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Strange pain in tip of penis
Hello Doctor,
For about a week and a half, i have been having an irritating pain in the head and tip of my penis that comes and goes at irregular intervals. I have been tested for chlymydia and gonorrhea and those tests were negative. i have been to two doctors who have examined me and believe that it is not herpes based on those examinations - there are no sores or pustules. When I asked for a herpes test, one of the doctors told me that it would come out positive if i had ever had a cold sore (which I have, three in my lifetime) so w/o a sore to do a culture, a herpes test would be a waste. the opening of my pee hole is red and sore, but there is no discharge and does not burn when I pee. however, when i wake up, my pee hole appears to be stuck closed. when i pee, it opens right up. does this sound like anything? i'm kind of not convinced that its not herpes. about a year ago, this same thing happened, though it really hurt bad when i peed and there was discharge for two weeks. after a sting of tests and two trips to the urologist, the doctor said he didn't know what it was. it went away on its own after two weeks. but again, no sores or pustules or anything like that.
For about a week and a half, i have been having an irritating pain in the head and tip of my penis that comes and goes at irregular intervals. I have been tested for chlymydia and gonorrhea and those tests were negative. i have been to two doctors who have examined me and believe that it is not herpes based on those examinations - there are no sores or pustules. When I asked for a herpes test, one of the doctors told me that it would come out positive if i had ever had a cold sore (which I have, three in my lifetime) so w/o a sore to do a culture, a herpes test would be a waste. the opening of my pee hole is red and sore, but there is no discharge and does not burn when I pee. however, when i wake up, my pee hole appears to be stuck closed. when i pee, it opens right up. does this sound like anything? i'm kind of not convinced that its not herpes. about a year ago, this same thing happened, though it really hurt bad when i peed and there was discharge for two weeks. after a sting of tests and two trips to the urologist, the doctor said he didn't know what it was. it went away on its own after two weeks. but again, no sores or pustules or anything like that.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
Your symptoms clearly suggest urethritis, i.e. inflammation of the urethra -- and since tests for gonorrhea and chlamydia were negative, it seems you have nongonococcal urethritis (NGU), which almost always is sexually acquired. (It would be helpful to know more about your STD risks. New partner in the past 2-3 months? Multiple partners? Partner with other partners besides you? Partners male or female? Vaginal, anal, or oral sex?) It is a little puzzling that your providers, especially a urologist, are apparently unable to document the urethritis and seem not to know the standard treatments; you should be on an antibiotic (discussed below).
NGU is the most common STD problem in men. Cases like yours are typical: chlamydia causes about 30% of NGU, but the exact cause usually is not known if chlamydia is absent. A few specific causes are known, but these bacteria are not detected in routine tests; typically a research lab is required for such special testing. The standard treatment is either a single 1.0 gram dose of azithromycin (which is long-acting and actually gives over a week of effective treatment); or doxycycline, usually 100 mg twice daily for a week. These cover chlamydia as well as nonchlamydial NGU.
HSV is responsible for 2-3% of NGU cases, so on statistical grounds, herpes is an unlikely cause in your case. Further, herpetic NGU usually is more painful than you describe, and most cases are associated with penile blisters/sores. On the other hand, it seems this is your second such episode, which at least raises the possibiliy of HSV. But recurrent herpes outbreak rarely last more than a few days, so persistent symptoms for a couple of weeks also is against HSV as the cause. Usually testing for HSV is not done in men with NGU, unless there are particular suspicion for it -- e.g., blisters/sores, more pain, or known exposure to a partner with herpes, or if the same symptoms recur in the future. (However, your doctor is wrong about the HSV blood tests. It is true that your cold sores mean you would have a positive test for HSV-1, but most genital herpes is caused by HSV-2, and the modern blood tests detect HSV-1 and HSV-2 separately.)
What to do now? I suggest finding a physician or clinic who knows more about STDs than (apparently) the ones you have seen so far. Your local health department STD clinic (or an NHS genitourinary medicine [GUM] clinic if you happen to be in the UK) would be an excellent choice. If urethritis is documented, you can expect an antibiotic prescription as suggested above. In addition, your recent sex partner(s) need to be examined and treated. However, I would not worry about herpes at this point.
Please let me know a bit about your sexual exposures, as suggested above; and feel free to return with a follow-up comment to describe the results of additional professional evaluation.
Regards-- HHH, MD
Your symptoms clearly suggest urethritis, i.e. inflammation of the urethra -- and since tests for gonorrhea and chlamydia were negative, it seems you have nongonococcal urethritis (NGU), which almost always is sexually acquired. (It would be helpful to know more about your STD risks. New partner in the past 2-3 months? Multiple partners? Partner with other partners besides you? Partners male or female? Vaginal, anal, or oral sex?) It is a little puzzling that your providers, especially a urologist, are apparently unable to document the urethritis and seem not to know the standard treatments; you should be on an antibiotic (discussed below).
NGU is the most common STD problem in men. Cases like yours are typical: chlamydia causes about 30% of NGU, but the exact cause usually is not known if chlamydia is absent. A few specific causes are known, but these bacteria are not detected in routine tests; typically a research lab is required for such special testing. The standard treatment is either a single 1.0 gram dose of azithromycin (which is long-acting and actually gives over a week of effective treatment); or doxycycline, usually 100 mg twice daily for a week. These cover chlamydia as well as nonchlamydial NGU.
HSV is responsible for 2-3% of NGU cases, so on statistical grounds, herpes is an unlikely cause in your case. Further, herpetic NGU usually is more painful than you describe, and most cases are associated with penile blisters/sores. On the other hand, it seems this is your second such episode, which at least raises the possibiliy of HSV. But recurrent herpes outbreak rarely last more than a few days, so persistent symptoms for a couple of weeks also is against HSV as the cause. Usually testing for HSV is not done in men with NGU, unless there are particular suspicion for it -- e.g., blisters/sores, more pain, or known exposure to a partner with herpes, or if the same symptoms recur in the future. (However, your doctor is wrong about the HSV blood tests. It is true that your cold sores mean you would have a positive test for HSV-1, but most genital herpes is caused by HSV-2, and the modern blood tests detect HSV-1 and HSV-2 separately.)
What to do now? I suggest finding a physician or clinic who knows more about STDs than (apparently) the ones you have seen so far. Your local health department STD clinic (or an NHS genitourinary medicine [GUM] clinic if you happen to be in the UK) would be an excellent choice. If urethritis is documented, you can expect an antibiotic prescription as suggested above. In addition, your recent sex partner(s) need to be examined and treated. However, I would not worry about herpes at this point.
Please let me know a bit about your sexual exposures, as suggested above; and feel free to return with a follow-up comment to describe the results of additional professional evaluation.
Regards-- HHH, MD
MEDICAL PROFESSIONAL
Yes.
Is taking two 500mg zithromax pills the same as taking 1gm of zithromax oral in the one shot drink?
MEDICAL PROFESSIONAL
Wow. You have been more comprehensively evaluated than I thought.
Urinalysis is not generally useful in diagnosis. I'm not surprised ciprofloxacin didn't help; it is an atypical treatment for NGU, not recommended by CDC or other authorities. That said, normally it probably would have made at least some difference. This raises herpes as perhaps a somewhat more likely possibility than I thought before. It would be wise to have an HSV-2 antibody test. If positive, it won't necessarily mean you have found the cause of the NGU, since 50% of all gay/bi men have HSV-2, often without symptoms. This might partly explain the STD clinician's belief that herpes testing wouldn't be helpful. But if positive, it would suggest that if the same problem reappears in the future, a viral test from the urethra could be done and a trial of anti-herpetic therapy might be worth a try.
One possibility is infection with another virus aside from herpes. Adenovirus causes 2-3% of NGU cases and does not respond to antibiotics; it is normally a respiratory virus and commonly transmitted by oral sex, so perhaps that explains the problem. If so, it will clear up on its own, probably pretty soon. Also, NGU in gay/bi men has not been studied as completely as for straight men. There might be potential causes related to anal or oral sex that haven't yet been considered or detected in your case.
Aside from those suggestions, there isn't much more I can do. You might discuss these thoughts with the STD clinic. If things remain unresolved, consider asking for consultation with an infectious diseases specialist.
Urinalysis is not generally useful in diagnosis. I'm not surprised ciprofloxacin didn't help; it is an atypical treatment for NGU, not recommended by CDC or other authorities. That said, normally it probably would have made at least some difference. This raises herpes as perhaps a somewhat more likely possibility than I thought before. It would be wise to have an HSV-2 antibody test. If positive, it won't necessarily mean you have found the cause of the NGU, since 50% of all gay/bi men have HSV-2, often without symptoms. This might partly explain the STD clinician's belief that herpes testing wouldn't be helpful. But if positive, it would suggest that if the same problem reappears in the future, a viral test from the urethra could be done and a trial of anti-herpetic therapy might be worth a try.
One possibility is infection with another virus aside from herpes. Adenovirus causes 2-3% of NGU cases and does not respond to antibiotics; it is normally a respiratory virus and commonly transmitted by oral sex, so perhaps that explains the problem. If so, it will clear up on its own, probably pretty soon. Also, NGU in gay/bi men has not been studied as completely as for straight men. There might be potential causes related to anal or oral sex that haven't yet been considered or detected in your case.
Aside from those suggestions, there isn't much more I can do. You might discuss these thoughts with the STD clinic. If things remain unresolved, consider asking for consultation with an infectious diseases specialist.
Hi Doctor,
Thank you for your reply.
Below are the test results from my urine analysis. My doctor prescribed a 7-day treatment of Cipro, which ended on Tuesday and did not clear the symptoms. When he gave me these test results, he said that he didn't know what i had but that it appeared to be insignificant. he is my GP. I haven't seen a urologist for this incident, but did see one for the incident last summer. I went to the local STD clinic on Monday and received more treatment for chlamydia and gonorrhea - two pink pills and a shot in the butt, tho I don't know the names of the antibiotics. It was at this STD clinic that the doctor told me about the herpes blood test. In the last 2-3 months, I have been with two people. both males. one of them i have known and had sex with for about seven years without any medical problems. i had insertive unprotected anal sex with him twice. we both test for HIV regularly and are both negative. i tested on Monday at the STD clinic and was negative as well. the other sexual partner i have recently met, and have not had anal sex with him. we have kissed and been naked with each other and exchanged oral sex. recently i have been working out at the gym a lot and, after a shower, would put the same pair of jeans on without wearing underwear. i have since stopped this and have washed those jeans. is this a possible cause of NGU?
Component Reference Range 7/22/2009
Glucose, UA NEGATIVE mg/dL <30 (NEG)
Ketones, UA NEGATIVE mg/dL <10 (NEG)
Specific gravity, UA 1.005-1.030 1.005
UA Hgb NEGATIVE mg/dL Hb <0.03 (NEG)
pH, UA 5.0-8.0 5.0
Protein, UA <30 (1+) mg/dL <10 (NEG)
Nitrite, UA NEGATIVE NEG
Bilirubin, UA NEGATIVE mg/dL <0.5 (NEG)
LEUKOCYTE ESTERASE, UA NEGATIVE NEG
Urobilinogen, UA, ql NEGATIVE mg/dL <2.0 (NEG)
MICROSCOPIC EXAM, URINE NOT INDICATED
CHLAMYDIA TRACHOMATIS RNA, URINE, AMPLIFIED PROBE, QUAL NEGATIVE
Neisseria gonorrhoeae sp RNA, urine, amplified probe NEGATIVE
Thank you for your reply.
Below are the test results from my urine analysis. My doctor prescribed a 7-day treatment of Cipro, which ended on Tuesday and did not clear the symptoms. When he gave me these test results, he said that he didn't know what i had but that it appeared to be insignificant. he is my GP. I haven't seen a urologist for this incident, but did see one for the incident last summer. I went to the local STD clinic on Monday and received more treatment for chlamydia and gonorrhea - two pink pills and a shot in the butt, tho I don't know the names of the antibiotics. It was at this STD clinic that the doctor told me about the herpes blood test. In the last 2-3 months, I have been with two people. both males. one of them i have known and had sex with for about seven years without any medical problems. i had insertive unprotected anal sex with him twice. we both test for HIV regularly and are both negative. i tested on Monday at the STD clinic and was negative as well. the other sexual partner i have recently met, and have not had anal sex with him. we have kissed and been naked with each other and exchanged oral sex. recently i have been working out at the gym a lot and, after a shower, would put the same pair of jeans on without wearing underwear. i have since stopped this and have washed those jeans. is this a possible cause of NGU?
Component Reference Range 7/22/2009
Glucose, UA NEGATIVE mg/dL <30 (NEG)
Ketones, UA NEGATIVE mg/dL <10 (NEG)
Specific gravity, UA 1.005-1.030 1.005
UA Hgb NEGATIVE mg/dL Hb <0.03 (NEG)
pH, UA 5.0-8.0 5.0
Protein, UA <30 (1+) mg/dL <10 (NEG)
Nitrite, UA NEGATIVE NEG
Bilirubin, UA NEGATIVE mg/dL <0.5 (NEG)
LEUKOCYTE ESTERASE, UA NEGATIVE NEG
Urobilinogen, UA, ql NEGATIVE mg/dL <2.0 (NEG)
MICROSCOPIC EXAM, URINE NOT INDICATED
CHLAMYDIA TRACHOMATIS RNA, URINE, AMPLIFIED PROBE, QUAL NEGATIVE
Neisseria gonorrhoeae sp RNA, urine, amplified probe NEGATIVE
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
