[Question #832] Persistent symptoms

53 months ago
Hi had unprotected oral but protected sex with csw on April 1, didn't shower after encounter. 2 days later noticed redness on head of penis and adjacent forskin(uncircumcised).  Applied antifungal cream, redness was gone Apr 7. Apr 8 had unprotected oral and protected sex with another csw.  2 days later noticed constant burning sensation in urethra, no burning on urinating or pain or any visual signs.  Saw dr on apr 11 and did urine test for gonnorhea and chlamydia.  I had to leave town apr 14-24 so I took cephalexin.  Apr 15 burning sensation felt to spread to bladder and had to pee eventhough nothing. Sx better after. Saw dr apr 25 urine test neg, 1 gr azithromycin taken.  Apr 29 screen for hep b, c syphilis and hiv all neg.  metronidazole on May 3. Fluconazole may 9. May 15 noticed a red patch on underside of penis. Nurse at CDC said looks normal. Saw urologist on May 25 said all looks good, to use polysporin triple antibiotic cream on red patch and my urine pH was 8 so take cranberry extract pills twice a day.  Burning went away  about may 5 but pokey crawley feeling at meatus lasts until now. Much more occasional but still can't say I'm 100% normal.  Everything is easily irritated, walking too much, sitting too much, I'm only comfortable lying down on my back
1 is this normal?  Will pokey feeling around meatus and in urethra go away?
2 any further tests?
3 any guess as to what is was?  Adenovirus, normal oral bacteria? 
Lost 10 lbs in last 7 weeks from anxiety and lethargic now. Taking antidepressant and trying hard to resume normal activity and ignore sensations but they happen and can't be ignored. Can I have unprotected sex with my regular partner?
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

Welcome to the Forum.  I'll try to help.  The story you tell is one of receipt of oral sex twice and a condom protected exposure which, taken together, are very low risk event.  Despite that, you report many symptoms which are not suggestive of typical STIs, negative tests, and multiple medications (cephalexin, azithromycin, metronidazole, fluconazole and a number of topical anti-bacterial or anti-fungal agents) despite negative tests.  In addition you have apparently been seen by a variety of health care professionals who did not provide a diagnosis but, in some instances gave you medications any way.  It is time for you to step back, do your best to relax and try to move forward.  My guess is that you may have had a non-chlamydial NGU following receipt of unprotected sex which would have either gone away by itself or resolved with azithromycin.  The antibiotics you have taken increase your risk for fungal infections or if one is present, make them harder to manage.  I doubt that there is an infection present at this time, given the fact that several health care professionals have told you they say no abnormalities and your tests were negative.  I would not worry further, would not seek further testing and certainly would not take more antibiotics.  I would not worry about sex with your regular partner and would try to move forward.

I hope this perspective is helpful.  EWH

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53 months ago
Thank you for your answer, my concern is that symptoms have taken so long to get better. Clearly the cephalexin was ineffective, even with the azithromycin and metronidazole there wasn't a dramatic reduction in symptoms.  If it was bacterial what could have withstood these antibiotics?  Even when I did have the constant burning symptom (never while urinating) there were no overt visual signs so anyone inspecting would say all looked normal but the symptoms were there.  I know what normal feels like and I'm only listening to my body and it's frustrating that I still feel these irritations in my urethra and meatus.  The poking feelings in the urethra border on hurting so doesn't that suggest there is still inflammation or irritation present and that what I have may have settled on its own to a near sub clinical level but still persists?  Could it be fungal or viral?  Thank you for your expertise
53 months ago
I just wanted to add that normal activities tend to irritate the meatus and urethra like walking, sitting too long, after urinating though it does settle after a time, and the past few days after showering and cleaning my penis(gently)there is a constant pricking sensation that last until I sleep, in the mornings all is well until I resume daily activities.
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

My message does not seem to be getting through.  You may or may not have had an STI following the events you described in your post but there is nothing to suggest that you do at this time.  As I said above "It is time for you to step back, do your best to relax and try to move forward.  My guess is that you may have had a non-chlamydial NGU following receipt of unprotected sex which would have either gone away by itself or resolved with azithromycin.  The antibiotics you have taken increase your risk for fungal infections or if one is present, make them harder to manage.  I doubt that there is an infection present at this time..."

None of the symptoms or pattern of symptoms that you describe are suggestive of any STI  I suspect you are not "listening to your body" except to "tell" it that normal sensation might be due to an STI.  EWH

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53 months ago
Thank you Dr Hook, I don't mean to be annoying, your response is very reassuring, it is difficult to not be worried about these types of sensations and I realize being hypersensitive to all sensations doesn't help the situation.  I just wanted to know if you have seen other pts experience the same thing or not.  And obviously not ever finding out exactly what caused my symptoms in the first place doesn't help either.  Just for information what types of organisms can cause non chlamydial NGU?  Which I know I am clear of now! It was just that it took so long for symptoms to clear that gave me doubt and worry and wondered if that was normal.  It is good to know that these pin pokey sensations are nothing to worry about and hopefully will go away as i move forward and put this incident behind me.  again thank you for your answers and expertise.
Edward W. Hook M.D.
Edward W. Hook M.D.
53 months ago

I have seen many patients with symptoms such as yours.  None of them have had STIs as the cause of their symptoms.

The cause of non-chlamydial NGU following oral sex is a subject of considerable study.  The leading hypothesis is that the oral sex results in introduction of a person's normal mouth bacteria into the urethra and because they are unfamiliar to the person developing urethritis, there is resulting inflammation. 

You are correct, as you are able to address your anxiety and concerns, I anticipate that your symptoms will resolve.

As you probably know, Forum guidelines permit three responses to each question.  This is my third response.  this thread will be closed in the next few hours.  Take care and please do your best to move forward.  There is no reason for you to be worried about an STI.  EWH

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