[Question #6886] NGU, Urethritis Help!

10 months ago
Hello Doctors,
have been experiencing some discomfort after having very regrettable brief unprotected sex with a female, this was VERY brief and only happened once. I have had symptoms of irritation in the penis or Urethra, it feels kind of like a tickle. This has been going on for a few months, I’m also experiencing some pain or burn in the penis, perineum, tailbone & low back (not sure if that is related or not) since the exposure I have not seen any discharge (at least anything noticeable). I’ve seen my doctor a few times since I started with the symptoms & have had clear urinalysis & a negative chlamydia, gonorrhea test. My doctor put me on a week of cipro & I feel it hasn’t helped. My doctor also doesn’t agree with more antibiotics because there’s no sign of infection in my urinalysis, he did not give me an exam to check for discharge. Are these true symptoms of NGU or Urethritis? If it was would an infection show on at least one urinalysis? I notice when I wake up in the morning I cannot feel anything in urethra or penis, it isn’t until a few hours later that I start to feel the symptoms. My wife has not shown any signs of std other than a uti a few months back.... please help!
10 months ago
ALSO after experiencing those symptoms I noticed during ejaculation I would feel discomfort or pain & the amount reduced & it also was clumpy this is unusual for me, those problems have since gone away & I'm left with pains that come & go in penis, testicles, low back, low left abdomen. But I do have a persistent feeling of irritation or tickle in urethra. After sex I do find Relief from these symptoms but they do come back later. My main concern is that this has gone on for a few months now. Doctor can’t seem to help me any further. In your professional experience are my symptoms pointing to anything I need to worry about?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
Welcome. Thanks for your question.

No STD causes such symptoms. Had you not told me your STD tests were negative, that's what I would have predicted. Looking at your opening sentence, I suspect "regrettable" is significant. If I were teaching medical students about symptoms of genitally focused anxiety following a sexual exposure that was regretted and caused stress or anxiety, I could give them your question and stop right there. NGU and other forms of urethritis are not logical explanations. The symptoms you describe clearly originate in the bladder, prostate, or elsewhere in the upper urinary tract -- but no the urethra, which is the site of urethritis (of course). I agree with your doctor that you have no infection, STD or otherwise, and I also would not recommend or prescribe any more antibiotics. 

Going to your follow-up comments, these simply reinforce my suspicion that your symptoms have an emotional/psychological origin. Please note that this doesn't imply the pain and discomfort are not real. They are. But this is not unlike tension headaches:  as the name itself implies, the underlying causes are stress, anxiety, etc (other words for "tension"), but the biological mechanism is physical. For headaches, increased tension in neck and scalp muscles; in the genital area, perineal and bladder muscles.

If your symptoms persist, continue to work with your doctor, perhaps in consultation with a urologist to exclude prostatiits. But for sure no STD is responsible for any of this.

I hope these comments are helpufl. Let me know if anyting isn't clear.

HHH, MD
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10 months ago
Thank you for helping putting my worries at ease, after submitting my question I read  question #6845 and realized someone had ALMOST the exact same symptoms with a regretted exposure & felt so much relief from your response as I would probably get the same type of answer, today I felt literally no symptoms that i described in my question & I have been feeling them for months (sometimes really bad) when I felt like I was starting, I noticed I was  thinking of the situation & felt tension or clenching in my pelvis area after being able to notice the clenching I can also relax and it goes away. Thank you so much for helping me realize about GFA. If there’s anyone reading this, I know it can be difficult to accept that anxiety or stress are behind these very real & concerning symptoms but it’s true. It’s very frustrating how every symptom in the genital region online always points to stds. The only symptom I feel currently is soreness in the entire pelvic region, I’m assuming due to the anxiety and clenching. 
10 months ago
I do have one final question, I read online discharge can also be “watery” how can you distinguish between if you have small amounts of watery discharge or if that’s just small amounts of urine? This is very confusing. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
"Watery" discharge generally means clear, not necessarily thin like water. Abnormal discharge almost always has mucus and is thicker than water. A scant, truly watery "discharge" probably almost always is urine.---