[Question #3027] Burning Urethra / Red Glans

38 months ago
Hi Doctor,

I'm a 23-year-old circumcised male and had unprotected vaginal sex 2 years ago. A little over one month after that I started experiencing burning in the urethra, both during urination and after urination. I also may notice it when my bladder gets full. This symptom has been persistent over the last two years. There are some days when I notice it and some days when I don't as much but seems rather random. Another equally concerning symptom for me has been red irritated glans on the entire top of the penis head. This symptom has persisted as well, with some days worse than others. The redness can be blotchy and has tiny bumps which look very similar to pearly penile papules. It can feel a little sensitive at times.  I also experience leaking/dripping after urination. I've never had any discharge that I've noticed.

I started off going to 2 different clinics and tested negative Chlamydia, Gonorrhea, HIV, Syphilis. I have also tested negative twice for mycoplasma genitalium and ureaplasma (one at a LabCorp facility and one self-test) using tests that claim to use NAAT technology. A couple months ago I went to a urologist who performed a urinalysis and urine culture test, as well as a physical examination. The urinalysis wasn't "perfectly clean" but he said that was normal and was confident in that after the urine culture was clean. He seemed to blame my problems on Meatal Stenosis. 

Treatments:  I have been treated with Rocephin and 1G Azithromycin,  1.5G Azithromycin, and Doxycycline. I also took medicine that would cure trichomonas. I have also used clotrimazole creams for possible yeast infection.

Questions:
1)  What do you think my next step should be?
2)  Should I try to get a swab test to look for signs of NGU?
3)  What could be causing the red glans?  NGU? HPV? Irritation from urine dripping? Overuse of topicals?
4)  Do you think its safe for me to be sexually active?

Let me know if you have any questions or anything I might have left out. Thanks!

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

Unfortunately, I don't think we can help very much. Such symptoms are not uncommon in men after potentially unsafe sexual exposures, but as best we know they are not caused by any infection. If you were a pateint in my clinic, we would have recommended pretty much all the tests you had. In addition to negative test results, all the known STDs that might cause such symptoms would have responded to one or more of the treatments you reeceived. Many if not all such cases are probably psychological in origin, i.e. anxiety or stress over a regretted sexual exposure magnifying trivial symptoms that otherwise would be dismissed or even not noticed, or normal genital sensations. To your specific questions:

1) The good news is that in my 40 years of STD experience, or in the reported literature, no men with symptoms like yours have any serious consequences:  no infertility, cancer, or other bad outcomes; and no consequences for current or future sex partners. Therefore, the normal advice -- and my advice to you -- is to cease any further attempts at diagnosis or treatment and to just live with your symptoms. In most such cases, the symptoms fade with time, as it sinks in that nothing serious is happening.

2) Contrary to what you think you have learned online, NGU has never been documented to cause symptoms of this sort. Also, NGU not associated with defined pathogens (chlamydia, M genitalium, etc) is believed to be harmless, hence nothing to worry much about.

3) My guess is that nothing is wrong. And what would it matter if your glans penis were a little redder than it used to be? If you are convinced this is abnormal or a change, I would suggest seeing a dermatologist. But I suspect that nothing would come of it.

4) Not onlly is it safe, I would recommend renewed sexual activity as probably a good thing. It certainly will not put partners at risk for any known health problem.

Sorry that I can't come up with a specific diagnosis, but I am confident you have nothing serious. I hope that alone will be helpful. Let me know if anything isn't clear.

HHH, MD

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38 months ago
Thank you, doctor. This and many of your responses to others have been very helpful to me.
 I have experienced stress and anxiety over this exposure, but it seems weird that the glans and meatus would continue to be red and irritated for so long.  I guess I just need to move on and remind myself nothing is wrong. Thank you again

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for the thanks. I'm glad to have helped.

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