[Question #5138] White lesions in Urethra

24 months ago
Hi please help.
I am male 36 years. After 2 days of brief unprotected oral sex exposure for 10 seconds, mouth to Penis. I started having discomfort in my urethra and after 4 days of exposure, that discomfort turned into burning in the urethra. Went to the urgent care they gave me a shot and prescribed Doxy, within 1 day of taking Doxy the burning sensation in urethra gone. However, I was still continuing my Doxy Antibiotics which was given for 10 days. But to my surprise the burning sensation came back within 2 days while taking Doxy and it continued, on 10th day of exposure I opened the urethra and found White lesions in urethra (in the urethra opening) covering urethra top and bottom, not shallow or raised but just like the flat ulcer type. got panicked and went to my GP got the swab test for Herpes - came back negative. after 12 weeks of exposure IGG blood test was negative for HSV1 and HSV2. But the white lesions are still there it's been 5 months, now the burning sensation occasionally I get it after I pee and sometimes there is irritation like itching. I am worried about the lesions still there. right now my 80% of opening of the urethra has off-white lesions and it's itchy and raw wound like feeling. One day it seems they are going away and one day they seem like still the same. I am confused. Is this some type of HPV if it's not Herpes. Please advice. Appreciate your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Welcome to our Forum.  I'll be glad to comment based on the information you have provided.  

1.  following your receipt of oral sex you may have had urethritis, most likely non-gonococcal urethritis.  Recommended therapy for NGU is doxycycline and I suspect the shot you received was ceftriaxone, meant to cure possible gonorrhea.  Without testing, there is no way to know what was there but we can say that you have received recommended therapy for the most likely diagnosis.  Your history suggests that you responded to the therapy.
2.  You can be completely sure you did not acquire herpes.  The presentation you describe is not typical for herpes and you have both swab tests and blood tests that are negative.  Be confident that you did not acquire herpes.
3.  The white urethral lesions you describe could be almost anything except an STI (other than perhaps HPV).  To have these lesions evaluated you should see a urologist who can guide further evaluation.  If the urologist thinks they are problematic, he may choose to biopsy the lesions.
4.  The intermittent burning after urination and itch that you describe are more likely due to your heightened awareness and looking for abnormalities than any STI.  STIs do not cause intermittent symptoms and it is quite typical for persons who are concerned about possible STIs to become aware of otherwise normal sensations which might otherwise be overlooked if you were not worried.

I hope these comments are helpful.  Bottom line, be confident that you do not have herpes, see a urologist for further evaluation.  Whatever is going on is unlikely to be related to your brief receipt of oral sex.  EWH
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24 months ago
Thank you for the response Doctor. So, are you suspecting this could be HPV?  Can the HPV be transmitted through Oral? I am scared of infecting my partner. I need to talk to my Urologist. 2 months ago when I went to Urologist, he did a Cystoscopy and did not take any biopsy, said nothing pathological found so didn't take any sample. However, I was reading online and found there is testing we can do at home, called vinegar testing for HPV. I noticed a smooth area just at the bottom of the foreskin which sometimes turn reddish only when I masturbate or have sex which was not there before, this is something I recently noticed. So, I sprayed the vinegar all around my genital area and to my surprise that smooth area turned whitish. So I am kind of terrified about the HPV. Please advice. appreciate your help. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
I think you are over interpreting my assessment and the additional information you provide reinforces my opinion.  I DID NOT suggest this is HPV and I do not know what this might be.  The FACT that you were seen by a urologist who did not see anything of concern is strong evidence that there is not a problem here and that your concern is causing you to interpret as abnormal and that the symptoms you are expressing are normal variation.

I'm sorry to hear that you have gone to the internet and have been mislead by what you found there. The vinegar "test" is often misleading and tends to demonstrate nonpathological, non-specific findings.  Given your continuing concerns, my advice is to seek evaluation with another urologist. If that trained expert also feels that there is northing abnormal, I urge you to accept this interpretation and move forward, doing your best not to worry.  EWH 
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24 months ago
Thanks for the advice dr Hook,  I will schedule an appointment with another Urologist.  Appreciate your help.