[Question #3643] Medical Mystery for Male, 30

87 months ago

On 2/11, 2/24, and 3/3 I received unprotected oral.

3/4: Burn after urination at the tip of my penis (last inch of my urethra). Burn subsided, but during the next several days, random pains and itches in my urethra.

3/5 - 3/11: Dull burning sensation and tingling in urethra, getting worse.

3/12: Urgent care urine test + UTI (result: negative), given medications for Chlamydia and Gonorrhea, as the likely culprits. Feeling pains and swelling in my groin lymph nodes.

3/15: Full-panel STD blood test (result: negative).

3/15 – 3/19: Chills, low grade fever, swelling of scrotum, orchitis, discomfort urinating. Second round of blood testing (result: negative).

3/20 – 3/29: Urologist prescribed levofloxican for 10 days. Marked improvement.

3/30 – 4/6: Pains and discomfort subside and mostly back to normal.

4/7 – 4/9: Urethra burning increase again, but highly variable day to day.

4/10: Get another urine test + UTI at doctor, add mycoplasma test (result: all negative).

4/11 – 4/17: Epididymitis and referred pain into abdomen now.

4/18 – 4/22: Azithromycin (Z-pack) prescription by urologist. First day feeling better, but zero progress after that.

4/23: Prostate begins to swell for first time. Go on moxifloxacin 400mg (14-day) immediately.

4/24 – present: Modest progress on antibiotic, but occasional pains in urethra persist (same site of original burn). Prostate swelling halted.

It feels like this has a mind of its own. Some days it feels like it’s getting better, then it gets worse. It moves around. Perplexing. Tip of urethra feels like “ground zero.” Urologist thinks Mycoplasma might have been false negative due to collection method (swab preferred?). Could this be viral? A parasite? What should I do next? How will I know it’s better?

PLEASE HELP

Edward W. Hook M.D.

87 months ago

Welcome to our forum and thanks for your detailed account of your symptoms and the efforts to address them. I will try to help but I am not sure I have too much to add to the evaluation you have had so far. The symptoms or irritation at the tip of your penis following urination are not typical STI symptoms which tend to be present during urination and which are typically felt more broadly than just at the tip of the urethra. Further, for infection to move from the epididymis to the prostate is quite unusual (I have never heard of this happening in over 35 years of STI focused practice. Finally the array of antibiotics you have taken would have cured all bacterial STIs by this time, I do not think that an STI is the problem. Several additional comments:

1. This problem sounds more urological than anything else. working with the urologist is the right approach. I think that continuing your moxifloxacin makes great sense.

2. urine collected at the beginning of urination will diagnose much but not all Mycoplasma genitalium. A swab is the "gold standard" I am not suggesting swab at this time however as I would anticipate that the moxifloxacin might make your test negative even if that was the problem.

3. If the moxifloxacin does not provide lasting relief, another possibility to discuss with your urologist is the chronic pelvic pain syndrome (CPPS). Understanding of CPPS is still a work in progress. The best description is actually in Wikipedia. If this is the problem, antibiotics do not help.

I hope these comments are helpful. I know that syndromes of this sort can be quite frustration. I can also tell you that vigilance and looking for symptoms however is the wrong thing to do as this practice tends to make people aware of normal sensations which are present but are normally "filtered" our of our consciousness.

I hope these comments are helpful. I have little more to offer and think sticking with your urologist is probably the way to go. EWH.

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