Hello - thanks for asking your question.
You note dysuria. Antibiotics include doxycycline, cipro, bactrim. You have been to 2 urologists and a dermatologist. Other medications include neurontin, amitriptyline, flomax, and lidocaine.
Please note my limitations since I have not examined you - 3 physicians who have did not have success.
Here are some considerations. You may want to be evaluated for prostatitis. This involves taking urine specimens and prostatic secretions before and after prostatic message. Make sure that any bacteria is sensitive to the antibiotic you are taking. Typically in chronic prostatitis 4-12 weeks of antibiotics are indicated.
An anatomical abnormality such as a urethral stricture or polyp are also considerations. Cystoscopy or IVP should be considered in conjunction with your urologist.
Finally, you may also want to consider a referral to a neurologist if all the tests are negative. They would evaluate for any nerve disorder causing your discomfort.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.