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Small ulcer near URETHRAL MEATUS with discharge. Treatment.

Resolved Question:

I work as a freelance researcher. I don't have insurance and I have to keep moving to follow new jobs. If I stop anywhere too long I'll be out of work and out of money. I've been in Southeast Asia all year.

I'm dealing with recurrent penile disorders that seem to be getting worse and worse. I was a very sexually active person, usually receiving unprotected oral and having protected intercourse almost daily, sometimes with commercial providers. Occasionally had penis to outer vagina contact without condom but no penetration. Only unprotected intercourse with steady girlfriend who lives with me and very likely doesn't sleep with anyone else even though she's okay with me being with others. Here's a concise version of what I've been dealing with.

Mid-April felt a pinch when girlfriend was giving oral. After sex noticed right side of meatus was irritated. In shower noticed a 2mm ulcer like lesion on meatus. Visited urologist at respected hospital in Thailand. He examined and said it looked like a cut from girlfriend, nothing more. Tested for gonorrhea, chlamydia, blood and white blood cells. Nothing out of the ordinary. Prescribed eye ointment to put on lesion twice a day. I did that for 1 month, nothing changed.

Mid-May visited Western doctor at international clinic in Japan. He examined and said it looked like a wound from activity and not an infection. He did a quick slide of very minor clear discharge and said it looked fine. Told me to quit the ointment and let the wound dry. I did that and the lesion healed about 2 weeks later (he said contact with urine was probably delaying the healing) and meatus irritation ended.

Things seems fine and started back with sexual activity, though limited intercourse with girlfriend to condom only.

Late July I awoke to a tiny amount of white discharge after receiving oral from a few different people. It turned to clear discharge during the day, but back to white the next morning. Cheap Thai clinic gave me 2g Azithromycin in one dose after asking my symptoms. Took it and discharge stopped for a few days then returned.

Early August discharge got more watery and frequent. Visited an international clinic in Malaysia. With only visual inspection Western doctor gave me Ceftriaxone 500g in two injections. Watery discharge increased.

Mid August I visited a general doctor at a respected international clinic in Indonesia. Doctor performed swab and urine tests. Chlamydia PCR, candida, trichomoniasis and GO/gonorrhoea all negative. White blood cell was 2-4, bacil gram negative was positive and epithel was positive. Doctor diagnosed “non specific urethritis” and prescribed twice daily doxycycline and pipemidic acid by mouth for two weeks. Symptoms finally stopped after ten days. Returned to sexual activity with girlfriend and a few others only. Condoms for intercourse.

Mid September left meatus became slight irritated for a few days. This went away but slight white discharge returned in mornings and clear discharge throughout the day. No pain throughout any of this except for very minor sting during urination in early August. Pharmacist gave Azithromycin 1g and Flagyl 2g to be taken orally at once until I could see doctor.

Late September finally was able to return to urologist at respected international hospital in Thailand only to find that my discharge had stopped. Tested urine for trichomonas, mycoplasma hominis, mycoplasma geitalium, chlamydia, gonorrhea and ureaplasma urealyticum/parvum. All negative. Tested blood for HIB Ag/Ab and VDRL (syphilis). Both negative. Told me nothing he could do from there.

Started to feel a little better although had slight dysuria (spraying in different directions when starting the urine stream and taking a while to get the last bit of urine out). Took a break from sexual activity and decided to limit myself to one woman. Last week decided to have unprotected sex with my girlfriend twice in one day. No problem until four days ago when I noticed the right side meatus was red and inflamed. The next morning after masturbating I noticed two small lesions in the same place the original lesion was. That night when I got in the shower I noticed three more pinhole sized lesions. This morning there seems to be two more of them. The meatus just looks red and raw until I get in the shower. When the water hits the lesions they become white, just like scabs do.

I've attached images taken before and after shower.

I'm in the middle of nowhere now. Even internet access is hard to come by. I won't be able to visit a doctor for another week. Does anyone have any idea what is going on here?? Please help!


Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Rajiv Goel is online now

Expert:  Dr. Rajiv Goel replied 4 Days.

Hello,
Thank you for posting your query at DoctorSpring.com
I have gone through your query and i personally feel you need repeat your test for syphilis. These lesions appear to be lesions of syphilis and you need to be investigated again.
The other possibility as was diagnosed by your local urologist is NGU ( Non-Gonococcal Urethritis ). Since mostly the bacteria causing this problem is difficult to identify it is difficult to treat also. Sometimes they take close to 3-4 weeks to disappear and hence medicines need to be continued for that long.
I will advise the following :
1) Abstain from having sex or getting oral sex from anyone with unknown STI status. It will further endanger your life.
2) Don't have sex for the next 4 weeks. Give it enough time to recover. In such cases, if you receive oral sex even normal mouth flora can lead to further infections.
3) I will advise Tab. Cefixime 200 mg twice daily for 2 weeks. If the lesions still persist it needs to be taken one more week. Please abstain from any kind of sexual activity in this period.
Also once again you need to repeat the test for syphilis to rule it out completely. Since you have pustules at present this will be the best time.
Doing oral sex is as dangerous as intercourse and you could have got infection from oral sex.

Hope this was helpful,
Sincerely
Rajiv Goel


Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
DNB - NBE
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
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