[Question #3993] Penile discharge/pain

31 months ago

Hello,

I (27 year old male) had unprotected oral sex (BJ) with a female (no ejaculation in the mouth) followed by protected vaginal sex. Here is the timeline of the events/symptoms:

June 27 - Date of the event

June 28 - Noticed very small yellow discharge from the penis in the morning

This was followed by very small watery discharge here and there for the next 4-5 days until it increased enough to have me a put a paper towel in my underwear

July 5 - Saw a doctor and was prescribed one dose of azithromycin (4 tablets) based on my symptoms under the presumption that it was due to chlamydia. Gave my urine sample that day as well to test for gonnorhea and chlamydia.

July 12 - Test results came back as negative but the discharge increased a bit so I saw the doctor again who took a swab from my urethra to again test for chlamydia/gonnorhea just to double check since my symptoms persisted. He also wrote me a blood test to screen for HIV, Hep C and Syphillis. These results should be back this week. He said it may be a yeast infection but we would wait for the retest results.

July 13 to today - The discharge seems to have peaked where I need to change the paper towel every hour or so and have an increased urge to urinate. The tip of the penis is a bit swollen as well (I'm not circumcised) with a small. When I inspect my penis, the tip is constantly wet with fluid dripping (looks white but shows up as yellow on the paper towel). There is pain/burning when peeing sometimes, but not every time. My penis in general now feels sore to touch and there is discomfort in moving the foreskin front/back.

Between July 13 and today - I also went to the ER (I'm in Canada) since I was worried about the increased/constant discharge and my doctor wasn't available on the weekend. The doctor at the ER suggested that it may be balanitis for which there is a week long antibiotic course I could do but we decided to wait until my second test results were back. He did a quick prostate examination as well and all seemed fine there.

Based on the above, do you have any thoughts on what might be going on?

H. Hunter Handsfield, MD

31 months ago

Welcome to the forum. Thanks for your confidence in our services.

Clearly you have urethritis (urethral inflammation and/or infection). The unusual is the speed of onset: although urethritis is common after oral sex, onset after only a day is highly atypical; most cases show up 3-10 days after exposure (variable for different causes, discussed below). Are you otherwise sexually active, including a regular partner? If you had sex with anyone else in the 10-14 days before onset of symptoms, this problem could have been acquired from that person and not from the exposure you have described. Alternatively, perhaps the earliest discharge (the next day) was not from this problem; the later "watery discharge" is more typical of true urethritis. In any case, for the remainder of this reply, I will assume that event is the only potential source.

The main cause of urethritis from oral sex is nongonococcal urethritis (NGU) that probably is often due to entirely normal oral bacteria. Gonorrhea also is common. Chlamydia is almost never acquired from oral sex. Herpes due to HSV1, the main cause of oral herpes, is possible. So is infection with adenovirus, one of the many garden variety respiratory viruses. The negative gonorrhea and chlamydia tests also are conclusive, so for sure neither is the cause. Having mentioned herpes, it is unlikely in this case. Most herpes urethritis is accompanied by typical herpes blisters or open sores of the penis, which apparently you don't have.

Balanitis is inflammation of the head of the penis, usually meaning infection under the foreskin in uncircumcised men. It implies redness/inflammation of the head of the penis, but doesn't usually cause urethral discharge. This is something to clarify with the doctor you are seeing. But I am inclined to doubt it. As for prostatitis, it never was a serious consideration, but it's good to hear that was checked and didn't show anything.

What to do now? Standard advice is to treat NGU with either single dose azithromycin, as already done, or with doxycycline for a week (100 mg twice daily). Whichever is used, if it doesn't work, the other is recommended. Therefore, you now should be treated with doxycycline.

I hope this information is helpful. Let me know if anything isn't clear. You might consider printing out this reply as a framework for discussion with your doctor.

HHH, MD

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