Please should you be so kind to help me out in this difficult and frustrating time. I am 25 years of age, male and have been experiencing Dysuria for the past four years or so. There is inflammation on the internal opening of the urethra with some very small red inflammed “bumps” which seem to disapppear and reappear from time to time. There is only a burning sensationat the tip when urinating with no discharge, smell nor do i have problems passing urine. From time to time when the inflammation flares up there is an itchy uncomfortable feeling inside the urethra for a couple weeks which resides to a point but on a normal basis there is the burning sensation whenever I urinate. With large intakes of water and reduced spicey food intake, the burning sensation is significantly reduced when passing urine, but has never ceased. To make matters worse, my lymphnodes in the groin were paining with accompanying scrotal pain which now four weeks later have NOT fully resided.?
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Within the past month my partner and I were tested again for HIV, Herpes, Hepatitis, Chlamydia (blood test),Syphilis, Urine cultures, Urinalysis and swab test for Gonorrhoea for Urethritis(taken 3 and a half hours after last voiding) and all are negative. My prostate was also cheked as well via a blood test and that registered 1.8. Is that good for my young age? I know that is normal for older males. After the third day of taking the swab, I felt no pain when urinating for a couple days but then the inflammation and pain returned subsequently.?
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I took Augmentin(Penincillin) and Flagyl(Metronidazole) two years ago, Zithromax (Azithromycin) upto two weeks ago, after which I was on Ciprofloxacin and Metronidazole for one week and the scrotal and lymphnode discomfort has reduced but not totally. However, my Gonorrhoea culture results have detected Pus cells and “Occasional Gram positve Cocci” with a microscopy of 8-15WBC/HPF. Should I be swab tested now for fungi, anaerobes, ureaplasma or get a direct smear done? I was administered Diflucan on more than one occasion since my partner has yeasts infection occassionally but that did not solve my Urethritis either.?
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Can you shed some light on this situation for me since this has become more than a nuisance for me now and is taken a toll on mself mentally, my girlfriend and my sex life since now I have difficulties with getting as hard and big an erection as I am accustom to and my penis size is smaller than it used to be in both the flaccid and erect state. Throughout the past couple years even with a hard erection, my erected penis has become noticeably smaller in length and girth. I am not sure if this is related to my primary problem or it may be of psychological origin or both, or some other Erectile dysfunction reason. Can my infection whatever it is be “eating away” at my penis tissue??
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I am asking very very graciously if you can please assist me in this matter since I am afraid these ongoing problems may become more serious.?

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Dr. Joshua’s Answer

? It seems that you have been thoroughly examined by your doctors, had? a good set of lab tests done, and had a variety of antibiotic treatments covering the major infectious agents typically causing urethritis in men. Given the finding in the gonorrhea culture, you need to make sure that gonorrhea is completely excluded for both you and your partner, as well as other STD’s.

One thing comes to mind. You mention the itchy uncomfortable feeling, and also that the symptoms come and go in cycles. Further, there is accompanying lymph node enlargement and pain in the genital area. To me, this? is? suggestive of herpes. Has a herpes simplex culture been done when the inflammation is active? Herpes serology (blood tests) may also provide more information.

In any case, regardless of the herpes test results, I would recommend that you talk to your doctor about the possibility of starting a herpes medication trial. Acyclovir 800 mg 5 times daily for one week, then 400 mg twice daily continuously. (This is fairly expensive, and the literature recommends 200 mg 5 times daily as initial treatment, but I am personally in favor of larger doses initially, considering that acyclovir is generally a very safe drug to take). If the symptoms disappear and do not occur again while on this regimen, herpes is the most likely cause and then you could discuss with your doctor the stategy and dosage for preventive treatment for you and, if necessary, for your partner.

If this does not work, discuss with your doctor the possibility of further lab tests and consultations with the proper specialists. According to the literature, the most important infectious agents (pathogens) causing urethritis include N gonorrhoeae, U urealyticum, C trachomatis, M hominis, T vaginalis and there is also a variety of rare causes which should be considered — you should be examined by the proper specialists. Considering your symptoms, a consultation with a urologist may be necessary.

Please remember that you’ll need to discuss all of this with your own doctor and please do not initiate any treatment without running it by your own doctor.

Good luck!