What are these symptoms since unprotected oral and frottage?

[ravensrox]

Please bear with me as I describe what has been happening over the past three months. I am a 57 yo male. Back in July 2019 I visited an adult bookstore and both received and gave unprotected oral sex with another guy.  Also engaged in some frottage.  The whole encounter was brief and neither of us had a orgasm.  About 4 days later I had burning with urination.  It stopped burning when I urinated after just a day or so but I still had a burning sensation most of the day.  In fact sometimes urinating alleviated the burning.

I saw an NP at my doctor's office, urine screen showed mildly elevated WBC, she diagnosed UTI and gave me Macrobid.  After taking this for 5 days with no improvement I went to a local urgent care.  That doctor gave me another urine screen which came back okay and ordered STD testing.  All of those came back negative.  But I continued to have burning on and off in my urethra in the head and was also having random pain in different parts of the skin on my shaft and scrotum.  I never developed any sores but the skin on the shaft just below the glans became red when the foreskin is pulled back.  

A few days after starting the Macrobid my tongue started getting white.  I had a regularly scheduled PCP visit in early August and told him what had happened.  He didn't think much of the white tongue, saw the negative STD results but still prescribed one dose of azithromycin and a week of doxycycline.  Neither helped my symptoms.  He also ordered a herpes test which was negative (about 6 weeks after the possible exposure).  

The burning in the head of my penis, the redness on the shaft and the random pains on the skin have come and gone since then.  The white tongue got worse, my lips have been chapped, sometimes my gums and the inside of my lips are sore.  Another physician at my PCP practice gave me two weeks of flucanozole based on my description of symptoms and picture of my tongue that I had emailed the office.  It didn't help.

I saw a NP at the local urolgist office in September.  She was stumped but did find an enlarged prostate and started me on Flomax.  She also gave me liquid Nystatin for what is thought to be oral thrush.  It seemed to help a bit but didn't take it away.  I followed up with her just a few days ago.  She saw a very tiny bump just under the head of the glans.  Said maybe it's a pearly papule (sp?) or it could be a genital wart!  Offered to give my something to put on it (I forget what it's called) to see if it goes away but I haven't gotten it filled yet.

Sorry for the long post but I'm trying to be thorough.  Any idea what this could be?  So basically I still have symptoms that come and go.  Occasional pain in the head of my penis along with redness on the shaft and random skin pain.  Also still have the white tongue and sore mouth/lips.  I've also tried some OTC remedies including hydrocortisone for the redness and gentian violet for the possible thrush.  Does this sound like thrush?  Any chance it's an oral std?  What about the symptoms on my penis?  Any advice would be greatly appreciated!

[ravensrox]

I thought I would provide an update.  It has now been over 4 months that I've been having this issue.  While it is better than the first few weeks, it still persists.  The main symptoms over the last couple of weeks has been burning  on either side of the frenulum, redness along that underside part of the shaft and burning on certain parts of my scrotum.  These symptoms come and go although the redness is there most of the time.  I am also still having the white on my tongue and occasional sore gums and lips.  

Thinking this still might be a persistent fungal infection I have been using the ketaconozole cream on my penis for more than 6 weeks without improvement.  I have also been on clotrimazole lozenges for about 10 days- prescribed by my PCP who referred me to an ENT but can't get an appt until January.  I have also tried following the candida diet.  I was strict with it for two weeks but have since eased up some.  I still avoid sugar for the most part.  I have also tried using coconut oil- a home remedy I read about online.

I also have an appointment with a dermatologist in two weeks.  Given all of the antifungals I've tried I'm not convinced it is a fungal infection.  But not sure what else it could be?  I've read about burning scrotum syndrome.  Another thread on here said burning can be a symptom of prostatitis.  Seems like there should be some kind of test that could definitively diagnose this.  

Had the standard STD testing early on and all came back negative.  Any reason to think this could be some kind of an STD?  Open to any and all input!

[auntiejessi]

You've been diagnosed with prostatitis - your prostate is inflamed. Prostatitis means inflamed prostate - itis means inflammation. Have you followed up on that with your urologist?

The white tongue - I don't know. I think the ENT is a good idea. I don't think this is an STD at all.

[ravensrox]

I was diagnosed with BPH and started on the Flomax which is helping with that issue.  I was seeing that as separate from the other symptoms.  I did just see a physician assistant at the dermatology office yesterday.  He diagnosed me with lichen planus and prescribed desonide ointment.  Just started that today.  He thought that would explain the white tongue and the genital symptoms.  He didn't think it was fungal given that I have been on so many antifungals and was still having symptoms.  He also didn't think the tiny bump was a wart but instead a single pearly papule.  Didn't know you could have just one of those.  I follow-up with him in one month.  The ENT appt isn't until early January.  I saw the urologist twice- last time in October.  She said to come back if symptoms weren't better in two months but she seemed at a loss at last appt.

Symptoms have come and gone for some time now.  The last two days have actually been pretty good.  Hoping it stays that way this time.

[auntiejessi]

I'm glad you're feeling better. :)

I'm also happy you're making some progress in getting some diagnoses. That must help. I think the unknown is often worse than the diagnosis. If you get a diagnosis, at least you can get a treatment plan and start feeling better.

I hope the progress continues. :)

[geno29]

A urine screen isn't a true test for NGU, really you should have a sample taken from inside your urethra looked at under a microscope for white blood cells. It's pretty quick and easy. The doxy and azithro should clear NGU, but there are some infections that have become resistant. But if your symptoms have subsided after the meds you're most likely fine.  

[auntiejessi]

I agree with this. A urine screen is an easy and cheap way for a lot of STD clinics to look for WBCs in your urine, and it works okay if they have someone looking at the sample under a scope, but you really should have a swab taken.

If your PSA was fine, they probably don't need to do an ultrasound. I do think that since you are still having symptoms, though intermittent, they should do a swab, especially before you take any more antibiotics since you have the thrush.

I'm not that familiar with treating oral thrush. If your doc is suggesting this treatment, and you're comfortable with it, go for it.

[ravensrox]

I thought NGU symptoms included a discharge and burning with urination.  I have not had either (except for some mild burning when urinating for a day in the very beginning of all of this).  I'll look into it though if you think it's advisable.

What about the NP's theory of possible HPV based on the tiny bump just under the glans?  It's a very small light colored bump, like a very tiny pimple.  You really have to look to see it.  Any thoughts about what it could be and if I should try the med she gave me?

[auntiejessi]

You can have NGU without symptoms.

There are also lots of causes of NGU that aren't sexually transmitted. It really just means any infection in the urethra that isn't gonorrhea.

I don't think you have NGU, necessarily. We are just going off the diagnosis you got, but since you've had a diagnosis of an enlarged prostate, that explains the elevated WBC and symptoms you did have. Have you been back to see if you still have elevated WBCs?

I think you can try the med. One tiny bump could be HPV, but the only way you'll know for sure is to get it biopsied. Since she wasn't sure what it was, it's up to you. You should read about the med first though - it can cause burning, itching, peeling skin, etc. - https://www.webmd.com/drugs/2/drug-1050-6193/podofilox-topical/podofilox-gel-topical/details You can always try it later if you get more bumps.

[ravensrox]

The only urine test that had an elevated WBC was the very first one 6 days after the possible exposure back in July.  I have had at least 3 since that were all normal.  The bump that she thought could maybe be HPV is so small I'm not sure how they would biopsy it.  She did mention the potential side effects of the podofilox.  I'm using the ketoconazole 2% cream for the redness/irritation on the shaft now but it's only been 3 days.  Maybe a yeast infection? I'll give that a week or so and see what it does before trying the other medicine.  

Would an enlarged prostate cause the burning sensation in the urethra? Thanks again for your input!

[auntiejessi]

Yes, an enlarged prostate can cause that - https://www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766 (Definitely check this out - it has a long list of possible symptoms)

I think continuing to use the cream first before using the podofilox is a smart idea. :)

[ravensrox]

Thanks for the reply auntiejessi.  I considered NGU as well after reading many posts on here but saw that the treatment was azithromycin and doxy so figured  since they didn't help it would have ruled NGU out.  No swab of the urethra has been taken.  The NP at the urologist office did mention the possibility of a cystoscopy if there is no improvement in two months.  My PSA is normal.  Nobody has suggested an ultrasound.  

As I mentioned in my original post, her last theory was perhaps HPV based on a very tiny bump.  She prescribed podofilox and stated that if the bump went away after using this it would confirm the diagnosis.  I just picked it up today but have not started using it.  Any thoughts about this?  What are the odds of getting HPV from receiving maybe two minutes of unprotected oral?  

I'm glad to hear you don't think what's going on with my tongue and mouth is related to an STD.  The whiteness doesn't really come off with a toothbrush.  It's not the cottage cheese-like appearance that I've seen in some pictures.  More just a general whiteness over most of my tongue.  Saw my regular PCP today.  He suggested another round of Nystatin liquid but this time twice per day for two weeks (instead of 4x/day like I did before).  So I will give that another shot.  He also prescribed ketoconazole 2% cream to apply to the redness on my shaft.  

Thanks again for your expertise!

[auntiejessi]

So first - let's address your genital symptoms, then your tongue.

When I first read your symptoms, and that you had some white blood cells, I thought NGU, which is an infection in your urethra. This can be caused by normal mouth bacteria entering the urethra. Azithromycin and doxy should cure it, though. Has anyone taken a swab of your urethra and cultured it to see if bacteria grows?

My other thought was prostate, and your enlarged prostate could explain it. Are they doing any further testing, like a PSA or ultrasound to rule out cancer or BPH? https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

Nothing you describe about your tongue would be from an STD. It wouldn't be a surprise if you got oral yeast (thrush) from taking all the antibiotics, though. If you use your toothbrush, or a tongue scraper, are you able to remove any of this whiteness?

I think you should stick with the urologist. Get some continuity of care.