Varicocele: Symptoms, Diagnosis, and Treatment Options

Varicocele

Hello Doctor,
About a month and a half ago, I had unprotected oral sex for about 10 seconds.
After about 7 days, I started experiencing pain in my left testicle, a burning sensation in my urethra, and pain on the left side of my penis.
On the 8th day, I visited a clinic and was prescribed Tetracycline and a fast-acting antibiotic for 14 days (I continued to experience pain throughout the treatment).
On the 10th day of taking the medication, I went to a laboratory to test for Chlamydia, Gonorrhea, and Mycoplasma, and all tests came back negative.
A month later, I went to three different hospitals (Chang Gung, Yadong, and Taoyuan Health Bureau) for ultrasounds.
Chang Gung reported bilateral varicocele but no epididymitis; Yadong reported bilateral epididymitis but no varicocele; and Taoyuan Health Bureau reported both bilateral epididymitis and varicocele.
I have been experiencing pain on both sides since the 15th day.
However, I have a problem: I have persistent pain and numbness on the left side of my penis, and a continuous burning sensation in my urethra.
The antibiotics have not improved my condition.
For the past month and a half, I have been searching online for information, trying to understand why this is happening.
Is this a sexually transmitted infection? (I will be going for an X-ray today).
I have been drinking insufficient water (about 1000cc the day before).

I would like to ask the doctor:
1.
If a sperm test shows no bacteria, can sexually transmitted infections be completely ruled out?
2.
Can simple epididymitis and varicocele cause simultaneous burning in the urethra and pain in the penis?
3.
How can we definitively diagnose whether there is bacterial inflammation in the prostate?
Please help me, Doctor!

Zhang, 30~39 year old female. Ask Date: 2016/09/29

Dr. Fu Shizhang reply Urology

1.
All sexually transmitted disease tests must be normal to rule them out; the presence of bacteria in the semen does not necessarily indicate a sexually transmitted infection.

2.
Burning sensation during urination and penile pain are symptoms of urethritis.

3.
Conduct a prostate fluid examination.

Reply Date: 2016/09/29

More Info

Understanding varicocele is essential for addressing the symptoms and concerns you've described. A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins that can occur in the legs. It is a common condition, particularly in younger men, and can lead to various symptoms and complications, including pain, discomfort, and potential fertility issues.

Symptoms of Varicocele
The symptoms of varicocele can vary from person to person. Common symptoms include:
- Pain or Discomfort: This is often described as a dull ache or heaviness in the scrotum, which may worsen after prolonged standing or physical activity.

- Visible Veins: Enlarged veins may be visible through the skin of the scrotum, often described as a "bag of worms."
- Testicular Atrophy: In some cases, the affected testicle may be smaller than the other one.

- Fertility Issues: Varicoceles are associated with decreased sperm production and quality, which can lead to infertility.

Diagnosis of Varicocele
Diagnosis typically involves a physical examination and imaging studies. During the physical exam, a healthcare provider may feel for enlarged veins in the scrotum. An ultrasound is often used to confirm the diagnosis and assess the severity of the varicocele.
In your case, multiple ultrasound examinations have indicated the presence of varicocele on both sides, along with inflammation of the testicles (orchitis). This dual diagnosis can complicate the clinical picture, as inflammation may contribute to pain and discomfort.

Treatment Options
Treatment for varicocele may not be necessary if symptoms are mild and there are no fertility concerns. However, if the varicocele is causing significant pain or is associated with fertility issues, treatment options include:
1. Observation: Regular monitoring may be sufficient if symptoms are mild.

2. Medications: Pain relief can be managed with over-the-counter pain relievers.

3. Surgery: Surgical options include varicocelectomy, where the affected veins are tied off to redirect blood flow. This can alleviate pain and improve fertility outcomes.

Addressing Your Concerns
1. Testing for STIs: If your tests for common sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and mycoplasma returned negative, it significantly reduces the likelihood of an active infection being the cause of your symptoms. However, some STIs can be asymptomatic or may not be detected in standard tests, so it's essential to discuss any ongoing symptoms with your healthcare provider.

2. Pain and Discomfort: It is possible for epididymitis (inflammation of the epididymis) and varicocele to coexist and contribute to symptoms like urethral burning and penile pain. Inflammation can lead to irritation of surrounding tissues, which may explain the burning sensation you are experiencing.

3. Prostate Inflammation: To determine if there is bacterial prostatitis (inflammation of the prostate), a healthcare provider may perform a digital rectal exam and may recommend tests such as a prostate-specific antigen (PSA) test or a urine culture after a prostate massage. These tests can help identify any bacterial infection in the prostate.

Conclusion
Given your symptoms and the complexity of your case, it is crucial to maintain open communication with your healthcare providers. They can help you navigate through the diagnostic process and develop a tailored treatment plan. If symptoms persist or worsen, seeking a second opinion or further evaluation may be beneficial. Staying hydrated and managing stress can also support your overall health during this time.

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