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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19449
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a 22 year old male, i have been suffering for over a year

Customer Question

I am a 22 year old male, i have been suffering for over a year with an occasional tingling sensation in my urethra at the meatus, and down the sides of the exterior of my penis -no further than an inch down. I have had several urine tests for bacteria and STIs but no cause has been found, I have been back and forth to several clinics and doctors and had different swabs and samples taken. There are no visible abnormalities but a nurse mentioned that the swab analysis showed puss was present, meaning there is some form of urethritis. All of this is confusing and I have been trying to push through an appointment to see a urologist, but with no luck yet. I have in the past suffered from fungal infections, and have taken the blue pill to combat thrush- although this could potentially be a yeast infection- I have not suffered from any other symptoms than occasional to frequent tingling. I carry HSV1, have only had one outbreak- but I have a theory that this may be nerve damage from that outbreak. Does this sound like anything that has ever been diagnosed? I feel that if there is puss, then there's hope that it's not nerve damage. Any ideas on what this could be? Or how I can help myself deal with it until I can see a urologist. If that's still even necessary.
Many thanks.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Hello from JustAnswer.
It will help if you could provide some further information.
Was the outbreak from HSV1 an oral lesion or a genital lesion?
Do you know whether any of these swabs of the urethra looked for fungi or HSV?

Customer: replied 3 years ago.
This was a genital outbreak, believed to be passed from oral contact.
I'm not entirely sure if they swabbed for either but they ruled out a lack of something in the urine test, that means I don't have a bacterial infection.
I don't know if the swabs looked for either. If its a fungal infection then I'm aware I'd have to lie to a very strict candida free diet, but what are the implications for hsv1, I'm aware that its a virus and will always be present
Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There are a couple of considerations in this situation.

It is rare for a fungal infection to affect the urethra, but it is possible. However, with the intermittent symptoms, it is more consistent with an HSV infection.

In someone with a prior HSV1 genital infection, it is possible that there are recurrent infections affecting the urethra. Most HSV infections affect the visible skin of a male, but it can sometimes affect the portion of the urethra around of just inside the meatus.

When speaking of HSV, it is true that the virus is always present, but it typically is lying dormant in the nerve most of the time. Occasionally, the virus will start growing again, travel to the end of the nerve, and grow again in the skin (or when the urethra is affected, the lining of the urethra. This could explain why you are only having occasional symptoms.

Trying to prove that it is HSV typically requires a viral culture done, but it will usually only be reliable when each outbreak has just started. Even when there is a clearly visible sore, so that it is definite that the sore is sampled for the culture, a culture can miss the HSV if the culture is not done early in the outbreak. If an examination or a culture is done between outbreaks, it will typically be normal. There is occasional shedding of the virus between outbreaks, but it only occurs infrequently and randomly, so a culture done between outbreaks may detect the virus, but usually will not.

If it does prove to be an HSV infection, there are medicines that can suppress the virus. It does not completely eradicate the virus, but it does cause the outbreaks to occur less often, to last for a shorter period of time when they do happen, and to decrease the amount of shedding between outbreaks.

Although grow of the virus can cause neurologic symptoms, such as tingling, it typically does not cause nerve damage. The nerve will function normally when the virus is dormant.

When I have a patient in whom I am trying to detect the virus by culture, I explain the importance of a rapid culture when symptoms first start, and arrange for a collection of a specimen in a timely manner, but the exact nature of such an arrangement would depend upon the situation in the physician's office and reference lab.

If I can provide any further information, please let me know.

Customer: replied 3 years ago.
Sorry I may not have described the symptoms well enough in the first place, it's actually very frequent tingling, I said occasional but they come about once every 10 minutes. Although It's not a constant feeling, they come then go, like a small electric shock. I have looked into neuropathy and these do sound like symptoms of nerve damage, but my confusion is in te fact that I still have puss in the urethra on samples. This frequent (sometimes I'm lucky and may feel it once a day, but lately every few minutes) tingling, makes me think it can't be a herpes lesion
Expert:  Dr. D. Love replied 3 years ago.
If the symptoms are happening daily, then that is not typical for a herpes infection affecting the urethra.

In that setting, a fungal infection is still a possibility. The other possibility that can cause daily symptoms would be a type of allergy that is affecting the meatus of the urethra. Inflammation from an allergy also can cause white cells to be present on a stain of the fluids or swabs of the urethra. There are many substance that can precipitate an allergy, but the common substances are those substances to which the penis comes in contact, such as certain soaps, laundry detergents, scents, and perfumes.

A neuropathy or other nerve problem can cause the tingling, but you are correct that it typically would not cause white blood cells to be apparent on examination of fluid or swabs of the urethra.

If an allergy is a consideration, an option for you to try at home would be an antihistamine to see if it eases symptoms.

Customer: replied 3 years ago.
Where would I put anti histamine? Can it go down the urethra? As you could imagine, having this condition for over a year I have tried changing detergents, using soap-free body wash etc. i have tried to change my diet, i once had luck for a couple of days by drinking green tea, but it may have all been inside my head, as it came back later. For the worst case, if I have nerve damage, will It ever go away?
Expert:  Dr. D. Love replied 3 years ago.
The antihistamine would simply be taken orally. There are topical antihistamines, but it is impractical to administer it into the urethra. It is not easy to place into the urethra and it will be flushed with the next urination.

Whether nerve damage improves would de[end upon the cause of the damage. There are some causes that will improve over time, but others will not.