[Question #5934] Chlamydial Urethritis

17 months ago
Hi,

Two weeks ago today I went to a strip club and had a lap dance.  I was pretty drunk, but do not remember anything which would have put me at high risk of contracting an STD (I.e. sex of any kind).  I do remember going home, so would imagine I would remember any sexual activity.

A few days later I became a tiny bit worried about a bit of skin irritation I have on the outside of my penis.  Then a week after the incident I experienced some discomfort after urinating, but not during.  Since then i have had almost constant discomfort l, sensitivity and sometime pain in the tip of my penis, and more recently some intermittent discomfort in my perineal and rectal area.  Urination itself is not particularly uncomfortable in general.  On one or two occasions it has been slightly more sensitive, generally when I have been forcing it, when there is scant and quite yellow urine or after masturbation.  Ejaculation is not painful.  I have looked inside my urethra on a number of times and there are patches which are slightly more red and the entire opening looks moist/ shiny, but there has been no obvious discharge.  I realise gonorrhea would have obvious discharge.  Considering my 'symptoms' I am now concerned I could have had some activity which i can't remember!

If you could answer the following questions it would be much appreciated:

1.  Would you expect some discharge with chlamydial urethritis?  Would it be obvious enough?
2.  Would the pain be constant or only when urinating?
3.  Should the urethra have a shiny/ moist appearance?  Are some slight areas of redness a concern?
4.   Is external skin irritation a symptom of STDs?
5.  Are my symptoms more likely to be anxiety based?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
Welcome to the Forum.  I happened to be on the site when your question came in so you are receiving a response somewhat more quickly than is typical and follow-ups may take a while as well.  Following events that are uncharacteristic of what persons consider of themselves (such as getting drunk and getting a lap dance) it is typical for persons to be looking for signs of infection or other evidence of a problem.  In turn, this often causes individuals to begin to notice things that are normal and might have been otherwise overlooked or ignored.  In my experience, it is most unusual for persons to have sex and not remember it.  Some of the things you mention, specifically darker urine color, noticeable moisture within the urethra.  My guess is that you did not have an exposure during the episode that you mention but of course there is no harm in getting a urine test for chlamydia and gonorrhea- its easy to do, highly accurate, and would resolve any doubts that you might have.

Regarding your specific questions:
1.  About 40% of chlamydial infections in men are asymptomatic.  Symptoms, when present can be mild.  
2.  Most typically, the discomfort associated with chlamydial infection is present on urination and not in between.
3.  This may well be normal.  Further, repeated self examination of the sort you describe are well recognized as a cause of irritation, redness and even slight increases in urethral secretions.
4.  Not typically
5.  That is certainly a good possibility.

So, what to do.  As I said above, testing is easy and accurate.  While I doubt that you even had sex at the time you describe, if you have not been tested recently, why not do it.  I anticipate that, should you choose to test, the test will be negative.  I hope these comments and perspective are helpful to you. EWH
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17 months ago
Hi and thank you for your quick reply, it is much appreciated.

I am very nervous about getting a test as I suffer from OCD in any event and I am in a committed relationship (although we have not had sex for a couple of months and only using protection).

I have no reason other than my symptoms to believe that I had any sexual activity.  Could I just confirm a couple of things if possible?

The pain and discomfort is nearly constant, and worse when thinking about it.  It is a stinging almost burning feeling.  From what I have read his does not sound like urethritis, which would be worse when actually urinating rather than correct?  

When discharge is present, is it usually noticeable?  I.e. actually comes out of the penis?

Could you just confirm the normal skin texture of the urethral opening?  Mine is definitely shiny, even just near the opening where it is definitely not wet at all.  I'm not even sure it is moist, it may just be the usual appearance of mucosal membranes?

I have been urinating more often than usual, I am confused if this is an STD symptom?

Finally, I am not quite sure what you meant in the following sentence 'Some of the things you mention, specifically darker urine color, noticeable moisture within the urethra.'

From the basis of the fact I am not aware of any actual exposure, would you suggest testing is required?
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
In my opinion, not knowing will be tougher on your OCD than testing and knowing that you are not infected.  As I already said, they symptoms you have described may well reflect overzealous self examination.

As I already said, the typical discomfort of urethral infection is burning on urination, not in between.

When present the discharge should not be hard to see/find.  It can be seen at the tip of the penis.

It sounds like you are describing normal mucous membranes at the head of your penis.

Urinary frequency is NOT a sign of STI.  it is a sign of anxiety.

You described "quite yellow urine" that "the entire opening looks moist/ shiny".  My comment was intended to tell you that these are NOT signs of any STI.

Is testing required- No.  I suggested it because I sensed your anxiety and thought that a negative test might be helpful.  I still think that is the case.  EWH

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