[Question #3626] Urinalysis Accuracy

34 months ago
Hi Dr. H, Sorry to be back, but it's not with "what if" questions. This question is for a bit more scientific clarity. I've experienced irritation/pain/burning at the penis tip and urethra from 2.5 weeks to the current 4 weeks after oral sex exposure, worse at some times in what seems to be later in the day.  There has been no discharge, and it does not hurt when I urinate, although the penis tip appears to be a bit red.  

Rather than ignore these very real sensations as just anxiety induced, I sought out WBC testing to be sure. I called the local Planned Parenthood and they only do standard urine testing and knew nothing about NGU or testing for urethritis. I went to my GP, and they had me do a urinalysis. I had not urinated in just over 4.5 hours, and collected the first amount in the cup. With their on-site testing, I assume dipstick, they said there was no sign of any infectious issue and all indications were good. I pushed a bit more about swab/microscope but they said no need. I don't feel she was very educated about it, and she was steadfast in the in-office urinalysis being accurate. No prescriptions were recommended, and only Alleve was suggested for inflammation if necessary. She did not even do an inspection as I've reported no discharge and her faith in the urinalysis outweighed that anyhow. 

1. How accurate are in-house urinalysis tests at a GP office? It seems like they cover a wide variety of things, and are used as a first-line testing method. I specifically asked about WBC and she said the test covers Leukocytes, which mine were normal. Would an infection have been picked up here, or do I need to push for a swab/microscope test, which I'm not sure they do? 

2. Even with the initial relief that nothing was found, I still experienced the same symptoms over the weekend, after the anxiety of something being wrong had apparently been proven misguided. Do I just ignore it and hope it goes away? 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome back to the site.  On this occasion I will be addressing your concerns.  I have reviewed both of your earlier interactions with Dr. Handsfield this month and agree with all that he has said, particularly his statement on several occasions that you are overthinking this.  You really need to put your groundless fears aside.  With that, brief answers to your questions:

Penile tip discomfort is not a sign of any STI unless clearly visible lesions are present.  For the tip of your penis to be "a bit" red is likely a manifestation of you paying far closer attention to your penis than is the norm, perhaps coupled with irritation from repeated self examination.

1.  The dipstick urine test is not quite as sensitive for detection of white blood cells within the urethra but is a very good test.  That you had not voided for over 4 hours before the urine was collected would increase the accuracy of the test.  If you had NGU (something your symptoms do not support) the urine test would most likely have been abnormal.

2.  Your question suggests that the symptoms you are experiencing are intermittent.  If that is the case, then it almost completely assures that you are not experiencing STD symptoms.  That being the case, my recommendation would be to move forward without concern, without further testing, and without antibiotics.  EWH
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34 months ago
Thank you doctor. To clarify:

- If there is no discharge or pain when urinating, even if there is urethra discomfort present, it’s unlikely to be caused by NGU? (by intermittent, I meant it can be more pronounced at times)

- With just urethra discomfort, and a burning feeling at the tip, the urinalysis should have been good enough to detect something if it were indeed due to NGU? 

- Could NGU be just inflammatory and not cause infectious symptoms like discharge or urinary pain? 

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
It almost sounds like you want to have NGU.  
1.  Correct, your symptoms do not suggest NGU.
2.  Please re-read my original response.  The urinalysis is not a perfect test but given that your symptoms do not suggest NGU and that your urinalysis does not suggest NGU (I.e.no WBCs detected) there is no evidence that you have NGU.
3.  No, by definition NGU has discharge, burning on urination, and/or detectable WBCs
EWH
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34 months ago
No, I absolutely do not want NGU, I want my discomfort to go away. I am still experiencing daily urethra and penis tip discomfort. The tip is red and the area around the opening is somewhat raised and red. The urethra itself feels uncomfortable/burning. No pain when urinating, no discharge.  I’m at a loss, as when not even thinking about it or reading your past advice that nothing is wrong, it still hurts. I’ve never experienced this discomfort and it just can’t be coincidental to this incident. 

- What would you recommend as a next step? Should I return to my GP? Should I ask for antibiotics? I’m not sure what their level of understanding will be about this. 

- What about sex moving forward? I believe it’s ok since it can’t be related to chlam/gon with my negative testing. 

Sorry to be repetitive with my last avail question. These symptoms started 2.5 weeks past exposure and it’s now 4.5 weeks and nothing has changed. I just want some relief and definitive assurance nothing is wrong. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Your symptoms do not suggest STI and there is little reason to be worried about them.  I am doubtful that antibiotics are going to help and they could add to urination (through fungal superinfection or side effect).  Your could try your GP but I suspect he/she has little more to offer.  If I were going to see anyone else, I would probably see a dermatologist. 

I would have no concerns about sexual activity with your regular partner.

As you know, we provide up to three responses to clients. this is the 3rd. Thus this thread will be closed without further comment in a few hours.  Take care.  I wish you well.  EWH
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