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Urology/Pain and urethral swelling for months

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Swelling
Swelling  

Discoloration
Discoloration  
Hello,

I received unprotected oral sex from an anonymous internet partner (10 minutes total, no ejaculate).  Within a week I had painful urination and clear discharge but it got extremely bad after ejaculation, like razor blades in my penis accompanied with extreme itching; the color of my ejaculate was also very yellow. The painful urination also increased after ejaculation very badly along with itching so I went to my GP and did urinalysis and a swab to test for gonorrhea and chlamydia. I had done the swab before but this swab was extremely painful and my whole body was shaking after it was finished, most painful experience of my life. After finding nitrates in my urine, the doc gave me azithromycin + shot of something to cover gonorrhea and chlamydia (the tests later came back negative for both). Most of the pain during urination and itching went away within a few days but still lingering pain in my penis head and throbbing painful lymph nodes in right side of groin and painful ejaculation. I went back to the doc and they gave me 10 days doxycycline. Over time (the next month or so), my ejaculate returned to regular color and my lymph nodes stopped throbbing.

I am still suffering from discomfort and inflammation 6 months later however. Here are my current symptoms:
- The pain/discomfort in my penis head is constant all day and my urethra gets swollen throughout the day.  The pain/discomfort can be described as feeling like urine is stuck in my penis head.
- There is an achy pain in the right pelvic region (where the lymph nodes used to throb) for most of the day.
- White discoloration on the tip of my penis that was not there before this encounter happened.

Pain seems to be better in the morning but it progressively gets worse throughout the day.  Sitting makes the pain worse and after sitting for long periods of time I notice that the swelling of my urethra is the worst.  For a couple months, I had pain in the base of my right testicle that got worse with bowel movement but I haven't had that happen for a few weeks or so.

I've been to a urologist as recommended by my GP and he did a urinalysis and digital rectal exam.  He said there is no active infection after antibiotics given already and he thinks it is lingering inflammation from the STD.  He did not have any explanation for the discoloration but noted that it was odd in appearance.  We tried uroxatral for a month but it did not have much impact at all so I stopped it last week per his recommendation.  Currently I am not on any meds and just "waiting for it to pass" and have a follow-up in 2 months.  I'm in pain and my daily life is pretty bad at this point,Iím not sure how this is going to go away on it's own.

Also, I have been having unprotected sex with my new girlfriend for the past 3 months or so and she has not had any symptoms or issues; therefore, I do not think it is an STD anymore.  I can only have sex once a week or so because itís hard to do it with the pain.

Urologist says we could do a cystoscopy but claims it will probably not find anything and most likely be a waste of time and money.  He says there is nothing to do but wait.

Any advice on what this could be?  Should I do the cystoscopy anyways?  Or perhaps I should seek consult from another urologist?

Answer
Trey:

I have no suggestions on what this could be.  If there is no improvement over the next few months, then a cystoscopy may be reasonable.  A longer course of doxycycline may also be an option.  Consider getting a second opinion from a local urologist.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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