Persistent Urethral Pain After Gonorrhea Treatment

Is the condition very serious?

Doctor's response: I still have questions.
I was diagnosed with gonorrhea and urethritis at the end of February and have been undergoing treatment for two months.
I have taken a lot of medication.
After stopping the medication for a week, I still experience occasional sharp pain in my urethra, although urination itself is fine.
My left testicle feels uncomfortable at times.
I have undergone urine culture and tests, all of which came back normal, with no detection of Chlamydia or Neisseria gonorrhoeae.
I had a pus culture taken (it looked like pus, but it took 3-4 days to get results, and a little would come out when I strained during bowel movements), which only showed Staphylococcus, which the doctor said is a normal flora.
The lab personnel also mentioned that the pus could be from semen or glands.
The doctor has now prescribed UROGEN for a week.
The sharp pain has improved somewhat.
I didn't expect the treatment to take this long without full recovery.
I also have a loss of appetite, some pain in my left knee, and I get tired easily.
Since February, I have not engaged in sexual intercourse or masturbation.
I have taken the following medications: Nakacef-A, Flagyl, Cephradine, and Tetracycline.
After stopping the medication for a week, I took UROGEN again for the urethral pain.

1.
Why do I still experience occasional sharp pain in my urethra?
2.
Why is there discomfort when no bacteria can be detected?
3.
What other conditions could this be? Could it possibly be chronic prostatitis? What are the symptoms?
4.
Shouldn't the gonorrhea and urethritis I previously had be fully cured by now? How can I confirm this?
5.
After recovery, how long should I wait before resuming sexual activity?
6.
What should I do next? Thank you...
I really appreciate you taking the time to answer my questions.
Thank you.

yīzhí méi hǎo, 30~39 year old female. Ask Date: 2005/05/03

Dr. Xu Weikai reply Urology

1.
Why does the urethra still experience occasional sharp pain and discomfort? Sometimes, after treating urethritis, due to the strong destructive capability of bacteria, such as in gonococcal urethritis, there can be a phenomenon of chronic urethritis.
This occurs when the bacteria have been eradicated, but the damage they caused has not fully healed.
Patients may experience symptoms such as itching and sharp pain, which can sometimes persist for a long time.
Generally, at this stage, antibiotics are not prescribed; instead, medications to reduce swelling and relieve pain are given, while waiting for the urethra to heal naturally.
2.
Why is there discomfort even when no bacteria can be detected? The reason is the same as the first point.
3.
What else could be the problem? Could it possibly be chronic prostatitis? What are the symptoms? Yes, chronic prostatitis is a possibility.
In addition to urethral symptoms, patients may also experience difficulty during bowel movements or a feeling of fullness in the rectal area.
4.
Shouldn't the previous gonorrhea and urethritis have already healed? How can this be confirmed? Based on the current antibiotics and your medical history, it should have been eradicated, unless there is an encounter with an extremely resistant strain.
However, such cases typically occur in patients with prolonged hospital stays due to hospital-acquired infections, and are rarely seen in outpatient settings.
5.
After recovery, how long until one can resume sexual activity? As long as there is no pain during erection, it can be resumed at any time.
However, due to the lingering sharp pain in the urethra after urethritis, it may affect "performance" for a period of time.
Nevertheless, it is not contagious.

Urology Department Chief, Dr.
Hsu Wei-Kai, responds on behalf of the Taitung Hospital, Department of Health, Executive Yuan, expressing concern for you.

Reply Date: 2005/05/03

More Info

Understanding persistent urethral pain after treatment for gonorrhea and urethritis can be quite complex, especially given the nuances of the urinary tract and the potential for lingering symptoms even after the initial infection has been treated. Let's break down your concerns and address them systematically.

1. Why is there still urethral pain?
Persistent urethral pain after treatment can occur for several reasons. One possibility is that the inflammation caused by the initial infection may take time to resolve, even after the bacteria have been eradicated. The urethra can remain sensitive and inflamed, leading to discomfort. Additionally, if there was any damage to the urethra during the infection, it might take longer to heal.
2. Why are there no detectable bacteria?
The absence of detectable bacteria in your tests does not necessarily mean that there is no ongoing issue. Some infections can be caused by organisms that are not routinely tested for, or they may be present in low quantities that do not trigger a positive test result. Furthermore, the presence of normal flora, like Staphylococcus, can sometimes be misinterpreted in the context of an infection.
3. What other conditions could be causing discomfort?
Yes, chronic prostatitis could be a possibility, especially if you are experiencing discomfort in the left testicle and other systemic symptoms like fatigue and knee pain. Chronic prostatitis can present with a variety of symptoms, including pelvic pain, urinary urgency, and discomfort during urination. Other potential causes of your symptoms could include interstitial cystitis, which is characterized by bladder pain and frequent urination, or even a post-infectious inflammatory response.

4. How can you confirm if the gonorrhea and urethritis have been fully treated?
To confirm that the infections have been fully treated, follow-up testing is often recommended. This may include repeat urine cultures or specific tests for gonorrhea and chlamydia, especially if symptoms persist. It's also important to ensure that any sexual partners have been treated to prevent reinfection.

5. When can you resume sexual activity?
Generally, it is advisable to wait until you have been symptom-free for at least a week and have received confirmation from your healthcare provider that the infection has been fully treated. Engaging in sexual activity too soon can risk reinfection or exacerbation of your symptoms.

6. What should you do next?
Given your ongoing symptoms, it would be prudent to follow up with your healthcare provider. They may consider additional tests or referrals to a urologist for further evaluation. It’s important to communicate all your symptoms, including the left testicular discomfort, fatigue, and any other systemic issues you are experiencing.
In summary, persistent urethral pain can be multifactorial, and while it can be frustrating, it is essential to work closely with your healthcare provider to explore all potential causes and ensure appropriate management. Keep track of your symptoms and any changes, and don’t hesitate to seek further medical advice if your condition does not improve.

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