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I’m not sure where to turn, Burning in the urethra, Off and…

I’m not sure where...

I’m not sure where to turn

Doctor's Assistant: What are all the symptoms you're experiencing (e.g. loss of appetite, fever, rash)?

Burning in the urethra

Doctor's Assistant: How long have you been dealing with the burning? Are you experiencing any other discomfort?

Off and on now going on 9 weeks

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Nothing personally, however, there was one exposure to Genital herpes. She has been on Valtrex for 10 years and wasn’t having an outbreak

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Answered in 7 minutes by:
6/27/2018
Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5,798
Experience: 20 Years in Internal Medicine, Neurology and Sports Medicine
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Hello. Have you had an STD work up?

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Customer reply replied 1 month ago
I was exposed to genital herpes after sexual intercourse. She has been taking Valtrex for ten years and was not in the middle of an outbreak. The burning started the very next morning and I was prescribed azithromycin two separate times and the symptoms went away. Just a few days ago it came back and was prescribed doxycycline for ten days and it hasn’t worked as well as the azithromycin. I was tested for gonorrhea, chlamydia and trichomoniasis and had a urinalysis done and all came back negative. I have had no other symptoms. It is simply the burning in the urethra.
Customer reply replied 1 month ago
The exposure was 9 weeks ago
Customer reply replied 1 month ago
The burning is not intense, rather it is just annoying. It does come and go through the day

There are multiple possible cause of urethral burning. It can anything from soap getting into the urethral orifice during a shower to mechanical stress on the glans during sex to an STD. The first two tend to improve within a few days to weeks, unless the cause continues to occur. As for STDs, they can be ruled out via urine and blood tests. You're covered for gonorrhea and chlamydia, but would need a blood test to rule out HIV, syphilis, hepatitis C or herpes. This would be a good idea as these entities can occur silently and linger for many years without one knowing it. A person with genital herpes (HSV2) can shed the virus even when they are not having an outbreak, though it is much less likely. Similarly, herpes can be shed even while taking acyclovir, though this reduces the risk as well.

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Customer reply replied 1 month ago
what would your professional opinion be seeing that the symptoms come and go and the antibiotics seemed to have had an effect? I’m already preparing for the possibility of it being herpes, but would what I just asked make sense since the antibiotics were effective?
Customer reply replied 1 month ago
Since they were effective, does that mean anything?

Were they effective, or was it a placebo effect? Sensations in the urethra can be very unreliable and prone to amplification from stress or anxiety. A bacterial infection such as gonorrhea or chlamydia should have been adequately treated by the antibiotics you took. Symptoms do not come back unless there is resistance, which is still (thankfully) rare in this country. Viral infections would not respond to the antibiotics at all, so they should not improve or come and go. Ask your doctor to check you for HSV2 IgG and IgM. This will tell you if you picked up the virus. It is not a dangerous virus to have. It is essentially the genital version of the virus that causes cold sores in the mouth (HSV1).

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Customer reply replied 1 month ago
I will have the doctor check me for the HSV2...since genital herpes is a viral infection, the antibiotics wouldn’t have had an effect on the symptoms would they? I only have the burning in the urethra and nothing else. I have become more stressed as I have read too much on the internet and about having the virus. During the time the symptoms were gone, I had little to no stress.

These types of symptoms are frequently stress related, and that might be all that it is. Either way, it will get better. If you turn out to have HSV2 it is not a big deal medically...it doesn't hurt or kill people. And it can be suppressed quite effectively, if necessary.

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Customer reply replied 1 month ago
At 9 weeks, I’ve seen a wide range of percentages for accuracy with the tests...how accurate are they at this point? And would retesting be necessary?

This is plenty of time to mount an antibody response in most individuals. That is what the tests look for (i.e antibodies). For HIV, we advise testing at 3 weeks, though some newer tests are reliable earlier. We also advise rechecking at 3 months just to give the body extra time to make antibodies. The HSV test would also be expected to be quite accurate by 9 weeks. This generally does not require restesting.

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Customer reply replied 1 month ago
I am having the test done today. I guess I am just so unsure of what’s going on. I know symptoms don’t have to be present and mine really aren’t “symptoms” but I just can’t get a grasp on what else it could be at this point. The antibiotics seem to have made a difference. And today it hasn’t been so bad. I took some of the AZO Maximum Strength and drank a lot of water and the sensation hasn’t really been there today. Is that normal or is that another placebo effect possibly?

I think this will turn out to be from something else and not an STD. Even minor trauma to the urethra from soap or the urine jet as it passes through can result in intermittent tingling or mild discomfort. This typically heals quite readily but can be amplified by the stress of not knowing what is going on. Getting the test is a good idea, but it will probably be negative. Either way, this will get better with time.

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Customer reply replied 1 month ago
Would it be possible that it could be trauma or just bacterial since it was the first time I had sex in over 4 months and it was with a new partner?

Yes, most likely.

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Customer reply replied 1 month ago
Sorry to send such a graphic photo, but I found this on my right butt cheek. Looks like a pimple and it has never itched, burned or tingled. My buttocks never has actually. Two about 3 inches apart. Should I be concerned?
Customer reply replied 1 month ago
I do workout and also work at a desk so I do have a lot of opportunity to sweat and cause irritation.
Customer reply replied 1 month ago
Nothing hurts to the touch
Customer reply replied 1 month ago
Before this who episode...I have had pimples on the buttocks quite a few times
Customer reply replied 1 month ago
I do also take supplements such as body mass gainer and creatine

Those appear to be superficial small papules, infections but not deep enough to be abscesses. They are more common in sweaty areas as well as areas that are shaved. They generally require no treatment unless one is diabetic or prone to boils. Warm soaks and/or a short course of antibiotics would probably clear these up within a week or two.

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Customer reply replied 1 month ago
Since we last spoke I have been takIn my anti inflammatory again and also took some AZO maximum strength and the burning has subsided quite a bit to just under a dull sensation for the most part. I have noticed some redness at the tip. I attached some pictures, again, I apologize, but does anything seem irregular or herpes related?
Customer reply replied 1 month ago
I’ve also drank a lot of water and that seems to dilute the urine and it doesn’t burn as much either. It seems to come and go and is usually worse while sitting for a long period

I don't see anything unusual or herpes related. The skin of the glans is very sensitive to the outside environment, whether it be to soaps, lotions, fabrics, or even the ambient temperature. In addition, there is a rich vascular bed just under the surface and the tiny vessels can dilate or constrict in unusual patterns. A reddish or pinkish discoloration can come and go and a blotchy appearance is not unusual.

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Customer reply replied 1 month ago
I’m just at a loss at what this could be at this point...nothing persists except the burning in the urethra and it’s been 10 weeks since the exposure and it has been very up and down and inconsistently present. No other symptoms and every little bump, red mark, itch, etc is making me feel very unsure. The burning is definitely inside the urethra. If I squeeze the penis I can feel it inside. Nothing on the outside.
Customer reply replied 1 month ago
Not sure if this is a spot of concern? It’s at the base of the penis shaft. I did shave last week. It does not itch or burn and never has in that location.

It looks like a little folliculitis, which is typically easily treated with antibiotics. You should see your doctor or a dermatologist to confirm the diagnosis and get on the proper medication. As for the burning, the only other route to take would be to see a urologist. They can put a tiny camera up the urethra and visualize what is going on (i.e. cystoscopy). This may be the only way to get a more definitive diagnosis, assuming the symptoms don't go away in the meantime (which happens frequently).

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Customer reply replied 1 month ago
These are pictures of my right thigh...does this look abnormal? Also, I did see the urologist today and they were leaning towards prostatitis. This is now week 11 and the burning is still present although the past few days have been very mild and a lot of times unnoticeable.
Customer reply replied 1 month ago
I also took some pictures of the glans. I’m just overly worried and concerned at this point. Does this look abnormal as well?

It's hard to be definitive with images alone, but the bumps on the glans appear to be normal pearly papules, while the skin lesions resemble follliculitis.

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Customer reply replied 1 month ago
I’m just unsure at this point...my doctor orinignally diagnosed me with epiditimis well before this all came about. Had the anti inflammatory prescribed and have been taking those. Once all his came to be it was urethritis and the urologist is saying prostatitis. Is there a similarity amongst these?

The difference is whether the infection is in the epididymis (testicular tubing), the prostate (the gland at the base of the penis through which the semen passes) or the urethra (the tube through which the ejaculate passes. They are all part of the male reproductive system and all can harbor bacteria, sometimes silently. They all typically respond well to a couple weeks of antibiotics. But these would not be directly related to your skin lesions. It appears that something else is going on with the skin, although an infection here would also typically improve with the kinds of antibiotics used for the reproductive tract.

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Customer reply replied 1 month ago
Which lesions are you referring to? I was on azithromycin twice and doxycycline after. Both seemed to work. The burning has been off and on during the day and for the duration of the 11 weeks now. It seems to improve when drinking a lot of water which diluted the urine. I notice it is more noticeable when eating or drinking irritants and sitting for prolonged periods. I have been stressed and anxiety filled so I’m just concerned overall. It seems like it could just be bacterial, but I know Herpes isn’t out of the question. It just seems like the burning wouldn’t persist this long if it were and wouldn’t be the only “symptom”. Am I thinking incorrectly?
Customer reply replied 1 month ago
Tomorrow is when I have my HSV2 test scheduled. I know that will provide more answers. Nothing seems to add up at this point

That might or might not help. I don't think it will explain your skin lesions. Ask your doctor for a trial of keflex to see if they clear.

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Customer reply replied 1 month ago
Referring to the Folliculitis?
Customer reply replied 1 month ago
It is almost cleared up. Unless the photos showed you other areas of concern.

It sometimes will clear on its own with careful skin care and cleansing.

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Customer reply replied 1 month ago
Were you referring to use the Keflex for the Folliculitis?

Yes.

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Customer reply replied 1 month ago
Do these concern you? There are on my right buttocks. Don’t itch, tingle or burn. I took a site bath last night and have been sweating quite a bit over last night and today
Customer reply replied 1 month ago
Should have read a sitz bath... here is a closer photo

No, they don't appear concerning, though I can't rule out an infection in those follicles. If you don't have access to antibiotics, you could treat these topically with hibiclens. It's a surgical scrub we use to kill bacteria, and is available over-the-counter.

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Customer reply replied 1 month ago
Okay I will try that out. I didn’t notice them until I was changing after work. The only time they have any type of sensation is when I touch them. That seemed to irritate them a little. I didn’t notice them last night. Is that normal for them to grow that quickly?

They can come up over the course of a day or two, especially in hairy or sweaty areas where there are a lot of oil-producing glands.

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Customer reply replied 1 month ago
The results have came back and they were negative. It was taken at the 10 week mark...and before the recommended 12 week timeframe...should I accept the results and move on or retest later?And thank you for all of your help. I really appreciate it.

You're welcome. That test should be good. It would be very unusual to not have antibodies at the 10 week mark. This pretty much ensures you do not have the infection. You should definitely move on and put this behind you.

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Customer reply replied 1 month ago
I’ve been pretty confident in the results but still have been looking myself over and was just curious if this is something of concern...it is the underside of the penis just under the glans.

Yes, I'll take a look. If you could provide a rating first that would be great.

We can continue the thread and answer any additional questions.

Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5,798
Experience: 20 Years in Internal Medicine, Neurology and Sports Medicine
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Customer reply replied 1 month ago
Absolutely. It has been completed.

So you are referring to the two small red areas on the sides of the glans?

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Customer reply replied 1 month ago
sir. The one side has a very very small red bump...I just noticed it today

That looks like an area of irritation or inflammation. Could be from anything but does not resemble herpes or any other STD.

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