Expert: Arthur Goldstein, M.D. - 4/14/2004

Question
my husband age 28 good healthjust yesterday developed irritation of the urethral opening on his penis - he wears boxers and does alot of bending and stooping and such @ his place of employment - he states that it does not burn when urinating only when fabric or such comes into contact with it- there is a slight discharge clear to mildish white-he is experiencing no other pains - i was test december of last year for STD's and came out negative- not that i am aware if he has ever been tested before or not-
we did have intercourse the night before this occured- i have no pain no discharge or any problems- any suggestions?

Answer
Theresa, you husband either has urethritis (an infection in the urethra - the tube running through the penis) or one of the types of prostatitis.  Urethritis is generally treated with antibiotics.  The most common cause of this complaint is an inflammation of the prostate gland, so called prostatitis.  Other symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, sexual dysfunction (such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum (the area between the scrotum and rectum – betwixt the “wind and the rain”).  The prostate is the organ that produces the majority of the semen in response to sexual stimulation. At the time of orgasm, the prostate contracts and forces its fluid into the urethra (urinary canal). Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this.  One should avoid any of the above that apply and ejaculate in moderation (about once or twice a week).   Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort.  Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms. A daily warm bath for 10-15 minutes also lessens the discomfort.  There are several types of prostatitis.  Sometimes prostatitis can be due to an infection of the gland with bacteria.  This usually requires a 4 week course of an appropriate antibiotic.  Typically, pus cells and bacteria are found in the prostatic fluid.  Abacterial prostatitis has several varieties.  In one, the prostatic fluid demonstrates pus cells but no bacteria.  In the other, called prostadynia, there are neither pus cells nor bacteria in the fluid, just the symptoms.  In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder.   Abacterial prostatitis usually responds to the general measures mentioned above.  Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha blockers (such as Flomax, Hytrin & Cardura).  The latter require a prescription from you physician if he thinks it is indicated.  Prostatitis may also be classified as acute (severe), subacute (mild), or asymptomatic.  It may also occur as a single episode,  recurrent or chronic.  I suggest he seek consultation with a urologist for evaluation and treatment.  In the meantime, he should avoid sexual activity as this might exacerbate his symptmos.  Good luck!