Persistent Urethral Pain and Discharge: Your Symptoms

Unable to detect urethritis, experiencing urinary pain and white, thick discharge after 2 months of treatment?

Hello, doctor.
At the end of July this year, I started feeling an itch in my genital area and noticed redness and swelling at the lower end of my urethral opening, accompanied by discharge from the urethra, mostly clear but occasionally white.
In August, I visited a urology clinic and requested injections and medication.
However, after a while, the inflammatory symptoms returned, so I went to a large hospital for further examination and was confirmed to have proteinuria.
I also underwent a urine culture to rule out gonorrhea, but no bacteria were cultured.
The doctor mentioned that my proteinuria level was very low, indicating mild inflammation.
They prescribed medication, but I still felt it was ineffective.
After 10 days, I returned for a urine test and informed the doctor that I had not taken any medication since finishing the prescription, yet there was no inflammatory response.
He also stated that the redness and swelling at my urethral opening were normal reactions.
From the end of July until now, mid-October, I am still experiencing these issues, and I am really troubled.
I would like to ask the doctor, if there is no inflammatory response, what could be causing the following symptoms: 1.
A moist feeling on the glans, with the sensation of discharge; sometimes, when I gently squeeze the base, I can see a small amount of white discharge.
2.
Occasional pain during urination, and if I lightly squeeze the area near the urethra, I feel an itch.
3.
Redness and swelling of the glans, extending to the area where it connects to the foreskin, with a visible line that seems to indicate inflammation extending downwards.
If the foreskin typically covers the glans, could it be more prone to recurrent inflammation, necessitating circumcision?

Kuai feng le de niao dao fa yan huan zhe, 20~29 year old female. Ask Date: 2018/10/20

Dr. Du Mingyi reply Urology

It is possible that the condition is balanoposthitis, and circumcision may be considered as a treatment option.

Reply Date: 2018/10/20

More Info

Persistent urethral pain and discharge can be quite distressing, and it seems you have been experiencing a range of symptoms since July. Based on your description, it appears that you have been evaluated for potential infections, including sexually transmitted infections (STIs) like gonorrhea, but the results have not provided a clear diagnosis. Here’s a breakdown of your symptoms and some potential considerations moving forward.

1. Symptoms Overview:
- You have reported itching, redness, and swelling at the urethral opening, along with a discharge that varies in appearance.
- You also experience pain during urination and a sensation of moisture or discharge from the glans (tip of the penis).

- The presence of a line extending from the glans down the shaft could indicate irritation or inflammation.

2. Possible Causes:
- Urethritis: Inflammation of the urethra can be caused by infections (bacterial, viral, or fungal) or non-infectious factors such as irritation from soaps, lotions, or even friction.

- Balanitis: Inflammation of the glans can occur, especially if the foreskin covers the glans, leading to moisture retention and potential irritation.

- Allergic Reactions or Irritants: Sometimes, personal care products or even laundry detergents can cause allergic reactions leading to similar symptoms.

- Chronic Inflammation: Even if initial tests for infections are negative, chronic inflammation can persist due to various factors, including anatomical issues or ongoing irritation.

3. Next Steps:
- Follow-Up with a Specialist: Since you have seen a urologist, consider returning for a more thorough evaluation. A urologist can perform additional tests, such as a urethral swab or cystoscopy, to visualize the urethra and bladder for any abnormalities.

- Consider a Dermatological Evaluation: A dermatologist specializing in genital skin conditions may provide insights into whether there is a dermatological cause for your symptoms.

- Review Hygiene Practices: Ensure that you are using gentle, unscented soaps and avoiding any products that may irritate the area. Proper hygiene can help reduce irritation.

- Assess for Phimosis: If the foreskin is tight and covers the glans, it may lead to recurrent infections or inflammation. In some cases, circumcision may be recommended to prevent future issues, but this should be discussed thoroughly with your healthcare provider.

4. Management of Symptoms:
- Topical Treatments: Depending on the diagnosis, topical corticosteroids or antifungal creams may be prescribed to reduce inflammation and irritation.

- Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort.

- Avoidance of Irritants: Identifying and avoiding any potential irritants in your environment or personal care products is crucial.

5. Monitoring: Keep a diary of your symptoms, noting any changes, triggers, or patterns. This information can be invaluable for your healthcare provider in determining the underlying cause and appropriate treatment.

In conclusion, while your symptoms may not currently indicate a clear infection, they warrant further investigation to rule out any underlying conditions. Persistent symptoms can be frustrating, but with the right approach and continued communication with your healthcare providers, you can work towards finding relief and understanding the root cause of your discomfort.

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