Persistent burning while urinating

[PBurn1216]

Approx 3 wks after having intercourse with my girlfriend, i began having a frequent, painless discharge from my penis.

I saw a urologist.  A dip was performed for UTI (negative). Due to no other symptoms and a very long time between sexual relationships, he felt it was nothing serious and possibly overactive glands. I continued to have sex with my girlfriend.

My symptoms began to progress and i started having the urge to urinate frequently, a mild burning sensation when urinating, and burning towards the end of ejaculation.  The discharge did however decrease.

I saw my primary doctor and they did a dip/culture for UTI and a culture for chlamydia/Gonnorrhea (first void).  The tests came back negative, but due to my symptoms my doctor prescribed me 1g azithrimycin.  I had "the talk" with my girlfriend and explained everything and encouraged her to see her doctor. At that time my symptoms started to go away.  

My girlfriend saw her doctor a few weeks later.  Upon examination and some tests, her doctor diagnosed her with Trich as well as both risk types of HPV.  She was prescribed 2g Metronidazole.  The day before she saw the doctor, my symptoms began again.  I called my doctor's office and i was prescribed 2g of Tinidazole.  After a week my symptoms were still there (mild discharge and burning while urinating only). I was prescribed 2g of Tinidazole again.  That was 10 days ago.  My discharge is gone but i still experience burning while urinating.  It is strongest when i have to go and at the beginning of urination, though sometimes it is burning at the end. We have not had intercourse since before diagnosis.

Any thoughts as to where i go from here?

[Edward W Hook, MD]

Thanks for the clarification.  Not much to add to y earlie commentsother than to point out that most clinicianas would sill choose to treat your GF with azithomycin, just to sre.  Obviously, this is unrelated to your continuuing symptoms.  Good luck.  EWH

[PBurn1216]

Thank you for answering.

1-no she was not.  With my tests for those being negative, her GYN did not find it necessary.

2-i was not aware of reliable testing for males.  We are awaiting her followup appointment to find out if she is clear.  An added note, she never had any symptoms whatsoever.

3-yes, that's what i meant  by when i said they had checked for UTI. They found no evidence of WBCs in my urine.

4-this is a possibility that i have considered.  I am very likely much more sensitive now to how everything "feels".

A final note to clarify on my original post.  We have not had actual intercourse since the week before I took the azithromycin. So I'm thinking any type of reinfection would have only occurred between the the time of initial symptoms and pre-treatment.  

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help. My sense is that you have done things correctly- getting tested and then, after your tests were not conclusive, having your girlfriend tested was the right thing to do and led to identification of at least part of the problem- trichomonas which can cause the sorts of symptoms you describe but be difficult to diagnose in men.  Further for you both to have been treated with medications for trich (tinidazole and metronidazole) which is also recommended.  This leads to several comments which I hpe will be helpful:

1.  When you were treated with azithromycin, was your GF also treated?  This would have been appropriate to do, even though your tests were negative.

2.  There are tests for trch that can now be done on both men and women.  Hologic/GenProbe makes a test that can be performed on urine from men r vaginal swabs from women which are very accurate.  Although rare, a small proportion of trich are resistant to metronidazole and tinidazole and it would be good to close this loop, making sure that the treatment you both took worked.

3.  It sounds like you have been checked for signs of inflammation in your urine or a smear from your penis, is this correct?  This would be a check for white blood cells (WBCs).  If not done, it should be.  If this is negative, there is little chance that there is persistent inflammation.  

4.  That brings me to the last possibility which is that having been through tis evaluation, you may be simply focusing on the experience of urination more than you did in the past.  If so, it would not be uncommon for you to notice sensations that you normally overlook.  (Frequent urination is not a typical sign of STI although discomfort or discharge is).  

Finally, I would suggest that you continue to work through tis with the same health care provider if possible.  There are some unusual aspects to your situation and if you change providers, they are likely to (and should) start over again from the beginning).  Working through this problem systematically with your provider is most likely to help resolve things.

I hope these comments are helpful. EWH