[Question #5622] Urethritis maybe?

19 months ago
So I started feeling like the very tip of my penis has been slightly more sensitive starting on Friday... 4 days ago. It also sometimes feels slightly irritated. I cant really describe it better than that. It's not severe, but it makes me want to reposition it.

I have had NGU (non specific) in the past... over a year ago. That was treated ( cant recall with what, sorry) and was gone. Ive had no symptoms between now and then and have had plenty of unprotected intercourse with my S/O since then. Neither of us experiencing symptoms, with her never experiencing any in several years.

I have no discharge, and it does not burn or hurt when I pee. No itch or anything visible other than the very tip sometimes looking a little red right at the opening... but it changes hour to hour and I'm thinking it's simply because I'm inspecting myself too much.

I had a brief unprotected encounter ( oral only for about a minute..  maybe less) with a CSW. We then had intercourse with a condom. This was 26 days before I started feeling this sensation.  That ia my only symptom like I said. Nothing visible, no discharge, no pain or burning ( idle or peeing), no itch.

Any chance this is anything to worry about? I dont feel like I would not have anxiety about the encounter due to it being cheating... but perhaps its subconscious?.. now that I believe I feel something I check VERY often... trying to see if I can squeeze out discharge, etc.

So is this likely nothing and I need to chill out? 
Could it be something?
Any chance it's stuck around from my very old NGU? And I've gotten it back from my s/o? Is this possible or likely given the length of time with no symptoms?

I was poorly informed and educated in the past... after reading several questions here, I guess my s/o should have been treated (i dont know if i mentioned but it was non specific... tested negative for chlam and gon)... so any thought that we have been passing this ngu back and forth for 14 to 18 months? She has never had symptoms. Or at l

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome back to the forum. I answered some questions about your NGU a little over two years ago -- different username and email, but the latter was sufficiently similar that it came up in a search of past threads. I'm afraid you're now in a situation that makes things quite difficult, both in understanding what's going on now and, perhaps most important, in what and when you're going to say to your significant other.

One reason I and most experts in the US like nongonococcal urethritis (NGU) rather than nonspecific urethritis (NSU) for exactly the same condition is that "nonspecific" makes it seem like not an infection and perhaps not imnportant; or that partners don't need treatment. Both assumptions are wrong. Of all urethritis, about 40% of cases are due to gonorrhea or chlamydia. The exact causes of the remaining cases are not completely understood -- but all are STDs and in all cases partners should be treated, which is what I advised last time. Could you and your SO have been sharing an infection, or passing it back and forth, all this time? Science doesn't have conclusive answers, but the answer is probably yes.

Based strictly on your symptoms, I would have believed you probably don't have urethritis again. I agree, as you suspect, that such symptoms often are due to anxeity, elevating awareness of minor symptoms or even normal body sensations that otherwise would be ignored or not even noticed. And you don't have discharge, as you did last time usually the main symptom. OTOH, your symptoms otherwise are similar as last time, and once again they came on a few weeks after sex outside your regular relationship, which was only partly condom protected. (This even was even higher risk, since apparently there was brief vaginal penetration without a condom.)

The fiirst step is to be professionally evaluated. See an STD expert; a health department clinic might be the best bet. (Your doctor last time apparently is not up to speed on these issues, otherwise s/he would have made it clear you had an STD and your SO needed examination, testing and treatment.) In addition to testing for gonorrhea and chlamydia (as well as syphliis and HIV), you need evaluation for white blood cells in your urethra. If you have urethritis, whether chlamydia, gonorrhea, or another episode of NGU, the way forward  will be clear:  examination, STD testing, and treatment of all partners in the past couple of months, including your SO. If you don't have anything, a case still could be made about examining and perhaps treating your SO. I can't say for sure it's necessary, but it is standard procedures in all such situations -- better safe than sorry, i.e. not to take chances that could harm your partner's health and perhaps lead to yet another round of symptoms in yourself.

One of my comments last time was that you weren't going to like some of my advice. That may be even more true this time. But this time I hope you'll take it. Your partner needs to understand what's going on here. (But don't jump the gun. Get evaluated yourself, so you can give her the clearest picture, including your current STD test resuls and full evaluation, whether or not you have a treatable infection.)

Good luck with it all--   HHH, MD
19 months ago
Thanks for the detailed reply.

You mentioned that there was brief penetration without a condom... perhaps it was a typo... there was NO vaginal penetration without a condom. Intercourse was protected. Only the brief oral was unprotected.

Does that change anything? I assume that misunderstanding is why you mention HIV screening.

I believe last time I asked the question, and then saw a 2nd doctor later that day or something... and subsequently forgot about my question... I never saw your reply.. 

but  I have read more stuff this time around. And now I know better. 

You are correct... this will be brutal. Not sure I'll make it out the other end. Any help is appreciated. You do great work here.

I look forward to your reply. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Yhanks for the clarificaitons. Your previous thread was no. 1590, if you'd like to see my comments back then.

I misunderstood your comments above -- I thought you had brief vaginal penetration. With only a very brief period of unprotected oral, your riks of any infection from the recent exposure is very low. This makes it more likely that your current sympotms are psychological, without actual urethritis. However, there is still the slim possibility ot infection from your SO. My advice for HIV is simply based on the standard recommendation that everyone having sex outside a mutually committed relationship should have STD testing from time to time, including HIV -- but this is clearly optional in your situation. It is true that oral sex is exceedingly low risk (perhaps truly zero risk) from oral sex; there has never been a proved case of HIV transmission oral to penis.

So my main advice remains to get your current symptoms professionally evaluated. If no urethritis is found, I would back off a bit on my previous comments about discussing all this with your SO and whether she needs examination or treatment. Discuss it with the doctor or clinic you see, and/or feel free to return here to let me know the outcome of your own evaluation.
19 months ago
Thanks for the follow up.

I just saw a doctor. Gave urine sample.

He took a look at my penis and I told him about my urethritis a year or 2 ago as well as the unprotected oral encounter.

I explained my symptom ( tip being more sensitive than normal.. not really irritated but sort of like a gentle touch on the tip kind of sensation.)

I also asked specifically about non-gon and non-chlam urethritis...

He said he saw nothing on my penis to suggest urethritis... he asked about discharge and difficulty or urgent feelings to pee of which i have none. 

He believes I have nothing to worry about and that I'm just anxious.... he didnt even insist on the urine test but offered it if  I wanted. I decided to give a sample anyway.

My only worry now is if it comes back negative for chlam and gon which based on what you tell others is likely to happen... is that if it IS actually somehow urethritis that is transferrable how would I even know? ... or ahould I take your comments plus this visit and just move on?

I can always go to a sexual health clinic, but where I am in canada it's over a week wait for appointment... I guess I could go there, but is there even a test for NGU that isn't chalmydia? What more would they do?

Sorry for so many questions... this is my 2nd follow up so trying to ask all I can. 

19 months ago
Also something o juat thought of is my SO and I have had anal sex a few times including one about 4 to 5 weeks ago and also prior to the last time I had urethritis... any chance it's from natural bacteria from her anus? We did not use condoms for anal. ... I'm guessing not but figured I'd give all the detail I can
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Anal sex could explain symptoms like yours -- it's more likely to result in minor trauma, and the rectal environent can be viewed as inherently inflammatory due to all the bacteria, enzymes, chemical residues of food digestion, and so on. At this point, I think it reasonable to just sit tight for a couple of weeks. If the irritation subsides, I don't think you need any further evaluation -- but if it persists, a second opinion from the sexual health clinic would be reasonable. You could make an appointment now, then cancel if things clear up in the meantime. And on reconsideration, assuming nothing pans out, I think it's safe to not discuss with your partner or arrange for her to be evaluated.

Normally that would conclude this thread, but I'll leave it open for one more cycle -- but would suggest holding off on that until another 1-2 weeks have passed, or after your sexual health clinic visit, if that comes to pass. OK?
19 months ago
Ok that sounds like a plan. Thank you so much for your help. This is an AMAZING service you and the other docs offer... You are all great people.

No need to reply to this. I'll update in a couple weeks or so.