Testing / Discharge Questions

[lancelot1306]

Hi Doc(s),

I've posted on this forum before, but I wanted to get someone's advice. My other post has all of the relevant sexual history information (at length), but briefly: I'm a 30 something male, quite a few (hetero) protected sexual encounters, received quite a bit of unprotected oral, & unprotected vaginal encounters with 3 women (1 = longtime girlfriend, other 2 were very brief, 30s - 1min), I have not been sexually active in almost a year. I started 'crotch watching' again last week, saw / felt a hard bump, went to my GP, said that it was normal (I think I had just irritated a fordyce spot, going to dermatologist soon). Today I went to urinate and noticed a drop of clear / sticky discharge on the tip of my penis. I had been holding my pee for a while. I notice this clear discharge somewhat often, sometimes after a bowel movement (which i know is 'normal'), but this was completely random. I sometimes have pain during / after urination and a 'forked stream'. I had a very painful bout of urination a couple of months ago coupled with cloudy urine / white 'flakes' in the urine; I am pretty sure this was a kidney stone and my GP agreed. I am currently taking 100mg of minocycline daily (for acne). I continue to worry about hsv. To the question... Since It's been so long since my last sexual encounter, and I'm taking minocycline daily, can I rule out NGU as the cause of my discharge? I was tested (urine) for bacterial infections after my last encounter (I think a week after, maybe 2) and it was negative, but I'm unsure whether they tested for NGU, and NGU seems to be related to HSV somehow from the reading I've done. Upshot: is this discharge likely related to any sti, particularly herpes, or do the symptoms sound more indicative of a prostate / urethra issue (I've been reading up on chronic pelvic pain syndrome)? What type of consult should I seek, and what type of testing is in order (i.e., test for ngu? test for hsv?). Thank you! Sorry for the long post.

[Edward W Hook, MD]

If your lesion were due to HSV, the biopsy should have shown it.  My advice is to talk with the person who took the biopsy and if need be, have them talk to the pathologist.  Both of these individuals have access to your biopsy and the dermatologist has examined you, neither of which I can do over the internet.  My sense however is that your concerns about HSV are misplaced.  Paying again will not change this.  EWH

[lancelot1306]

I will update you after my visit to the urologist. But, I have a number of questions regarding the biopsy results. I feel they didn't run the appropriate tests and thus precluded the ability to know (rather than think) that the bump wasn't HSV (it's hard for me to rationalize having sex with someone based on "I had a bump on my penis so I had it biopsied, the results indicated that it could be anything, including a virus"). If I paid and re-posted could you address these questions? It seems as though the people I have at my disposal cannot answer questions such as these... Thank you.

[Edward W Hook, MD]

This biopsy does not suggest HSV.

This will be my final answer unless you have something to say following your visit to the urologist. EWH

[lancelot1306]

It seems like they didn't run the appropriate test(s)? A PCR? Can they do that with the biopsied tissue, and if so, could they still do that?

[lancelot1306]

I got the results back from the biopsy, they are equivocal? I have no clue what this stuff means. My dermatologist told me not to worry, I told her I got the biopsy so I wouldn't have to worry. Can you look at the results below and tell me what you think? Please? Thank you.

Microscopic description: there is an inflammatory cell infiltrate present in the dermis composed of lymphocytes, histiocytes, and scattered eosinophils. Focal spongiosis is present in the epidermis and focal mounds of parakeratosis are present in the stratum corneum.

Diagnosis: Spongiotic Dermatitis. See Note:

Note: The differntial diagnosis includes acute allergic contact dermatitis, a viral exanthem, atopic dermatitis or drug eruption. A PAS stain is recommended to rule out the presence of Candida or a dermatophyte.

[wtfblzntd19]

Have you been checked for kidney stones?

[Edward W Hook, MD]

Please let me know what the urologist says.  EWH

[lancelot1306]

Ok, thank you. I'm going to get a urinalysis done right now, have an apt. with my gp scheduled in a few hrs, and an apt with my urologist on thurs. The pain in the right side of my pelvis is really concerning; as are the chunks of stuff that are coming out when i pee. I have discharge every time I pee now, there is no burning, but they're firm chunks, along with some of the clear discharge I've seen in the past. This is all very scary to me...

[Edward W Hook, MD]

The continued symptom you describe are not suggestive of STD. There are other urological problems which might explain them.  My reecommendation recommends taht you see a urologist. EWH

[lancelot1306]

I should say that the pelvis pain started on Sunday (the lesion was biopsied on Wed.), I took a shower and when I got out it felt like I had blue balls. Now the pain is just on one side right above the base of my penis. I have not masturbated since I had the lesion biopsied, but have felt aroused... I've seen the little sticky drops of clear discharge a couple times on the end of my penis.... But, this time i had a bowel movement and urinated, when I was done urinating there was a couple of congealed chunks of something, they were clear, but firm like gelatin. Could this be a sign of herpes or another std? Could it be related to the incision (which I had a gp look at yesterday, she said it looked fine)? Could this be related to semen build up or something? Any help would be greatly appreciated... They say the biopsy results might take another week.

[lancelot1306]

Hi Doc, I know you said nothing further to say. But, things have definitely changed, big time. I now have a very tender area just above the base of my penis, I can't say these are swollen / tender lymph nodes, but there's an area of my pelvis (on just one side) that is very tender and radiates down to my testicle. I also just had a very clumpy, clear discharge after urinating -- it was gelatinous. I haven't had sex in a year, but as I said, I did engage in some frontage, maybe brief genital to genital contact, about 3.5 weeks ago. I have a urinalysis scheduled for tomorrow, but results may take a while? Also, no results on the biopsy of the lesion yet... If you could weigh in on this, I would greatly appreciate it. Very scared.

[Edward W Hook, MD]

Nothing further to say.  Feel free to update this thread with you test results.  EWH

[lancelot1306]

Thank you for your comment. I had a little bit of the discharge again (it's just like a drop of clear sticky fluid), and testicle pain yesterday (like 'blue balls' pain). I think that there's something going on with my prostate... The discharge has been a common occurrence for me for at least a year. Still no test results from the biopsy, but the bump was kind of hard and looked like a pimple (the dermatologist said I could probably pop it out), but I know that I'd think about it forever if I just didn't have it tested... That's why I would like to have a blood test for hsv, because I know every time something pops up, I'm going to be in the dermatologist's office.

[Edward W Hook, MD]

Sorry, I did not comment becasue there was not much to say.  There is simply no reason to think that the lesion you noted was HSV.  I am confident that the biospy will show that the lesion you noted was not HSV and it it were, the biopsy would be positive.  Getting an IgG will not be helpful and may well be misleading.

My assessment has not changed. There is really no medical reason to consider STD of any sort as the origin of your symptoms, or the lesion you noted.  EWH

[lancelot1306]

Just wondering if the non-response is intentional? Thank you.

[lancelot1306]

Thank you for your comments. I plan on seeing my urologist next week. I don't know if this is thread jumping, but I really wanted to ask about hsv testing. Today I woke up and saw what appears to be a pimple on the head of my penis, again could be an irritated fordyce spot / pearly penile papule. But, I went to the dermatologist, she looked at it and told me not to worry. But, I had her test it anyways (she did a punch biopsy, which seems excessive?), now i have stitches in the head of my penis... I cannot shake this fear of herpes... I have a lot of bumps on my penis and I seem to see something 'new' or concerning every month. I also have the urination / discharge problems (and tingling...) I have had unprotected sex in the past, but it has been over 12 months since my last unprotected encounter, which was brief (but did engage in some frottage about 2 weeks ago, she had panties on). Should I just go get an IGG test done to ease my mind?

[Edward W Hook, MD]

Sorry, I wrote doxycycline.  I meant minocycline which has the same or greater activity.  As I said, NGU is most unlikely.   EWH

[Edward W Hook, MD]

Welcome to the Forum.  A number of factors make STI unlikely, including your negative tests, that you are taking doxycycline, and the relatively low risk nature of your exposures.  The clear discharge you describe may be normal prostate fluid that tends to be expressed, particularly when having a bowel movement (this increases the pressure inside the abdomen, pushing the fluid out).  I have les explanation for the pain on urination.  You are of an age when kidney stones begin to present, this may be a possibility.  My suggestion would be to seek evaluation by a urologist without fear that your symptoms represent an STI.  If you wish to discuss what he/she says, feel free to return to this thread and I can provide limited comments.  EWH