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Persistent swollen/irritated meatus or burning urethra


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I have had genital herpes for almost 3 months now and everyday I have irritation or burning on my meatus and urethra. It does not hurt to urinate but I am wondering if anyone else out there has a irritated tip of penis like I do. It is constant and somedays I wake up with a swollen red meatus. My penis feels sensitive and irritated and it really depresses and scares me that this condition I might have forever. When I force myself to get an erection, even that does not feel normal and it is irritating. Please let me know if anyone out there has experienced this for several months like I have. I just want to see how long it has lasted for you or what you might have taken to heal this so I can be a normal herpes sufferer with just some outbreaks every few months. Thank you guys.

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@fonda I don't have a penis, but I can say that I do experience a very sensitive, irritated feeling, and sometimes swollen clitoris/urethra. I've had genital herpes for 15 years, and to be honest, I don't remember if this was something that happened in the early months/years... At that time, I was too overwhelmed with the emotional aspect and the incredible nerve pain in my buttock and leg. When I experience the clitoris/urethra symptoms, it's not terribly frequent, and they only last 2 or 3 days. But again, I've had herpes for 15 years, so that may have something to do with it. I hope it eases up for you soon. (((hugs)))

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Hello Fonda, what you are describing is known as urethritis. There are two forms, non-gonococcal and gonococcal. HSV is a rare cause of non-gonococcal urethritis (usually HSV-2). However, it is rarely the cause of persistent urethritis, more often it is the cause of recurrent urethritis. In addition, herpes should burn with urination. Your findings are not typical of herpes and I suspect you have been coinfected. How did you acquire your HSV (oral, anal, genital) and what type is it. Your first step should be to go to a STD clinic or your doctor to be checked for the standard STDs ( syphilis, G/C, trichomonas, Ureaplasma and mycoplasma). In addition, your urine may need to be checked for HSV by PCR to see if you are in fact shedding. If none of these yields a result, due not fret. Approximately 50-60 percent of non-gonococcal urethritis has no identifiable cause. This may be due to the mode of acquisition. People often forget that the mouth is full of bacterial organsims and only about half can be grown or detected by non-PCR methods. You may need to be put on an empiric antibiotic for NGU.

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Thank you for the words of encouragement Lollyann76! Thank you for the advice Jack101! I had sex with a condom and received unprotected oral sex. 10 days later I had 4 blisters on genitals and IGM showed positive for hsv 1 and 2 but neg on IGG (one month later I had another visual minor outbreak of two bumps on scrotum). That is why I am waiting for a little over the 3 month mark which will be in about 10 days to take IGG test again. All other standard STD tests were neg. My general practitioner doctor gave me cipro at first thinking it was a UTI but I am still having consistent irritation/swelling/pain on the tip of my penis. My urologist told me it was probably due to nerve pain from herpes and prescribed me ametriptyline hcl 10mg at bedtime. Even though it is an anti depressant, he said it works to heal the nerve pain as well and would not give me any antibiotics for NGU because it does not hurt when I urinate and the symptoms were more aligned with post herpes nerve pain. Then he went over how side effects of the antibiotics for NGU were not worth it even though I wanted to try everything just so I would not suffer any longer. Every day when I wake up and go to bed is the worst because of the constant reminder and fear of this feeling lasting indefinitely. Jack101, is urine detection for HSV by PCR expensive or unusual? I am going to ask the nurse for it and just want to know if what I am asking is beyond the standard operating procedure. Thank you very much!

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Jack101, oh yeah my urologist also said he is going to test me with a urine sample for something called mycoplasma genitalium even though he does not think that is what I have because I have no discharge from penis or pain when I urinate. What do you think?

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Hello Fonda, I have a lot to say on your situation and management.


First, I am slightly concerned by your physician's knowledge of herpes testing and you may need to receive a second opinion. You should not have received a Herpes IgM test. They are in fact worthless and a waste of money, as they cannot reliably distinguish between IgM for herpes type 1 and type 2 and may exhibit cross reactivity with other members of the herpes family (herpes zoster, EBV) (and remember, by the age of 30 a majority of individuals will be positive for HSV-1). These tests have long been rejected by the Centers for Disease Control and Prevention and many labs have pulled these tests from the menu.


In addition, your negative IgG tests for HSV-1 and HSV-2 do not mean you have not been infected with HSV-1. The most popular test for Herpes, the Herpesselect ELISA misses about 30% of HSV-1 infections (false negative).


Given your history of condom use and unprotected oral, you are most a risk for HSV-1, assuming you have not been infected as a child orally. You should have had a PCR swab done of the lesions to confirm HSV infection.


As for the diagnosis of post-herpetic neuralgia. That is a diagnosis of exclusion. It is too soon to say, as you don't have a definitive diagnosis of herpes only a clinical presentation that is highly suggestive. I am physician and I would like patients to understand, that diagnoses of exclusion should really only be rendered after an exhaustive diagnostic work-up. In addition, that diagnosis is made after the lesions and rash have abated and pain still persists. According to you, your rash is still present. All to often, physicians render the diagnosis to avoid further work-up.


As far as Mycoplasma genitalum goes, it is unlikely due to the fact that you used a condom and the oral cavity has not been definitely found to habor mycoplasma genitalium (though other mycoplasma species have been found). However, it is odd that the physician is ordering a test for a cause of NGU, when according to your above statement he does not believe it to be non-specific urethritis. I do think the test will be low yield, but is worth performing.


I am also concerned that your physician thinks symptoms equate with infection. A good majority of these infections can be asymptomatic including gonorrhea or present with an atypical presentation especially if they are from normal oral flora not typically associated with a STD. The majority of the bacteria present in the oral tract will not be grown on normal culture nor or they included in the standard STD panel. I was wondering if you had a swab done of your urethra surrounding the inflammation, and the proximal and mid portion of the urethra to look for inflammation under a gram stain. I would assume this was the case as you were told you do not have NGU and inflammation of this mucosal area would indicate you in fact have an inflammatory process. This should be done before first morning voiding if possible, as urine often dilutes/removes the inflammation in the urethra.


In addition, urine testing for HSV-1 is not standard, but can be done and is no more expensive than swabs for PCR.


The standard treatment of NGU is azithromycin (1g) or doxocycline 100mg bid for 7 days. These antibiotics do have side effects, but are generally considered safe. In addition, there are also side effects for ametriptyline. I agree these antibiotics should not be given without evidence of inflammation, but from your post, no definitive test was performed to exclude urethral inflammation, beside visual inspection.


In short, you may have herpes with postherpetic neuralgia or chronic pelvic pain syndrome/chronic non-bacterial prostatitis. However, a further work-up needs to be performed before rendering long term diagnoses with no cure and chronic management, if a condition that can be treated is simply overlooked. I would like to stress that just because you are infected with one condition, does not mean you are not infected with other. Oral sex is particularly associated with atypical presentations of NGU that often reveal no organisms. With the increase in oral sex, medicine may need to consider testing for oral pathogens in the standard treatment of STDs.

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Thank you Jack101! After my initial outbreak, I went to a urgent care doctor and he did not do swabs but just ordered blood test and it was IGG (this was 2 weeks after I was infected). He visually diagnosed me for having herpes and prescribed Valtrex. At the 6 week mark I went to my General Practitioner and did another blood test but this time with IGM and it was positive for both HSV1 and 2 but still negative for IGG. The urine tests marked everything normal as well with a neg for chlamydia and gonorea. She advised I do another blood test at the 3 month and 6 month mark.


After that I went to my General Practitioner again complaining of my burning head of the penis and she referred me to a Urologist and also prescribed me Cipro in case it was UTI. Sometime shortly after that I had another minor outbreak which was two bumps on my scrotum which went away after a week. After taking the Cipro, the burning mostly did stop but my penis head (especially on right side) feels irritated and painful every once in awhile. The meatus is still irritated/swollen as well. But just to be 100% I am waiting for the three month mark so that I can get my IGG blood test again although I am almost positive that herpes is what I have (what else can cause recurring blisters on genitals?).


Just to clarify I do not have a rash on my penis and never was a swab taken by my doctors because I did not have a outbreak at the visit (except for the first urgent care visit, he thought that blood test was all I needed). I wish I talked to you before so that I could have brought it up to all the doctors I have seen. During this whole time the head of my penis has been irritated or burning, especially the tip. And the meatus looks swollen or red sometimes and it does not hurt when I urinate.


I will try again with my urologist and ask for a swab of my urethra to see if it can detect a NGU. He did, however, open the meatus up a little to see that it was irritated/red. Do you think that I should ask for Cipro again as well since it did stop the more intensive burning feeling (maybe I should go for another cycle)? Thank you again for your advice!

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The reduction in the intensive feeling after cipro may suggest a bacterial etiology, people often forget that the sores of HSV can become infected by bacteria (including normal skin flora) after an outbreak.


My above advice still stands. We need to get objective evidence of inflammation and exclude other causes. In general, post herpetic neuralgia occurs with herpes zoster in patients over 60. HSV neuralgia occurs in less than 2-3 percent of cases and there are no good studies for HSV PHN. As you can see, with the rarity of PHN with herpes, other more common conditions, including superimposed bacterial infection need to be excluded.

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Non-gonococcal urethritis is not one entity, but rather should be called non-specific urethritis. Non-gonococcal urethritis can be caused by a variety of etiologies including infection, allergy, irritation, etc. As far as infections go, they can be viral and bacterial. Top bacterial organisms include chlamydia (30%), mycoplasma (15%), ureaplasma (debate is out on this one). Top viral include HSV(2-3%) and adenovirus (approximately 4%).

However, 50-60% have no identifiable cause. Oral sex is more often associated with no identifiable cause (i.e. the bacteria or virus is not detected.


Of the infectious causes, the majority of them are asymptomatic or exhibit only mild symptoms, hence why so many people carry the disease both orally and genitally with no recognition of symptoms. It is only when they infect someone that becomes symptomatic that it is noted.


For your particular case, I am concerned about infection with oral or skin flora with possible cellulitis of the urethra. This would not cause a charge or pain with urination. However, after urination, the pain may increase or show more discomfort. I am also concerned about bladder spasms with referred pain that may mimic chronic pelvic pain syndrome as the urethra can at times be a source of referred pain. Is your pain worse, better, or the same after urination and do you have any bladder symptoms (urgency, a feeling of emptiness or fullness).


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I don't think I have any more discomfort than I already have after I pee so I would say it is the same after urination. I will concentrate on any feelings after I pee though now that you mentioned it. But I can say with certainty that I do not have any bladder spasms. I am going to set another appointment with a new Urologist though and next time I will ask him to check prostate and a urethral swab. Thank you again for your invaluable medical knowledge!

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Thanks for your support Jack101, it means a lot. It has been a week since I started taking Amitriptyline 5mg. The drowsiness has become tolerable and the pain has gone down but it is still slightly irritated and the meatus still looks swollen and red at times. I am still waiting for my appointment with my new Urologist. 3 days ago, the pain was not there so I thought it would be safe to masturbate. I masturbated 4 times that day and felt fine and relieved and hopeful that I was getting better but the very next day when I woke up, there was pain in my urethra and red meatus even while I was on Amitriptyline! I will still be on 5mg of Amitriptyline/day until I see my appointment with my new Urologist tells me otherwise.

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  • 2 weeks later...

Jack101, I went to my new urologist today and he examined my prostate this time and said that there was inflammation of prostate. My urethra was reddish too. He prescribed me 14 days of Meloxicam. He said that certain bacteria could have gone all the way to my prostate from the unprotected oral sex thus diagnosing me with prostatitis. He also took a urine sample for myco, urea, and trich and a round of bacteria stuff to detect stuff like ecoli and etc. He was bewildered why my other urologist didnt even bother to examine my prostate.

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  • 3 weeks later...

The Meloxicam helped but it did not cure 100% so I am still taking it. I still have irritation and sporadic pain on the tip of my penis. The Urologist also gave me Bactrim for 10 days in case of bacteria even though the urine test showed no sign of bacteria and no sign of ureaplasma/mycoplasma. I am getting depressed thinking there is no cure and will not be able to have sex for the rest of my life. I can deal with the genital herpes but this chronic inflammation of meatus and urethra is killing me slowly. If anyone else has the same problem, please share.

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@Fonda, sorry for the delay in my response, work has been busy before the holidays.

Meloxicam is a NSAID (same class as aspirin) and will not cure an infection but only decrease the inflammation, giving you temporary relief of symptoms. I suspect you have an occult bacterial infection that cannot be grown by culture or detected by the routine tests performed on urine samples. I doubt the bactrim will provide coverage for the organism, but it is only a minimal risk to finish the course. I would suggest a different regimen of antibiotics, but I would like for you to try Mastic gum first as it is known to have many antifungal and antibacterial properties and can be obtained at amazon or other stores without a presciption. The success rate for this regimen is rather low (as we are not completely sure what we are targeting), but as there are no side effects with the exception of loose stools it cannot hurt to try.


Week 1: 1000mg of mastic gum daily on an empty stomach

Week 2: 2000mg of mastic gum daily, divided into two dosages taken on an empty stomach (take in the morning and afternoon)

Week 3: 3000mg of mastic gum daily, divided into three dosages taken on an empty stomach (morning, afternoon, and evening)


If you are allergic to Schinus terebinthifolious and other Pistacia species, do not take.


If this fails, I will suggest another appropriate antibiotic course, but I hesitant to interfere with the current directions of your physician.

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Thank you so much Jack101! I was prescribed another 14 days of meloxicam and am still taking 5mg of Ametriptyline everyday. My Urologist told me on Dec 22nd that with non bacterial prostatitis, that my painful condition will not be there forever but he did not tell me how long it will take to go away. He seemed convinced that sometimes, all it takes is meloxicam, and that it will soothe the inflammation even after I stop taking it. I will look into the mastic gum regimen but I was wondering what kind of antibiotic course you were thinking. I want to know so that I can also get the opinion of my Urologist next time I see him. When I was on Bactrim, I was nauseous and it made the pain on meatus worse! But it did not burn as much as it did when I was on Cipro (I took Cipro for 5 days months ago b/c my general practitioner thought it was a UTI). I stopped taking the Bactrim after only a few days b/c I thought the antibiotics were supposed to improve the symptoms, not make it worse so I became worried and will contact my Urologist to see if worsening of the pain is normal or not. Once again I thank you for your support and advice Jack!

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