[Question #228] Persistent Urethral Post Void Irritation

95 months ago
 originally had a oral only exposure in Early October 2014 with a SW. Performed on me a male. 

39 years old, healthy, bmi 39, married\with partner 18 years.

I started feeling some urethra discomfort and post void irritation 

18/11/14 Full set of tests hiv, hep, gon, chlamydia, full suite, British inlcuding bloods, urine,  no urethra swab . All Negative 

returned to have a normal sex life with long term partner after this diagnosis 

14/1/15 Return clinic Chlamydia Gonohrea tests including oral swabs no urethra swab - All Negatie 

Long periods of anxiety and checking and still some sensation of post void irritation/drip but this comes and goes 

28/4/15 Revisit clinic - urine samples and I ask for Urethra swab haven't urinated for 8 -10 hours pre this (first thing in morning) and told some white blood cells so NGUNSU  present not sure how high a level prescribed 7 days Doxcycline Urine tests come back negative for Chlamydia and Gonorhea 
Take full course 

Extremly anxious start using condoms with partner, she has 1g azithromycin but no symptoms of anything ever 

9/6/15 revisit clinic urethral swab clear, full set of urines taken for CT, Gon VT,  all Negative 

1/9/15 Another set of urine test - includin MG UP, Syph, Chlamydia, Gonohrea - all clear 

Clinic now refusing any other treatment and have been reffered for mental health  for anxiety! 

Not having regular sex with long term partner. Causing us difficulties. 

Some days I feel OK, and others I can feel a discharge upon urination, worse with a bowel movement, irritation persists in urethra on some days, 

Can anyone think what else could be causing this after a year 5 sets of tests? 
Where else can I turn to other than the mental health/anxiety route? 

I'm not dreaming this stuff up. Up till tis point last year my life was ok, don't do the crime if you can't do the time, but I wish I could get this resolved and move on, i'm spiraling down into s dysfunctioning state. 

Any help would be much appreciated 

oh forgot a vasectomy in  Jan 15. 
95 months ago
Sorry couple of typos and further detail

BMI 29, normally healthy and active, no previous issues. alcohol consumption above weekly recommended 40 units plus.

When I get the urethral issue I can milk my penis and produce a clear fluid more viscose than urine. There's also a urine drip.

Ref bowel movement, the drip\discharge can defenetly be more pronounced during a bowel movement.

H. Hunter Handsfield, MD
95 months ago
Welcome to the forum. Thanks for your question.

To cut to the chase, I am confident you did not acquire any STD from the sexual exposure described; and on the off chance you did, for sure do not have any persisting STD now to explain your symptoms. Further, I think your doctors are on the right track in suspecting a psychological origin for your symptoms and their decision not to treat you with any further antibiotics. Those would be my exact recommendations if you were my patient.

Here is my reasoning. First, you had a low risk exposure. While some STDs can be acquired by oral sex, in general it is safe sex with very low risk for all STDs and zero for some. Second, your symptoms are not typical for any STD and never have been; while on the other hand, they are absolutely textbook typical for the symptoms of genitally focused anxiety. Third, having a few WBC in the urethra does not, in itself, warrant a diagnosis of NGU or any other STD. Entirely healthy men often have a few WBC in their urethras from time to time. Fourth, the lab tests for STDs other than NGU are highly accurate -- and you had multiple negative results. There is no chance they missed any infections. Fifth, if despite all this you in fact had NGU or some other STD, the treatments you had would have cleared them up. The persistence of your symptoms despite antibiotics is not evidence of a resistant infection; it is rather evidence you had no infection at all. Sixth, expression of fluid during defectation happens to many men from time to time and isn't in itself abnormal; it's just stool pressing on seminal vesicles and prostate as it passes through the rectum. Similarly, almost any guy can milk a little clear fluid from his urethra if he tries hard enough; and repeated efforts can actually increase mucus flow, making it easier than before.

This does not mean I believe you are "dreaming up" your symptoms. The pain and discomfort are not just in your head. The urinary urgency, genital or pelvic discomfort, and all other symptoms like yours have a physical cause -- specifically, tension in pelvic muscles. But that tension definitely can be (and usually is) the result of psychological factors. It's basically the same pain mechanism as a tension headache, which results from muscular tension (neck, scalp muscles, etc); nobody denies the pain is real, but in addition nobody denies that stress or anxiety cause it. Why should the genital area be any different?

So my advice is to just let this go. For sure you have nothing that will ever harm you or your current or any future sex partners. You should be having unprotected sex with your wife; it will probably do you more good than anything else I can think of. Humans sometimes have to live with unexplained aches and pains; it doesn't necessarily mean disease. If it continues to bother you, then professional counseling is the best next step. Whatever else, stop pursuing further attempts at medical diagnosis or treatment. It won't get you anywhere except to further  accelerate your "downward spiral" and dysfunction when it doesn't provide answers.

I hope this has been helpful. Best wishes--  HHH, MD

94 months ago
Thanks Dr. That's reassuring I'm most worried about Chlamydia as the intermittent discharge that I've seen has been clear. The exposure I had was oral only, I've read different advice on the effectiveness of Chamydia transfer via Oral? 

The reason I'm in a spin on this again is that my Wife has mentioned a sporadic hip pain which she's put down to jogging, she has mentioned it occasionally over the last 2 months which would be + 10 months since my exposure, can see in my original post I said how I'd resumed normal relations after the first STI suite of tests were negative. My Wife had 1 gram antibiotic as per original, would PID be causing hip pain only after 10 - 12 months? Would the antibiotic not have been effective in April.

I can't decide if I'm in 1. Denial and there is something wring despite all the science to the contrary or 2. I'm in a mental state.

Thanks again, what's your opinion on oral transfer Clhamydia and on PID?
H. Hunter Handsfield, MD
94 months ago
Chlamydia is very rarely transmitted by oral sex, both because it is rarely carried in the oral cavity and, when present, is uncommonly transmitted. Further, the chlamydia lab tests are highly accurate. Finally, you've been treated with doxycycline, which never fails against chlamydia. It is impossible you have it. Your symptoms don't change that, and your assumption that clear discharge somehow indicates chlamydia is wrong.

Your wife's symptoms also don't hint at an STD or any other consequence of the sexual exposure a year ago. And PID doesn't cause hip pain.

I can't say for sure the cause of all your symptoms, but many or most are almost certainly psychological in origin, as I said above. Whatever the cause, they are not from any infection from your sexual exposure. It seems very clear that your mind has conflated your axieties over a sexual choice you regret with the potential infectious consequences of that event. They are not the same. Deal with the former as you need to, but disregard the latter.

94 months ago
Dr. Thank you sincerly , this is a great service.

I've got some cbt coming up, hopefully I can use this as you suggest.

H. Hunter Handsfield, MD
94 months ago
Thanks for the thanks. Good luck with the therapy; you won't regret it. Take care and stay safe.