Could Chronic Gonorrhea Be the Cause of Persistent Urethral Pain?

Is there a possibility of chronic gonorrhea?

Hello doctor, about six months ago, I had unprotected oral sex.
A week later, I noticed a burning sensation in my genital area and a persistent urge to urinate, even after using the restroom.
My glans was somewhat inflamed.
I went to see a doctor, and the urine tests came back normal.
I was prescribed antibiotics, but the pain did not subside.
The doctor suggested continuing the antibiotics, but there was still no improvement.
I switched medications a few times and tested for syphilis, HIV, chlamydia, trichomoniasis, and herpes, all of which came back negative at three and six months.
During the medication period, I manually induced ejaculation, but afterward, the original pain would intensify.
I have not engaged in any sexual activity during these six months, but the daily pain persists.
I noticed that squeezing the penis increases the pain.
Could it be that I might have had untreated gonorrhea that turned into chronic gonorrhea? I have visited several hospitals, and the syphilis and HIV tests have consistently shown no issues.
Could there be something that has been overlooked? Currently, the appearance is normal, and there is no discharge.
Urination is also normal.
Is it possible that bacteria still exist in the semen?

Yan, 20~29 year old female. Ask Date: 2020/01/18

Dr. Du Mingyi reply Urology

Basically, if the examination results are normal, then it is considered normal.
Sometimes, it may just be a sensory nerve abnormality that does not require attention.

Reply Date: 2020/01/18

More Info

Chronic urethral pain can be a complex and frustrating condition, especially when initial treatments do not yield the desired results. Based on your description, it seems that you experienced symptoms consistent with a urinary tract infection (UTI) or possibly a sexually transmitted infection (STI) following unprotected oral sex. The burning sensation, persistent urge to urinate, and inflammation of the glans (head of the penis) are common symptoms associated with these conditions.

While you have undergone testing for various STIs, including gonorrhea, syphilis, HIV, chlamydia, and herpes, and received negative results, it is still possible that a chronic infection could be present. Chronic gonorrhea is less common but can occur, particularly if the initial infection was not adequately treated. However, it is essential to consider other potential causes of your persistent urethral pain.

1. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): This condition can cause persistent pain in the pelvic region, including the urethra, and may not always be associated with a detectable infection. Symptoms can include pain during urination, pain during ejaculation, and chronic discomfort in the pelvic area.

2. Urethral Stricture: A narrowing of the urethra can lead to pain and difficulty urinating. This condition can develop after an infection or injury and may require specific treatments, such as dilation or surgical intervention.

3. Interstitial Cystitis (IC): This is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain. It can mimic UTI symptoms but does not respond to typical antibiotic treatments.

4. Psychogenic Factors: Chronic pain can sometimes be exacerbated by anxiety or stress, which can create a cycle of pain and anxiety that is difficult to break. Psychological factors can contribute to the perception of pain and may require a multidisciplinary approach to treatment.

5. Post-Antibiotic Effects: Sometimes, antibiotics can disrupt the normal flora of the body, leading to secondary infections or imbalances that can cause discomfort. Probiotics may help restore balance, but this should be discussed with your healthcare provider.

Given that you have already seen multiple healthcare providers and undergone various tests, it may be beneficial to consult a urologist who specializes in chronic pelvic pain or a pain management specialist. They can perform a thorough evaluation, including a physical examination, and may recommend additional tests, such as a cystoscopy, to visualize the urethra and bladder directly.

In terms of treatment, options may include:
- Pain Management: Medications such as NSAIDs or other pain relievers can help manage discomfort.

- Physical Therapy: Pelvic floor physical therapy can be beneficial for addressing muscular issues contributing to pain.

- Behavioral Therapy: Cognitive-behavioral therapy (CBT) can help manage the psychological aspects of chronic pain.

- Antibiotic Therapy: If there is a suspicion of a chronic infection, a longer course of antibiotics may be warranted, even if initial tests were negative.

It is crucial to maintain open communication with your healthcare providers about your symptoms and any changes you experience. Keeping a symptom diary may also help identify patterns or triggers related to your pain. Ultimately, a comprehensive approach that addresses both physical and psychological aspects of your condition may provide the best chance for relief.

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