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What causes irritation in penis and with irritation during urination?

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Posted on Sat, 12 Jul 2014
Question: I am a 46 year old male. In late January of this year i saw an escort. We had protected vaginal sex, but i did receive unprotected oral sex. About 3 or 4 hours later (not days) I started to feel some irritation inside my penis tip and some pressure inside my rectum. Not painful, just irritation. This continued for a few days and i saw my physician. He did a urine test and put me on 500mg cipro for two weeks. This urine test came back negative for any bacteria. I got these results back about a week after the symptoms had begun, and immediately upon hearing that this was not an infection, my symptoms disappeared. I sort of assumed then the symptoms were all due to anxiety after having been with a prostitute (i'm married). The symptoms were gone for about two weeks and then returned. I started back on the cipro for a longer period and the symptoms would sort of come and go. Usually worse in the morning and then fade during the day. At that point i was having symptoms 70% of days and 30% with no symptoms. My doctor switched my to doxyxyclene at my request, and i took those for about 4 weeks. Over that time my symptoms became less frequent. I ended the doxy and because i was still having some occasional symptoms i saw a Urologist. She did a urine test, and checked my prostate. All normal. Again almost immediately after seeing the Urologist the symptoms disappeared for about two weeks. Then the symptoms slowly returned and have been persistent for the last month. There has not been a day in the last month i did not have symptoms. In the morning the symptoms are more pronounced, but even when the symptoms fade during the day some, i always feel something. I have been doing physical therapy for the muscles in that area and also acupuncture, but no change in my symptoms. This is not debilitating pain, just very annoying and i would say incrementally worse over the last month.

These are my symptoms:

1. Irritation/pain in my penis tip. Every day.
2. Slight Irritation when i urinate.
3. Pressure/pain in the perianal region. Every day.
4. Dribbling at the end of urination. Every time i urinate.

From everything i have read there seems to be no way these symptoms are the result of receiving unprotected oral sex from the escort as they started almost immediately and its rare to get an STI from receiving oral sex. I have another appointment with my Urologist, but i was hoping that someone here might have some suggestions. This is really starting to get me down. I thought that it was going away, and then it came back and has been more constant than before. Any advice would be greatly appreciated.

doctor
Answered by Dr. P. T. Patil (1 hour later)
Brief Answer:
Could be due to Prostatitis.

Detailed Answer:
Hello
Thanks for your query,and detail history .Based on the facts that you have posted it appears that you have irritation at the tip of penis ,pain in perineal region,dribbling a the end of urination.

These symptoms could be due to Prostatitis.Please consult qualified Urologist for clinical and digital rectal examination and get following basic test to confirm the diagnosis.
1) Urine Routine and culture to find out the organisms causing this infection and antibiotics to which they are sensitive to.
2) Ultrasound scanning of the abdomen
3) Trans Rectal Ultrasound Scanning (TRUS)
4) Swab test and Culture of Urethral discharge obtained after prostatic massage.

I am not sure if all these tests were performed already. If yes, please upload them here. You can ask your doctor if the tests are not done.

Prostatitis takes long time to get cured hence one has to take appropriate antibiotics for 2-3 months.

In the mean while start taking combination of Sulphamethoxazole and Trimethoprim twice daily and later on switch on to appropriate antibiotic as per culture report .
Doing prostatic massage very day will help to reduce congestion of prostate For this you will need help of a qualified nurse or a health personnel.

Hope I have answered your query ,please feel free to ask if you have more questions ,
I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. P. T. Patil (3 hours later)
Thanks very much for your reply, Dr. XXXXXXX I appreciate your comments, but as i indicated in my original note i have had urine cultures done over the past few months. I had one done in early February after the onset of symptoms and that was negative. I then had another one done a few weeks later and that was also negative. And I had one done about a month ago and that was also negative for any bacteria. At that time i actually had two cultures done. One was before the Urologist performed a digital rectal exam and pushed on the prostate and the other right after. All negative. At that time my prostate was not enlarged or enflames according to the Urologist. In some ways i would be very happy to hear that i had a positive urine culture because it would show there is something there that is treatable, however that has not been the case.

I should also mention that in March of this year i had an MRI of the area and that came back unremarkable as well.

A prescription for Sulphamethoxazole and Trimethoprim is required so i can't just go out and get it myself, and without a positive urnine culture for bacteria my Urologist will not prescribe any more antibiotics. I'm sort of at a loss. Anything else you can suggest?

doctor
Answered by Dr. P. T. Patil (4 hours later)
Brief Answer:
Likely to be due to Abacterial Prostatitis.

Detailed Answer:
Hello
Thanks for writing again.
There one entity called Abacterial Prostatitis where you do not get any positive pathological or radiological evidence of bacterial infection but the patient has symptoms typical pf Prostatitis.

A alpha blockers like Tomsulosin once daily along with daily prostatic massage by a health personnel helps to reduce congestion of prostate and relieve symptoms.

I have been practising this regime for my patients of Chronic Prostatitis over last 40 years of my practice and getting encouraging results.If feasible you can try this .

Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. P. T. Patil (1 hour later)
Thanks Dr. XXXXXXX I failed to indicate that i had been on Tomsulosin for a couple weeks as well without any change in my symptoms. I did not do daily prostatic massage as its not really practical to have a health professional available every day for this kind of service. I'm not sure how anyone could do that.

I hope to see my urologist here in the next week to see if there is anything else she would recommend.

I was hoping there was something else you might suggest. As i mentioned, this is not debilitating, but it is very annoying and distracting and it makes me very sad. I just want the irritation to go away. Would you still suggest trying the longer course of antibiotics? Do you think this could have been caused by the oral sex i mentioned? The symptoms started right away.. within a few hours, so it just seems unlikely that was the cause of what i am experiencing.

Regards,

Tony

doctor
Answered by Dr. P. T. Patil (10 hours later)
Brief Answer:
Can try Doxicycline twice daily for on month.

Detailed Answer:
Hello
Thanks for follow up.
Prostatic massage is very simple to learn .Any male adult or your wife can learn it from the Urologist and get it done at home ..

Since we do not have any positive evidence from the tests done repeatedly it is unlikely that it is due to Oral Sex.

You can take Doxicycline twice daily .on long term for a period of two months,
Thanks and regards,
Dr.Patil.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. P. T. Patil

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What causes irritation in penis and with irritation during urination?

Brief Answer: Could be due to Prostatitis. Detailed Answer: Hello Thanks for your query,and detail history .Based on the facts that you have posted it appears that you have irritation at the tip of penis ,pain in perineal region,dribbling a the end of urination. These symptoms could be due to Prostatitis.Please consult qualified Urologist for clinical and digital rectal examination and get following basic test to confirm the diagnosis. 1) Urine Routine and culture to find out the organisms causing this infection and antibiotics to which they are sensitive to. 2) Ultrasound scanning of the abdomen 3) Trans Rectal Ultrasound Scanning (TRUS) 4) Swab test and Culture of Urethral discharge obtained after prostatic massage. I am not sure if all these tests were performed already. If yes, please upload them here. You can ask your doctor if the tests are not done. Prostatitis takes long time to get cured hence one has to take appropriate antibiotics for 2-3 months. In the mean while start taking combination of Sulphamethoxazole and Trimethoprim twice daily and later on switch on to appropriate antibiotic as per culture report . Doing prostatic massage very day will help to reduce congestion of prostate For this you will need help of a qualified nurse or a health personnel. Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you Thanks and Regards. Dr.Patil.