[Question #5943] Urethra Irritation

20 months ago

Dear Drs


2 weeks ago, had protected intercourse with a CSW, (both vaginal and oral protected with no break).


Morning after, I started to feel discomfort in my urethra normally after urination. I have had this issue before (even after masturbation) and it usually subsides within 2 days. For information, there was no discharge, no painful urination, or any other symptoms -- other than discomfort/sensitivity in my urethra (near the tip)-- I am circumcised.


Day 3, I went to see a Urologist who ran urine work and, just as a precaution, gave me Zithromax 1g to take as a single dose. The next day (Day 4), issue still there, I went to see another Urologist who ran urine and blood work. On both occasions, the results came back clear including for Leucocites.


Day 7, issue comes and goes - discomfort and mild burning AFTER urination. So I went back to the Urologist again, he told me to give it time. He did an ultrasound to check on my prostate and said it was fine. I insisted I wanted antibiotics just as an extra precaution, and he prescribed Levofloxacin 500mg to take once daily for 7 days. I have been on the meds now for 5 days and my issue has completely resolved.


Was I, at any point in time, at risk here? If not, why did this happen? I'm trying to get my head around the fact that the antibiotics must have cured whatever it was that I had or could it just have been a coincidence and that time had healed me as opposed to the antibiotics! Surely, if this was simply an irritation caused from a sensitivity to the condom (her condom) or whether this condom had spermicide or not then the antibiotics would not have done much. Prior to this I had not had intercourse for 1.5 months and Dr. said that could also be the reason (a plumbing problem) with a narrow urethra which could be prone to irritation after ejaculation.

Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Welcome to our Forum.  I'll be glad to comment and hope that my comments will be helpful to you.  The exposure that you describe was a no risk event for STIs.  Most CSWs do not have STIs, when the do most exposures do not lead to infection and you used condoms for all exposures (throughout the event I presume) and condoms are highly effective for STI prevention.  Further, your symptoms are atypical for STIs - there are no STIs which would cause symptoms in less than 24 hours after exposure (the microbes need some time to cause inflammation) and when urethral infection is present the discomfort is typically present during urination, not afterward.  Finally, you have been directly examined by two trained health care providers, neither of whom found anything of concern.  I am confident that this was not an STI acquired during the exposure you describe.  That however does not change the fact that you had symptoms.  This leads to several other thoughts:

1.  You mention the possibility of latex, spermicide or lubricant allergy.  Certainly the timing is correct as these problems tend to manifest themselves soon after intercourse.  9% of the population is allergic to latex and while the proportion is less well known many persons are allergic to spermicide components as well.  I have had patients in the past who put a condom on without having sex and were able to reproduce their symptoms, documenting their latex allergy.
2.  Could you have in some way irritated/traumatized your urethra during sex.  Seems unlikely but the fact that this has happened in the past makes me wonder. 
3.  Fungal/yeast infections occur from time to time in men and can cause the sort of irritation that you describe.  I would have expected this to not get better however if untreated. 
4.  General comment.  You do not mention testing.  I must say that treatment without testing often just confuses things.   Antibiotics have their own side effects and create their own sets of problems.  I urge you not to "demand" antibiotics in the future- my guess is that your irritation would have gone away on its own (further I should add that if this were an infection, it should have, by all means, progressed and it did not)

Sorry I don't have better answers.  The one thing I am confident of however is that  your irritation was not an STI.  EWH