[Question #4222] Persistent Burning and Inflammation

83 months ago

April 11th I had unprotected oral and protected vaginal sex. Symptoms occurred 5 days later and have been persistent. Since then i have had three std panels of which i have been positive for only HSV1 which I had previously known and negative for: HEP A, HEP B, HEP C, HSV2 IGG, HIV 1 RNA,Chlamydia, Gonorrhea, Syphilis and TRICH. Last STD test was 16 weeks after exposure.

Three separate urinalysis have been negative.

Prostate PSA levels in range.

I have seen two GPs, two dermatologist, and a urologist which prescribed these medications:

DOXYCYCLINE 100mg 2x 7 days

AZITHROMYCIN 1 G

KETOCONAZOLE CREAM

MOXYFLOXACIN 400mg 7 days

CIPROFLOXACIN - 500mg 2x 28 days

FLUCONOZALE - 200mg

ROCEPHINE Shot

AZITHROMYCIN 2G.

METRONIDAZOLE

LEVOFLOXACIN - 500MG 2 weeks

TRIAMCINOLONE OINTMENT

SYMPTOMS:

Burning pain and Inflammation of entire Penis Head (Meatus) not just tip.

Only mild burning during urination on occasion. Irritation of urethra is noticeable a few minutes after urination.

This inflammation (icy/hot feeling) of meatus persists all day. Burning almost feels like it is on skin but it is not.

Burning heat radiates to scrotum and perineum area.

Crawly pin prick feel sometimes in urethra in head of penis.

Discomfort is not localized in specific spot.

Not increased frequency to urinate.

No Itching.

No discharge.

Not tender to touch.

Visibly red splotchy discolored inflammation on head of penis comes and goes. Inflammation is not raised or locally pinpointed. Almost like heat rash. Slightly red tip comes and goes. Scrotum gets red.In the morning most all physical signs of inflammation are gone, but burning and discomfort pain still there.

QUESTIONS

What would visible inflammation and burning of the meatus be a sign of? Burning of scrotum and perianum?

Do I need to get a swab for a more accurate Mycoplasma and Ureaplasma test or are the current urine test adequate?

Do these symptoms match a prostatitis prognosis? What else?

H. Hunter Handsfield, MD

83 months ago

Welcome to the forum. Thanks for your question.

Unfortunately, I can't help very much. It seems very clear you have no STD or any other infection from the sexual exposure described. Your negative tests all are valid and conclusive, plus the fact that the multiple treatments you had would have taken care of the problem if an STD or any other infection were responsible. And in any case, most of the symptoms described are not typical of infection. To your specific questions:

1) "Visible inflammation" is subjective. In my experience, the large majority of men who believe their meatuses are inflamed in this situation look entirely normal to my examination. Often such symptoms are the result of anxiety or other emotional factors (e.g. because of a regretted sexual decision) magnifying minor symptoms or even normal body sensations that otherwise would not be bothersome and perhaps not even noticed.

2) Mycoplasma and ureaplasma don't cause symptoms like yours. Ureaplasma is normal in the genital tract, and only some types of mycoplasma cause known symptoms, specifically Mycoplasma genitalium. But if you had either of them, one or more of the antibiotics you took would have cured it and relieved your symptoms.

3) This doesn't sound like prostatitis to me.

Perhaps most important, in nearly 40 years of caring for many men with this sort of problem, I have never once seen or heard of any patient who turned out to have anything serious. Nobody with these problems later turned up with infertility, cancer, urethral stricture, epididymitis, or any other complication of the sort that can follow genital STDs and other infections. So whatever is going on clearly is harmless. I strongly advise that you cease any further attempts at diagnosis or treatment and just sit tight for at least a few months. In most such men, the symptoms eventually fade away.

I hope this information is helpful, but let me know if anything isn't clear. Good luck to you.

HHH, MD

---

H. Hunter Handsfield, MD

83 months ago

Also, if you have a regular sex partner continue (or resume) your usual sexual practices. Sometimes regular sexual activity seems to be beneficial in these situation. There is no possibility you have anything that would in any way harm a sex partner.---