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Dr Basu
Dr Basu, Experienced Specialist
Category: Health
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Experience:  MD
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I am a male with a persistent UTI that manifests itself with

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I am a male with a persistent UTI that manifests itself with a general irritation in the shaft of the penis. There is no pain on urination. I've been on 2 cycles of doxycycline and azithromax. Is there a better antibiotic for this?
mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

mysticdoc :

Hello,

mysticdoc :

Thanks for your question.

mysticdoc :

Doxycycline and azithromycin are good antibiotics.

mysticdoc :

However, Bactrim DS is a better antibiotic in case of UTI.

mysticdoc :

Urine analysis, culture and sensitivity should be checked for any resistant bacteria.

mysticdoc :

Other possibility of penile shaft irritation can be urethral stricture or narrowing.

mysticdoc :

Urethral irritation from the passage of small stone also can cause similar symptoms.

mysticdoc :

These possibilities can be checked by the urologist with a procedure called cystoscopy.

mysticdoc :

This is a small probe with camera to directly visualize the urethra for any lesions.

mysticdoc :

Urinary anesthetic Pyridium ( OTC Azo) can be used for symptomatic relief besides antibiotic.

mysticdoc :

Please do discuss these options with your doctor.

Customer:

How would you get these lesions? Or strictures?

mysticdoc :

This can be from the past infections.

mysticdoc :

Passage of stone is another cause.

mysticdoc :

Sometimes this can be from friction during masturbation or sexual activity.

Customer:

I would know if I passed a stone I assume. Dont recall that..

mysticdoc :

sometime you may not see it unless you are straining the urine in a cup.

Customer:

I see. One other issue that my be related is I have been having a difficult time reaching orgasm.

mysticdoc :

if you have urethral injury, then this is possible.

mysticdoc :

another possibility is the prostate problem like prostate enlarge unlikely at your age.

Customer:

A recent PSA is .8 which is normal I think

mysticdoc :

yes it is not concerning.

mysticdoc :

Testosterone level also should be checked.

Customer:

My GP checked it and it was 432 which was low he said but he didnt want to start Test therapy.

mysticdoc :

free testosterone level should be checked if it is normal or not --this is the active form.

Customer:

Wanted me to get more exercise and lose weight

mysticdoc :

ok

mysticdoc :

repeat the level in 3 months and if still low, should consider T therapy

Customer:

Once you start can you ever stop T therapy? My understanding is T therapy never normalizes your natural test production or could it?

mysticdoc :

No the T production can normalize over time.

mysticdoc :

But the problem should be identified.

Customer:

Even with the artificial T therapy

mysticdoc :

if your testis are not working well, then T production will not normalize even without therapy.

mysticdoc :

On the other hand, if there is problem from the pituitary gland, then this may normalize.

mysticdoc :

GnRH analog therapy is another option to stimulate testis to normalize T production.

mysticdoc :

This is utilized to help with conceiving child.

mysticdoc :

It is better to see a specialist like endocrinologist.

Customer:

I read online the irritation could be caused by the infection trichonomosis

mysticdoc :

that can be checked from urethral swab.

mysticdoc :

Metronidazole course will help if that is the case.

Customer:

Ive actually taken a 2 gram dose of that and it didnt work

mysticdoc :

that means you do not have trichomonas.

mysticdoc :

trichomonas is very sensitive to metronidazole --resistance very uncommon.

mysticdoc :

so it is other way around--that is it is not trichomonas.

Customer:

And its nothing that can be killed with doxy and azith either then.

Customer:

This has been going on for a few months

mysticdoc :

doxy and azithro take care of gonorrhea and chlamydia.

mysticdoc :

Please do not forget the other possibilities discussed above.

mysticdoc :

If urine analysis fail to show any infection, this is unlikely.

Customer:

The last urinalysis showed no infection.

Customer:

But Im not sure what he tested for.

mysticdoc :

ok then other causes should be explored.

mysticdoc :

time to see a specialist.

Customer:

maybe I just need to go to a urologist

mysticdoc :

definitely

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