Constant Burning In Urethra

[Piton]

I am a healthy 39 year old male with no prior health issues. I have a very high sex drive, and have sex with my wife approximately 3 times per week, as well as masturbating another 2 to 3 times per week. Approximately 6 weeks ago, after having been affected by a bout of the flu, which had left my sinuses inflamed and infected, and I was having constant post nasal drip which was affecting my throat (however, I am not one to jump on antibiotics right away, and decided to allow my body to fight it) I masturbated 2 or 3 times in addition to having sex with my wife over a 3 day period, the next day I began to have significant discomfort and burning when urinating. It progessively got worse throughout the day and I began passing bright red blood when urinating in the evening with significant pain. I had I went to see my general practitioner the next day who tested my urine with a dipstick and found a significant quantity of blood (eventhough none was visible in the sample) and signs of infection. She felt that it was a sure sign of a UTI and perscribed me with a 7 day couse of Cipro. The symptoms subsided, and a urine analysis was conducted on the 6th day with no evidence of blood or infection found by the lab. Approximately 2 1/2 weeks later I masturbated twice in one day and then had sex with my wife, who happened to be on her period. The next morning I began to feel burning in my urethra again and began to pass blood in my urine again. My GP had given me an extra supply of antibiotics to travel with since I was away and I took one right away. The next day I went for a urine analysis, a blood test to test my PSA levels, and an ultrasound on my kidneys, bladder and prostate. My urine analysis came back normal except for a high WBC count of over 20, trace blood and no culture growth. My PSA levels were also normal, as well as my ultrasound which showed no evidence of any stones or abnormalities/polyps, and my bladder, prostate and kidneys normal. I went to see a urologist, who performed a digital rectal exam and found no evidence of an inflamed prostate. He believes that it was a UTI and the Cipro course that I had initially taken was to short, and put me back on Cipro for another 14 days. I just finished the second course of Cipro approximately 5 days ago, and while there is no visible evidence of any blood in my urine, I still have an almost constant mild burning/irritated feel in my urethra, especially near the tip of my penis, which usually gets a little more irritable after having sex or masturbating. I am starting to become very concerned, and would appreciate your opinion.  

[Dr Smitha Mathews]

Hi,

It appears that you have an infection of the prostate. This is a possibility even if you there was no apparent inflammation on the ultrasound. The other possibility is that you could have a kidney cyst that could be infected and keep releasing a certain load of bacteria into the urinary tract at intervals (this has been ruled out in the ultrasound?).

Additionally, in individuals in whom there are persistent symptoms of UTI but nor organism detected on urinalysis or culture it is best to test for chlamydia and mycoplasma. This is because these two infections occur as intracellular parasites and need specific antigen and culture tests for their detection.

The infective organisms may be located only within the prostate and/or kidney and come into the urethra during ejaculation. If they are not flushed away by urine, they would continue to be present in the urethra and try to grow there causing irritation and pain.

You may need to have another urinalysis done, preferably from a sample collected just after ejaculation. A prostate fluid analysis can also be done. This is to identify the organism causing the infection and may be followed by a culture sensitivity test to determine which antibiotic the organism is sensitive to.

Antibiotic therapy is prescribed for long durations in prostate infections in view of the poor permeability of the prostate gland to antibiotics. The course will be for about 15-21 days and may even be for a few weeks.

Ensure that you keep your fluid intake over 2000 ml per day and avoid irritants, such as caffeine, alcohol, and spicy foods. Also avoid sitting for long periods of time or on surfaces that are not well padded.

If you do indulge in intercourse during the period of treatment, ensure that you practise safe sex (condoms) so as to not infect or be infected by your partner.

Do keep us posted on your doubts and progress.

[Piton]

Please doctor, I would really appreciate your opinion.