[Question #9439] urethritis...non specific urethritis...sti...bph?
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32 months ago
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Last night I woke up from a nap with discomfort in the glans of my penis and urethra. I was able to urinate easily. This morning when I woke up I was still in a bit of discomfort. There was no staining on my underwear but when I expressed my urethra, there was a bb shaped amount of white discharge, which has continued throughout the day (only on expression when I go to urinate), although it has turned from white to cloudy to clear. I still have some stinging discomfort in my urethra and urethral opening, along with a feeling of pressure in my testicles and abdomen. I can urinate freely and have no stinging, pain, or discomfort while doing so. I had unprotected sex with a woman I have been seeing as recently as 5 days ago. She says she tested negative for all sti's after we started dating and hasn't seen anyone sense. My last encounter with someone else was over 3 weeks ago.
Last night, a few hours prior to symptoms appearing, I masturbated somewhat vigorously. I have chronic recurring bph but that usually involves more urinary issues when it flares up. I went today and got a full sti panel...waiting on results but they "dipped" my urine and said there was no sign of infection. Previously my urologist has told me this is indicative of not having a sti, and if an sti were causing symptoms it would flag during the quick urine dip for signs of general infection. That's a lot of info but the point is that this is not a first time issue for me. I have had multiple instances of this type of discharge and inflammation that lasts for days (not overnight ejaculate "build up"). It always sends me running to the doctor but (knock wood) I have never showed signs of infection except bacterial prostatitis once.
not sure whats up. I am told there is a condition called non specific urethritis that can result from things other than sti's or protatitis. I am curious how this should be treated. What does one do to heal it, or differentiate it from sti/ngu?
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Edward W. Hook M.D.
32 months ago
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Welcome to the forum. Thanks for your detailed descriptions- they will help me in providing advice.
The fact that your urine dip did not show white blood cells certainly makes the likelihood of NGU lower, as does the fact that you have experienced similar episodes in the past. OTOH, that this has occurred a few days after unprotected sex does raise the issue of NGU which, in about 30-40% of cases, no pathogen such as chlamydia can be identified. In cases of chlamydia negative NGU, there is no evidence that there is a danger to the health of sex partners and in the UK, such syndromes are not always treated. My advice, presuming that your STI tests will be negative, would be to watch for another day or two; if the problem persists or gets worse, see the health care provider you have already seen for the problem (so that they do not need to start your evaluation again).
Prostatitis is very rarely caused by STIs. In bacterial prostatitis, prolonged courses of antibiotics (often trimethoprim-sulfa or ciprofloxacin) are often helpful For non-bacterial prostatitis, the problem can be more challenging to address. As I said above, discussing this with your urologist is the way to go and, presuming that you feel your lines of communication with him/her are good, is the best course of action.
I hope these comments are helpfu;. If any part of my answers are unclear or there are further questions, please use your up to two follow-ups for clarification. EWH
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32 months ago
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Good morning Dr Hook,
Thanks for your response.
A couple of follow ups. I spoke with the woman I was with 3 weeks ago, and she had tests done last week and is sti negative. So assuming that everyone is being honest (which I do) that means my last exposure vía yet another person would have been over a month ago. In my understanding Chlamydia shows symptoms fairly quickly if it is going to show symptoms…is that correct? In other words since both recent partners tested negative for STI’s, it makes it fairly unlikely these are newly presenting symptoms from an sti that I would have to have acquired over a month ago, that I also would have somehow managed to not pass via unprotected sex to two subsequent people?
Regarding non sti based urethritis, ie- not gonorrhea or ngu, is it true that it can be caused by things like masturbation, rough sex, injury, strain, soaps, lotions, etc? Or are these stories we tell ourselves to make us feel less like we “got an sti”? And just to be clear- if my tests do come back clear of STI’s , I should feel comfortable resuming sex with the woman I’m seeing? Would that be somewhat safe to do now (doc is telling me test results can take 7-10 days)? She seems to be confident I can’t have an sti based on the above.
Thanks. Appreciate your knowledge and advice.
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Edward W. Hook M.D.
32 months ago
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I agree with you that it is unlikely that you acquired an STI from either of your recent partners. As you mention, chlamydia symptoms tend to appear a week to 10 days following exposure.
You are correct that lotions, creams, lubricants, and other chemical agents can cause irritation. Most often the rotation caused by these agents is predominantly external in nature.
If your tests are negative for STI’s, which I expect they will be, you can certainly feel comfortable and having unprotected sex without concern of transmitting an infection to others. EWH
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32 months ago
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Hi Dr Hook
Thanks
Last question would be assuming my tests come back negative for sti, should I pursue further testing or antibiotic treatment for the symptoms? The clear drainage and discomfort, while lessening slightly, are still continuing. I am obviously not a doctor (that’s why I’m here!) but it would seem I have some type of urethritis. Not sure if I should treat it regardless of test results or wait for it to fix itself….if that is even a possibility.
Thanks
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Edward W. Hook M.D.
32 months ago
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I trust your STI tests included a test for Mycoplasma genitalium. If not, I would suggest testing for it as treatment of M. genitalium is different than treatment for chlamydial or non-chlamydial NGU.
Presuming the tests are negative, the first step towards making a decision about what to do is to verify that there are not white blood cells (WBCs) in your urethra. This can be done by dipping the first part of a urine specimen collected after not voiding for at least one and preferably 2-3 hours. If no WBCs are there and your STI tests negative, there is no reason for treatment. OTOH, if WBCs are present, most but all experts would probably treat you with 7 days of doxycycline or a dose of azithromycin. As I said above, there are no meaningful data to suggest that non-chlamydia, non-M. genitalium NGU represents a danger to sex partners so the goal of treatment would be to relive bothersome symptoms.
---I hope this is helpful. Sorry for the complexity. EWH
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32 months ago
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Hi Dr Hook
Not too complex. I appreciate the detail.
My tests for Gonorrhea and chlamydia came back negative. Unfortunately they did not test for m. Genitalium or Trichominiasis, which they had me come in and do last night. Not sure why they didn’t include those in the first round but they say they’re not part of the regular sti panel?
I will see what comes back and try the dip. Although I think when they dipped my urine the other day it had been at least an hour since I’d urinated, and no signs of white bloods cells.
thanks for your advice.