NSU + chronic pain at tip = probably need cystoscopy...and perhaps repeat cultures for gonorrhea. Just mho....
Helpful - 0
Thanks for the feedback. I am going back to the urologist for imaging next week and they said if they don't see anything I will likely have to have a cystoscopy. Stay tuned.
Avatar universal
I think it is important to note that the pain tends to come and go every 2-3 days very randomly. If I masturbate, it comes on immediately and remains for at least 3 days, and I get a very red meatus. I am sure there is no fungal infection since they tested for that/gave me an oral anti-fungal, and I am sure there is no skin condition, because like I posted, it comes and goes. Right now, I feel okay, but I am certain by tonight or tomorrow, I will be back in pain again. When I take Advil, it does nothing at all. I think tylenol has helped a little, but not sure if it is a placebo.
Helpful - 0
Avatar universal
You have certainly done your due diligence. Good work.

It could be neuralgia of some sort...hard to diagnose, difficult to treat.

I don't have other suggestions, except one to try. That is to try a 2 week course of Pyridium. Pyridium is an over-the-counter urinary antiseptic and pain reliever. The downside is it turns your urine orange/red.

I am suggesting this purely as an empirical treatment, a shot in the dark. To me, it'd be worth a try.

Good luck.
Helpful - 0
Thanks for the response. I should note that during my very first visit to the urgent care facility, while awaiting the results of the gon/chly testing, they gave me Phenazopyridine. It unfortunately didn't do much more than stain my clothes and sheets as I have this post urination dribble issue. Would you recommend I see a nerve specialist- and if so how do I approach a situation like this? Most neurologists seem to focus on brain issues rather than penile issues.
You are correct. A neurologist probably wouldn't help but I don't know for sure.

Have you asked whether your dribbling and your pain could be connected? Have you had cystoscopy or urine flow tests? Just guessing perhaps you could have a urethral stricture.,

Sorry it's out of my area of expertise.

Wish you well....
The urologist actually said that if the swab comes back neg, and he does imaging and see nothing that I should go in for a cystoscopy. I guess I am just worried to go through with that test.
Not a pleasant test but he's the expert. Perhaps he can sedate or Propofol you for those few minutes.

If you have a stricture, then treatment is straightforward, not too difficult.

The key is to avoid discomfort. He can accomplish that for you. And have your pyridium ready with his permission.
The only thing that is troubling is that all the research I have done says that there would not be any pain at the tip of the meatus with a stricture- Just limited flow and retention. While I have some limited flow, I think it is just related to the non specific urethritis which we have not found the cause of yet. Plus there is no blood in my urine whatsoever which is another red flag. I worry about doing the cryptography and it causing additional complications.
1081992 tn?1389903637
Here's a thought: there is such a thing as sterile inflammation. I.e., there is no infectious agent.
Helpful - 0
Avatar universal
Get urine and penis checked by a urologist. Sorry you have such a problem.
Helpful - 0
It was checked by a urologist and he had no answers. He said it could have been lingering prostatits pain, but considering I did not have those symptoms, I felt that was just a brush off answer. He did a prostate exam and found nothing wrong- no inflammation and no bacterial discharge.

I am wondering if it is nerve related now.
Avatar universal
Sorry that post says 2 months, but it has now been 4 months of pain.
Helpful - 0
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