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Painful lymph nodes in groin, bumps on anus, discomfort in genitals, acne. Have hemorrhoids. Stress related?

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Urologist
Practicing since : 1991
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Hi - I will start with symptoms, then give a brief symptom history, then treatment history.
Symptoms - Extremely painful lymph nodes in groin (inguinal, both sides); bubbling feeling around lymph nodes and across lower abdomen (below navel, above pubic hair); persistent, stinging pain that begins across lower abodomen and radiates out down thighs and up to chest; marked lethargy; discomfort in genitalia (accompanied by occassional shooting, sharp pain - not triggered/aggravated/alleviated by erection/intercourse/ejaculation); no unusual discharge except that ejaculate may be thicker/whiter than in past (not sure though); bumps on anus accompanied by bright red blood upon bowel movements, some difficulty with bowel movements, possibly some type of anal discharge (not sure) (the symptoms relating to anus were diagnosed as hemroids after visual inspection - see below); occassional, mildly painful bumps in groin area (diagnosed as acne, and I do have fairly bad acne across my body).
Symptom History - Here is the full disclosure on everything I can remember. In the past 2.5 years, I have been with three sexual partners (all female). During spring/summer of 2010 was with all three: vaginal/oral (giving and receiving). Afterward I have been in an exclusive relationship with one. Always wore condom for vaginal intercourse (oral was unprotected both ways), though there may have been unprotected contact between my penis and the external parts of partners' vagina. Now unprotected sex on regular basis with exclusive partner. Late summer 2010 notice some discomfort in penis, not severe, and it went away after a week. I didn't think much about it because I had surgery as a child to widen my urethra and it still causes occasional discomfort, but this was slightly different. Fall 2010 I noticed some pain/mild discomfort with erection/ejaculation as well as increase in pre-ejaculate. Again this subsided after a brief period (a few weeks, maybe a month). Maybe 8-12 months ago (so around spring/summer 2011) noticed the bubbling feeling. No pain, just weird and annoying. Then mild lymph pain started. The symptoms would come in cycles, lasting a few days or weeks, then going away for a few weeks or months. So initially, I didn't pay it much mind - I figured gas, or my surgery, or stress, whatever - it would just go away, so no problem. But about 4-6 months ago, pain started increasing. Every time I would get ready to go to the doctor, it would go away. During this last cycle, the symptoms obtained the characteristics above, and the pain was unbearable. I could barely walk or think straight. The pain is not position/pressure sensitive, but I still wore loose clothing for fear of aggravating it.
Treatment History: Prior to last week, last STD tests would have been in 2006-07 time frame. Had gonnorhea and chalmydia tests by urethral swab - both negative. Had urine culture to look at infections of kidney; bladder; UTI; etc. Care provider said she tested for "everything." Care provider said symptoms did not fit any diagnosis cleanly, but she felt certain no HIV/syphillis indicated by my symptoms. Visual inspection of genitalia did not reveal anything abnormal - no signs of herpes/warts. Visual and manual inspection of genitalia (penis, scrotum, and testicles), abdomen, inguinal area did not reveal signs of cancer or structural problems (though scar tissue from aforementioned surgery was noted). Visual inspection of anus confirmed hemroids - but this was an aside and not very thorough. No prostate or other type of anal exam.
Preemptive round of STRONG antibiotics given. I had shot of antibiotics (not sure which one, but she said it was powerful), and a Z-Pac (4 pills, all in one dose) the next day. The symptoms had immediate, pronounced relief - it was really stark (in a good way) - I also noticed an immediate increase in sex drive (perhaps cuz no pain). But then two days later, I still noticed lingering symptoms - though it was back to the bubbling feeling in my stomach that had not been around for some time. Now mild lymph node pain and sharp pain in abdomen have returned today. The care provider called yesterday, said all tests - urine culture and STD - were negative. She said she felt comfortable ruling out STIs, but was at a loss. Though it responded to antibiotics (I think - like I said, it will subside on its own - but usually not so quickly and definitively) and I had lingering symptoms, care provider said she would not give any more antibiotics. She said keep drinking fluids and chalk it up to one of those weird things.
Other notes: I injured my groin area lifting a heavy object in summer 2008. Was later diagnosed with possible inguinal muscle tear, but I never pursued further treatment. My exclusive girlfriend has had a thick, white, non-odorous discharge regularly for the past few months, and I am not sure, but I think the outer appearance of her vagina has changed (swollen labia, less pronounced clitoris) - but again not sure. Also one of the aforementioned sex partners had a lot, a LOT, of natural vaginal lubrication. None of them had any STIs to their knowledge.
I have been under an extreme amount of stress for the past year. I had an eye infection last year, treated with antibiotic but it lingers and was not diagnosed. I had what I thought was a heart attack in summer/fall 2010 but care providers did not find anything and suggested it was stress-related or in my head.
I am 30, Caucasian, smoker, drinker, drink a lot of energy drinks. Don't regularly exercise; diet is not great, but not bad.
Please help; I am scared and don't have insurance, so I can't spend a fortune on tests to track this down.
Posted Wed, 23 May 2012 in Infections
 
 
Answered by Dr. G.Srinivasan 11 hours later
Hi,

I went through your detailed history. Points leading to a possible diagnosis are painful nodes and bumps on anus.

1.     Painful nodes are almost always related to infection in areas of drainage of nodes. I feel these nodes are due to the perianal infection, which could be boils/ abscess/ fistula. The answer lies in meeting a colorectal/ gastrointestinal surgeon who needs to examine you thoroughly with focus on the anal region.

2.     It is better to get an ultrasound scan of your abdomen done to look for any nodes inside the tummy and also this may give an idea about the solid organs inside.

3.     If it is only a boil, it should subside with a course or two of antibiotics that act against staphylococcus (like cloxacillin). You may also be benefitted by topical ointments like sodium fusidate.

4.     If it is an abscess or fistula, the colorectal surgeon would be the right person to guide you.
Please keep me informed of your progress.


Dr G Srinivasan.
Above answer was peer-reviewed by
 
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