[Question #3823] Occasional stinging in end of penis, frequent urination--mycoplasma?

33 months ago
Good morning,

About 12 days ago I had an unprotected anal encounter with another man. I was the insertive partner. The day after the encounter I went to an urgent care clinic and was given a shot of rocephin and 1 g of azithromycin. I also had some doxycycline that was about 6 months past its expiration date that I took for a week anyways. 

About a week after the encounter, I started feeling an almost-constant sensation near/in the tip of my penis. It does not burn when urinating, but afterwards it occasionally stings, and I feel an intermittent sensation near the urethral opening. I wouldn't describe it as pain per se but it is something. I have also been urinating frequently the last week or so--sometimes every hour. No discharge.

I became worried about mycoplasma so I started 7 days of moxifloxacin. I am 4 doses into it and my symptoms are still present. I have tested negative for gonorrhea and chlaymdia (at 4 days post exposure and 8 days post exposure), and my partner tested negative for everything.

This leads me to believe the only thing it could be is mycoplasma, which I've read is become increasingly resistant to antibiotic treatment. My questions are as follows:

1) Is it possible I could have failed treatment for gonorrhea or chlamydia but the tests are being rendered ineffective by the antibiotics? In other words, is it possible that I took antibiotics sufficient to hide chlamydia/gonorrhea from detectability by the tests but still be present in my system?

2) How long after exposure can I test for mycoplasma genitalium? I sent a urine sample today (~12 days post encounter) to be tested for mycoplasma, but is it possible to get a false negative either because it's too soon after the encounter or the moxifloxacin lowered the bacteria enough to not be picked up by the test?

3) Are there any other explanations for my symptoms? I understand trich does not colonize the rectum so I have not tested or treated for that. Should I?

I have a steady partner who I do not want to
33 months ago
Is there something I did wrong in this posting or did I not pay my fee properly? I see other contemporaneous posts have been addressed. Apologize for the impatience but my mind is fixated on this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome to the forum. Thanks for your confidence in our services.

My initial reactions are that almost certainly you have no STD, including Mycoplasma genitalium; and that you have been overtreated, and that the excess antibiotics might even be responsible for your symptoms. Although a case can be made for the initial treatment with ceftriaxone and azithromycin, neither the doxyccyline nor the moxilactam was likely to be helpful and might have been harmful. In any case, I'm pretty sure you have no urethral infection of any kind at this time. You do not meet any of the standard criteria by which such infections are diagnosed, i.e. presence of discharge; discomfort during urination but not other times; and professional exam that reveals excess white blood cells in the urethra. 

1) This question reflects a basic misunderstanding. If antibiotics make tests for bacterial infections negative, such as gonorrhea or chlamydia, they do so by curing the infection. They do not suppress positve tests without curing the infection. (They could do that for a few days, but if not cured, the tests would again become positive within a few more days.) In any case, chlamydia and gonorrhea are virtually always cured by the treatments you had. There was no need and really no point in being tested after those treatments. 

2) M. genitalium is not known to cause urethral pain without discharge. No STDs do that, or too rarely to be a realistic possibility. I would not have recommended such testing.

3) Correct, trichomonas is not known to infect the rectum or to ever be transmitted between male partners. Other explanations for your symptoms? Yeast infection is possible, triggered by over-treatment with broad spectrum antibiotics. Physical or chemical irritation of the urethra, whether from the sexual contact or some other cause. Referred pain from a prostate problem is a classic reason for pain at the tip of the urethra or penis. Non-STD urinary tract infection is among the most common medical problems following insertive anal sex, and so must be considered; and this also can involve the prostate (see above). Anxiety magnifying a minor symptom (or even normal body sensations) that you otherwise would ignore or not even notice is a reasonable possibility. A viral STD, especially herpes (or, less likely, adenovirus) is a slim possibility.

My advice at this time is to cease all antibiotic treatment; wait 1-2 weeks; and if your symptoms are persisting at that time (or if in the meantime you develop any other symptoms, especially discharge), see a doctor knowledgeable about STDs and genitourinary infections. At that time, it might be appropriate -- depending on symptoms at the time -- to evaluate for some of the problems mentioned above. In the meantime, do your best not to worry. The chance this reflects any health problem of potential danger to you or your regular partner is virtually zero.

You also need testing for HIV -- not that it would cause your symptoms, but obviously this was a high risk event in regard to HIV. It also risked syphilis -- but that's one of the infections that is now impossible given the antibiotics you have received. It's not worth even doing a blood test.

A couple of other take-home messages also should be obvious from my opening comments:  in the event of new exposures like this one, 1) use condoms! and 2) lay off the antibiotics until and unless an infection needing such treatment is diagnosed.

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

HHH, MD

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32 months ago
Dr. Handsfield,

Thanks for your informed response--I feel somewhat better now. There are a couple things I just can't shake from my mind though:
1) I have read some places that chlamydia can go into the prostate, the tissue of which is hard for antibiotics to penetrate. Is it possible that I got chlamydia, eradicated it from my urinary tract with treatment (thus resulting in the negative tests), but that it is still lurking my prostate causing the odd sensations in my penis (and, more importantly, able to be transmitted to my partner)?
2) Treatment failures. I know it's rare, but I live in a large southeastern city where there are billboards all over highlighting drug-proof gonorrhea, so it seems like I may be in a place that's on the "cutting edge" of unprecedented resistance to treatment of STDs.
3) Herpes. The tingling/pinprick sensation is always in the same spot on the head of my penis, which leads me to believe it's not psychological. I truly think there is something going on there--it just seems too coincidental for all this to happen now. Is an initial herpes outbreak ever limited to just tingling and pain for 4+ days without the eruption of lesions?
4) Discharge. I have not noticed any other than a bit of clear mucous-like fluid after a bowel movement this morning. I understand this is not itself indicative of a problem, but I've never noticed it before. I have tried milking my penis for more since then, but nothing comes out. In any event, is it possible the moxifloxacin, which I have stopped taking, suppressed but did not kill some NGU bacteria (such as mycoplasma gen)? There reports online (I be this phrase makes you cringe after all these years doing this) their symptoms improve slightly with moxifloxacin but then come back after ceasing treatment. Also, such discharge is not intermittent? I would be having it routinely, not just once a day?

Obviously, I am extremely concerned about giving my partner an infection (mainly an NGU-causing bacteria). I have spent over $1,000 so far on tests and even visited a urologist two days ago, who said my penis looks normal and that I am fine, but I have not yet received the results of the urine sample given during the visit. If there are elevated white blood cells, that will be very concerning. I will probably use my final post to update with those results, and I eagerly await your feedback on my follow-up questions in the interim. Thank you again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
1) From the earliest days after chlamydia was established as a cause of NGU (1970s) there were theories about its potential contribution to some cases of prostatitis. After innumerable research studies on the topic since then, such an association has never been proved. You can easily find claims online, but for the most part they should be ignored. In any case, the treatments you had would have eradicated chlamydia if you had it, including if it were in the prostate.

2) Indeed some areas of the US have high rates of gonorrhea drug resistance than others. But those are cautionary statements. All gonorrhea in the US responds to the treatments you received.

3) That the tingling is "always in the same spot" does not say anything about whether or not it is psychological in origin.

4) As you seem to already realize, this usually is not evidence of any infection.

So this information does not alter my opinions and advice above:  no treatment of any kind for 1-2 weeks, then follow-up again with your urologist. In the meantime, I suggest you trust the urologist and follow his advice. I'll be happy to comment one more time, preferably after further evaulation and no treatment in the meantime. But I won't have any further comments or advice until then. In the meantime, I suggest you also resume sex with your regular partner.  You're making way too much of all this and there is  absolutely no evidence you have anything that could harm him.
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32 months ago
Some new information to add: my test for mycoplasma (12 days post exposure) was negative and my urinalysis (11 days post) came back normal except for ketones. HIV RNA test negative at 11 days as well. I continue to experience an almost constant urge to urinate and there is still a strange, almost-constant sensation--akin to a sensitivity, tingling or pulsating (intermittently painful)  in my penis/urethra. Also some stinging in the tip of the urethra after voiding, although there is still no discharge or pain. 
So for my final queries:

1. As a point of clarification, my regular partner is female. Because a) she would like to have children in the future and b) I would like to be the one she has children with, I am extremely worried about passing her anything potentially harmful or symptom-causing. The main concern I have in this regard relates to nonchlamydial NGU. Should I undergo further testing for mycoplasma gen, ureaplasma u, gardenerella (sp?) to be sure I do not pass anything to her? Again, I am afraid all of the antibiotics I took may have compromised the accuracy of both the urinalysis and the various STD tests that were done.

2. I have come across many accounts of people experiencing similar symptoms after receiving oral sex (which I did, although it was not mentioned in the original comment). Assuming that I have NGU caused by some unknown pathogen or mycoplasma/ureaplasma, would it be transmissible to my regular female partner? I can deal with symptoms personally, but the last thing I want to do is make her deal with them.

3. Is HSV2 still a legitimate possibility? I haven't seen any lesions, but I have oral HSV1 so perhaps the initial outbreak was not as serious and consisted only of the odd penile tip sensations

In sum, I am just struggling to logically understand how these issues (weird penis sensations/pains, stinging after voiding, frequent trips to the toilet) could have coincidentally manifested themselves after an unwise unprotected encounter--they have to be linked. I truly feel something isn't right down there, and it is frustrating to be unable to pinpoint a cause and a solution. I appreciate your responses Dr. Handsfield, and I will do my best to take your advice and extensive knowledge to heart.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
1) The evidence is clear that you have no STD or other infection that could harm your partner or interfere with successful conception and healthy children. Antibiotics do not "compromise" the accuracy of the tests you had. It simply doesn't happen. (They can cure infection, and thus make tests negative. But they do not suppress test results without curing the problem. So a negative test is proof you were not infected at the time the test was done.)

2) NGU not due to chlamydia (or maybe Mycoplasma genitalium) is harmless for women. No worries even if you have it -- but for sure you do not. Stay away from websites that cater to people without answers to their medical problems. These are the most unreliable of all sources of information, hands down. Stick with professional or medically monitored sites.

3) No, HSV2 is not a legitimate possibility for such infections. Not in the slightest.

"struggling to logically understand how these issues (weird penis sensations/pains, stinging after voiding, frequent trips to the toilet) could have coincidentally manifested themselves after an unwise unprotected encounter--they have to be linked."  This shows you misunderstand my basic messages above. I AGREE THEY ARE LINKED!  But that doesn't mean an infection. The linkage is through the psychology of it all, i.e. anxiety over a regretted sexual decision making you more aware of trivial symptoms or even normal body sensations that you otherwise would not notice or would ignore. There is absolutely no evidence of any infection as the cause. Your best course is to pursue a normal life, including normal sexual relations (without warning or otherwise saying anything at all to your partner(s)) and to do it repeatedly. Not all symptoms mean disease! Over time, your symptoms probably will fade as it sinks in that nothing is wrong. And for goodness' sake stop searching online about your symptoms.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.


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