Background:

I was treated a 20+ years ago for prostatitis (ofloxacin I believe) and had a urethrotomy about a decade ago for a urethral stricture which has relieved most symptoms for most of the past 10 years, although the prostate-like symptoms have come & gone over the years including the past couple months.

Currently:

I'm in my late 40s, single and sexually active. I take a standard STI panel (HIV, chlam/GC/syph) prior to engaging with new partners, including my most recent test in early Sept., which was negative for all of the above. I have never tested positive. Confident in my latest results, I recently began sexual relations with a new partner involving unprotected receptive oral & protected then later unprotected PIV.

Two weeks ago and about a week after my last sexual encounter, I noticed a one-time white discharge at my urethra as I was preparing to pee, which didn't return again in the ensuing days, but to be safe I retested for the above panel the following Monday (results again all negative). I felt confident in those results and had moved on until yesterday, when I again spotted another smattering of white discharge upon getting ready to pee. It's been about 24 hours and I have not seen this again since. 

Assessment:

I am confident in my two recent negative tests and mostly convinced that all of my current symptoms (ongoing discomfort in the perineum; discomfort at the tip after voiding) point to my prostate rather than NGU which per the Q&A on these pages would seem to be more persistent with the discharge. All symptoms also seem to resolve after a few days' break from sexual activity & ejaculation.

Advice: 

Do you agree with my assessment and what do you recommend I request of my provider if I make an appointment for these issues?

Thank you so much.

Yes, I agree with your assessment:  I doubt you have NGU. With urethritis, discharge generally is continuous; if intermittent, it's still usually noticeable several times over the day. Also, discharge tends to be most noticeable on arising in the morning, having not urinated overnight; and stains on the underwear also are common. Absent all those things, I doubt NGU or any other urethritis (e.g. chlamydia or gonorrhea).

You mention discharge prior to urination, but what about defecation? Sometimes stool plus straining can express semen from the seminal vesicles during bowel movements.

In view of the nature of your symptoms plus your negative recent STD testing, I think it's appropriate to follow-up with your own doctor (presumably a urologist?).

Let me know if this is helpful or if anything isn't clear.

HHH, MD

I have had small spots in my underwear at times from the discharge, but only at the same times I’ve seen it live at the tip of my urethra, so still only a couple times over the several weeks. The first time, I felt a bit of an “itch” and had to squeeze it out from further down in order to make its presence known (more evidence of prostatic source?). The second time it was just there when I took it out to pee. I don’t notice any at bowel movements but I take fiber supplements regularly and rarely have to strain. Sometimes though, I do feel stools brushing against my perineum on the way out in a way similar to how it feels when there’s been discharge. 

Thank you so much again for your advice, which I’ll use to guide my work up at my next appointment. I’ll try to save my last reply to share what we find out. 

Thanks for the thanks; I'm glad to have been of help. As you suspected, the additional information doesn't change my evaluation or advice. Feel free to let me know the outcome of your appointment, but be aware our professional advice ends once STDs and HIV are completely out of the picture. Barring a big surprise, I don't expect to have much in the way of further comments. (Also, any further comments will have to be within 4 weeks, at which time threads are closed routinely.)