[Question #10892] Milk Colored Urine with high urge to urinate

18 months ago

I am a 42 year-old heterosexual male and, on occasion (maybe once a year or every other year), I get a sudden and intense urge to urinate. When I relieve myself, the first part of the void's color is normal. When The void starts up again, my urine is milk/colored white. Typically, the next 12 hours I will have an urge to frequently urinate, but the urine is normal colored. The frequent urge to urinate goes away within 24 hours or less. I don't have any pain when I urinate. My STD tests have been negative. My GP stated my milk-colored urine is not discharge. He stated my symptoms do not seem like an STD because they only manifest themselves for 24 hours and then go away on their own. He immediately dismissed HSV due to a lack of history with outbreaks. I was nervous this could be herpetic urethritis. He stated herpetic urethritis would be more severe and would not come and go. My GP is of the opinion that this is more related to my sporting activities (I do martial arts) and dehydration. My questions are 1) Do you agree with my GP that these symptoms are not related to an STD? 2) Is milk-colored urine a symptom of any STDs? 3) Could this be herpes?

H. Hunter Handsfield, MD

18 months ago

Welcome to the forum. Thank you for your confidence in our services.

I agree with your GP. You have no STD. There are no STDs that cause cloudy or milky urine. The main cause of urine cloudiness is the presence of phosphate crystals in the urine, which is caused by changes in diet and fluid intake. On the other hand, this is unlikely to explain cloudiness only during the second part of voiding, and it is possible you have a non STD urinary tract infection. Prostatitis (i.e. infection/inflammation in the prostate gland) might be responsible, although your symptoms really aren't typical for this problem either. And prostatitis is not commonly caused by any STD. (Going back to phosphate crystals, you can try adding a few drops of acid, like vinegar or lemon juice, to a sample of your milky/cloudy urine. If it's phosphate crystals, the urine will instantly clear.)

I am surprised you don't mention urinalysis. If not yet done, ask your doctor about urinalysis on both the first part of your urine (clear) and later part (milky/cloudy).

Herpetic urethritis occurs mostly in men with obvious external herpes lesions of the penis, but not always. But other things also are against herpes. Among other things, it is exceedingly painful; each episode would last 1-2 weeks, with severe urinary pain the whole time, then would clear up entirely; and would not cause milky urine.

Those comments pretty well answer all three of your questions, but to be crystal clear: 1) I agree with your GP; these are not STD symptoms. 2) No STD causes milky or cloudy urine. 3) There is no possibility this is herpes.

My advice is to keep discussing this with your GP, including my comments. If s/he agrees prostatitis is possible but not highly experienced with it, discuss possible referral to a urologist.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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18 months ago

Thank you for your response, Dr. My initial question was flagged for being too long, so I tried to be as concise as possible. I had a urinalysis done. The results were normal. That being said, these instances with milk-colored urine are one-off events, and by the time I get in for an appointment, the symptoms are gone. I have reached out to my GP concerning prostatitis being a possibility.

With regards to herpes. I have been in several long-term monogamous relationships. However, I have also had several shorter-term relationships. I discuss STDs with all my potential partners, but as you know many people don't even know they have HSV. I think it's statistically impossible that I have not been exposed to HSV-2, but my GP seems to not think of it as much of a concern. I suffer from diagnosed OCD and would definitely not miss an outbreak (no matter how mild). I have oral HSV-1 and when it manifests, it is almost textbook with clustered blisters that form, burst and then scab over about 10 days. Would having HSV-1 cause a primary HSV-2 outbreak to be milder? This is probably my OCD talking because my rational brain does not believe I have HSV-2. Thank you again for the service you provide.

H. Hunter Handsfield, MD

18 months ago

You can always save a specimen of cloudy urine; it would keep in the refrigerator for a few days before urinalysis is done. Or use it to test for phosphates as suggested above.

I agree you likely have been sexually exposed to partners with HSV2. So what? Same for most sexually active persons. The average transmission risk for a single episode of unprotected vaginal sex with an HSV2 infected female partner is around one chance in a thousand. Since it is very unlikely you have had hundreds of exposures to infected partners, and have had no symptoms to suggest genital herpes, you can safely assume you do not have it. Yes HSV1 can reduce the severity of HSV2 if acquired, but it also reduces the chance of HSV2 infection itself. There is absolutely no basis for suspicion you have HSV2: Listen to your "rational brain"!

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