I'm 36 years old and two nights after having sex

Patient

Q: I'm 36 years old and two nights after having sex with a new partner - I had to pee frequently with no pain. A few days later there was some burning sensations when urinating and then pain on ejaculation of the left testicle and pain on the tip of my penis. This was approximately 3-4 months ago. I was tested for a UTI, HIV, syphillis, ghonorrea, chlamydia, Hep B and Hep C and everything was negative. My partner was also negative for everything as I asked her to get tested. She stated that she has never had any symptoms of any STD's and gets tested every year. The burning sensation when I pee comes and goes as does the pain on the tip of my penis (especially left tip). If I drink a lot of fluid - there's no more burning. Over the last 4-5 weeks I've had discomfort in my pubic area - sometimes itching- sometimes pain. I've had no blisters, no ulcers, or anything indicating herpes. I have had one single pimple - which looks like an ingrown hair and went away after 2 days with no blistering or crusting. The pain and itching in the pubic region was nowhere near the pimple. I have had some severe bleeding from hemerroids recently - which is not uncommon. The bleeding has stopped.

I do have vericose veins in my left testicle that I've had treated but have come back. I have 2 worries.

I went to an STI clinic and since there were no sores - the nurse said she would not be able to tell whether or not there is herpes.


1) That it could be herpes ( but herpes wouldn't last 4-5 weeks and comes in clusters of blisters or pimples wouldn't it? How long would herpes symptoms/signs typically last?)

2) This is possibly something cancerous.

I'm extremely anxious that it is one of the two -
Could you please advise? Thank you

Symptoms:  Please see above
Doctor

A:   Hi.
Thanks for your query.
I have read your elucidate history and understood the concerns.
To answer your queries:
1) That it could be herpes ( but herpes wouldn't last 4-5 weeks and comes in clusters of blisters or pimples wouldn't it? How long would herpes symptoms/signs typically last?)
> Yes, herpes symptoms and signs last for about 3-5 weeks. Within this period the blisters/rash would disappear. In some patients the pain can last for months or even years, particularly in the elderly.

2) This is possibly something cancerous.
> These symptoms are not that of cancer as there is no mass or ulcer or bleeding per urethra.

Your symptoms may be due to non-specific urethritis where the tests may all be negative as in your case.
You need the following:
Urine culture and sensitivity by aerobic and anerobic methods.
Ultrasonography and color doppler of the whole abdomen and scrotum.
Therapeutic trial with a broad spectrum antibiotic such as Doxycyclin after the urine is given for tests.
An opinion of an Urologist.

I hope this answers your query.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Comments / Follow Ups

Patient: So I guess my follow up is that this is less likely to be herpes as it there's are no sores etc but more likely to be urithritis? Is there an accurate test to do for herpes to rule it out?
Doctor: The accurate test is possible only if there are fluid filled sores.
Please carry on the advise given above so that you get a correct diagnosis.

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