Bizarre Urinary symptoms like a bacterial STI, but not (sinus, bladder, pain)

[indecisiveman]

Hello, I'm writing here because I'm looking for input. I've been incredibly stressed and anxious the past few months. Unfortunately, I had unprotected sex with a woman (I'm a 26yr old male) on 12/28 and 1/6. I also had quit smoking large amounts of marijuana in late January. I started becoming concerned about my health in mid February as tinnitus in my right ear began to act up. I went to a clinic and was told to take some nasal decongestants. Okay, no big deal.

A few days later though my gut started really paining me and I felt terribly out of it. This was on 2/20 and I tried smoking to help, even though I had quit. I felt alright but then started feeling awful as I noticed a dull ache in my right testicle. I went back to the clinic the next day 2/21 and after they ran a urinalysis, told me there were several abnormalities in my urine like ketones, bilirubin, and trace blood.

So, I went to the ER that night. They ran a urinalysis and did bloodwork and tested me. They said I present very healthy and don't seem to have anything wrong. My tests came back negative. However the next day, my tests for gono/chlam didn't come back yet and I started to feel discharge from my penis, like a leaky/crawly feeling in my penis head.

I examined and it seemed there was pus within so I went back to the ER. They ran more bloodwork and did a CT on everything below my chest and didn't find anything wrong, my organs all seemed normal. They empirically prescribed me doxy and gave me a shot of ceftriaxone. I went back the next day as I still felt off but they didn't run anything which makes sense.

My discharge symptoms seemed to go away. The next week though, on 3/1 I went back to the ER because I still had a lot of gut pain. I went to a different hospital this time. They ran more tests and everything came back fine. Two doctors I spoke to seemed very confident I was fine. I went back the next day because it looked like there was blood in my stool but there wasn't really and it hasn't returned. I reached out to some people on here about Weed PAWS and it seemed like that was causing my symptoms like aching and night sweats.

Meanwhile I had a culture done of my urethra on 2/25 by my doctor. About a week later I went back and was told there was some stool contamination. The infection was of E. faecalis and I was prescribed penicillin for it. I took the course. I started it about 3/10. Meanwhile at this point I was starting to feel good and I took a risk and smoked with a couple friends. My mood improved over the next two days but this was a mistake as my feelings of discharge seemed to return after two days. It was like a leaky/crawling feeling that is very distressing and distracting. It seemed to go away in the middle of my medication course but it returned after those two days (so 3/18).

So, I went back to my doctor on 3/19 and had another culture done. The infection was still there so I did another penicillin course which I finished around 4/10 I think. The symptom of leaky/discharge/crawling seemed to go away halfway through. Around this time i started fixating on HIV and Syphilis and other STDs. I didn't have any symptoms but I kept fixating and kept getting tested. Everything kept coming back negative.

So, I let go of HIV and Syphilis about a week ago. But then I discovered Mycoplasma Genitalium at the beginning of this month and starting freaking out because of so many elements, like that it's hard to detect, small bacteria, extremely common yet not very often talked about, asymptomatic in most people, can cause complications if not treated, and has the same symptoms of gono and chlam. It's been so confusing with all the information about it and my doctor didn't even know about it when I talked to her recently.

Meanwhile I have never had a fever, my gut pain has been gone, no painful urination or ejaculation or anything. I thought my symptoms were due to Weed PAWs as my jaw was aching recently, a lot of muscle aches, potential ED, etc. But it seems like as soon as I started thinking about Mgen my feeling of leakyness / discharge came back on Sunday, 5/2.

I don't know what's happening honestly. The head of my penis feels moist very often and my ******* has been very tingly the past few days, like it'll tingle every 5-10 minutes. It almost feels like urine is trickling out of my penis very often, even right now. I was having precum pretty often the past couple days especially after I peed, even though I haven't been sexually active since Jan and I am not at all sexually aroused at all during the day. In my pants it almost feels like my penis is exercising or moving. There's just a lot of activity going on and I don't understand why. I have a hard time trusting my Mgen result because it's hard to detect and I was on penicillin less than 4 weeks ago so I feel like that would skew it. I also provided a large sample on 5/4 and I'm afraid it diluted the sample. There's just SO many elements to Mgen and how hard it is to detect that make me not believe the result.

I believe I tested for that and hominis and ureaplasma at the urologist in the middle of March but I don't trust that because I was on doxy at the time. It also wasn't my first void. So, I got tested for them all again 5/7 along with a comprehensive urinalysis at labcorp and I'm hoping it all comes back negative. Like I said above, my test for Mgen on 5/4 came back 5/6 negative but I'm just still really perplexed because I keep having these weird symptoms. I was having night sweating and vivid dreams and chills and sweaty palms and fingers until recently, but those have all gone away.

I don't have night sweats anymore. The only thing left is a slight leaky feeling, tingly ******* very often, moist penis head. I don't really understand how this could be my anxiety, My doctor said I shouldn't be experiencing withdrawals anymore as I haven't smoked since 3/16 so it shouldn't be in my body anymore. She prescribed me azithromycin 1g which I took today because I was concerned about Mgen and those other ones. It made me nauseas and have diarrhea but other than that the leaky feeling and tingly ******* are still here. I expressed the leaky feeling to my urologist at the beginning of April and he didn't seem concerned.

So at this point it really seems like my penis is just leaking a little bit and my ******* is tingly. When I retract the foreskin up and down it'll come out and it isn't like mucus and it isn't discolored, it just seems like urine or something and it doesn't smell, there's no foul odor except the odor from my penis bc i haven't washed it in the past couple days. It doesn't stain paper yellow. It's kind of watery and clear I think. My doc took another culture today and said it didn't look unusual and that there wasn't any noticeable discharge on the swab. I looked, there wasn't. My discharge was slightly discolored when I had the first swab taken in late Feb.

I'm just really confused and at my wits end about the whole thing, I almost want to admit myself to a ward because it's making me suicidal not knowing what the answer is to what my body is doing. My anti-anxiety meds arent really working. I'm trying to think that if it were Mgen it wouldn't have gone away in the middle of the penicillin and that it would have gotten worse and that I'd know. Like I said I don't have any pain when I pee or anything, no pain right now.

I just feel like I don't understand what's going on and can't find answers. I have to stop myself from going to the ER again. I really just want someone with a professional opinion to look at this and tell me what they think. My doctor says I'm hyperfixating but it really does not feel like this is normal what my body is doing. The only thing I can think of is that maybe my prostate or pelvic floor as acting up due to my anxiety and trauma about the situation but I don't understand that either.

So, now it's 5/15 and I worked for the first time yesterday and I'm struggling to feel like an actual human because of this constant leaky feeling. My urologist didnt' seem at all concerned and especially doesn't think anything pathogenic is going on. I also tested again for the mycoplasma stuff on 5/7 and it came back negative today. A doctor I asked online said it likely is prostatitis caused by stress. But I wonder if my previous infection has come back because it seemed to respond to the medication I was on earlier. I'm seeing my doctor Wednesday and hopefully I'll get an answer because we did another culture.

This is so long, I'm just so stressed and confused and I want to feel normal again. I'm just looking for insight anywhere I can. My urine has come back clean multiple times so I'm trying to convince myself an STD would present some kind of evidence somewhere. Thank you if you've read up to this point, I just feel at my absolute wits end.

[Medical Lab Guy]

As long as STD's have been ruled out then that is the first thing that needs to be done considering there was a discharge early on. Gonococcal urethritis along with NGU should be ruled out. It's unclear if M. genitalium was ruled out considering there isn't an FDA approved test out there. It is impressive all of the tests that were done inclusive of ureaplasma.

Leakage of urine could indicate prostate issues since the prostate acts like a plug that helps clamp down by the bladder. Women tend to have more urine leakage because they don't have a prostate and a short urethra. Men, who had their prostate taken out, have to do Kegel exercises to help control incontinence. You say it feels tingly which I understand to mean a little irritated. You don't have to answer me but some people find relief when they masturbate while others feel more irritated if not out right pain. You mention you don't get pain. If either is the case then that again points to the prostate.

The urologist thinks it's prostate related and there appears to be the case with all the negative findings. I would be curious to know if he did a digital prostate exam or prostatic massage for secretions looking at under the microscope and culture. Testicular pain can also be a symptom. Most of the time antibiotics can be tried empirically to see if there is symptomatic relief but even if there is it doesn't necessarily mean that it is bacterial. Antibiotics can be anti-inflammatory effects that might relieve the pain but the symptoms might come back after the antibiotics are stopped. If there is no verifiable infection that can be detected then one does not want to go too overboard with antibiotics because of the risk of resistance and allergic reactions with time. The problem with antibiotics is that most antibiotics used with UTI's are not intended for the prostate as most don't penetrate into the prostate because of the pH. One can also end up with stones in your prostate as you age and they can be sites for biofilm formation and added antibiotic resistance.

I would take flavonoids like Quercetin and eat lots of broccoli ie broccoli soup. See if it helps and it should help with inflammation that might be creating the discomfort. One can also try having sit down baths to help with any pain or inflammation.

UTI's are not common in men compared to women. Unfortunately prostatitis is not easy to treat when it's abacterial (no bacterial pathogens found).

[indecisiveman]

Originally Posted by Medical Lab Guy

As long as STD's have been ruled out then that is the first thing that needs to be done considering there was a discharge early on. Gonococcal urethritis along with NGU should be ruled out. It's unclear if M. genitalium was ruled out considering there isn't an FDA approved test out there. It is impressive all of the tests that were done inclusive of ureaplasma.

Leakage of urine could indicate prostate issues since the prostate acts like a plug that helps clamp down by the bladder. Women tend to have more urine leakage because they don't have a prostate and a short urethra. Men, who had their prostate taken out, have to do Kegel exercises to help control incontinence. You say it feels tingly which I understand to mean a little irritated. You don't have to answer me but some people find relief when they masturbate while others feel more irritated if not out right pain. You mention you don't get pain. If either is the case then that again points to the prostate.

The urologist thinks it's prostate related and there appears to be the case with all the negative findings. I would be curious to know if he did a digital prostate exam or prostatic massage for secretions looking at under the microscope and culture. Testicular pain can also be a symptom. Most of the time antibiotics can be tried empirically to see if there is symptomatic relief but even if there is it doesn't necessarily mean that it is bacterial. Antibiotics can be anti-inflammatory effects that might relieve the pain but the symptoms might come back after the antibiotics are stopped. If there is no verifiable infection that can be detected then one does not want to go too overboard with antibiotics because of the risk of resistance and allergic reactions with time. The problem with antibiotics is that most antibiotics used with UTI's are not intended for the prostate as most don't penetrate into the prostate because of the pH. One can also end up with stones in your prostate as you age and they can be sites for biofilm formation and added antibiotic resistance.

I would take flavonoids like Quercetin and eat lots of broccoli ie broccoli soup. See if it helps and it should help with inflammation that might be creating the discomfort. One can also try having sit down baths to help with any pain or inflammation.

UTI's are not common in men compared to women. Unfortunately prostatitis is not easy to treat when it's abacterial (no bacterial pathogens found).

I've had two negative Mgen tests at this point. Also the thing that is tingly is my s.crotum, it was censored in the post. Love old school pboards. Anyway it's not really an irritation, just like a tingle sensation. Also yes it's really interesting because the symptoms stopped for a month after I used the penicillin but came right back. I also had a CT scan done on 2/22 and everything came back fine. I asked a doctor on JustAnswer and he believes it's related to prostatitis and anxiety. But my urologist said at my age (26, male) I shouldn't be having prostate issues. I'll see what my doctor can do for me on Wednesday. But I'm hoping all stds are ruled out at this point. Also, there is a very slight testicular ache, right testicle. It's intermittent but still there. And ejaculating actually does seem to help relieve this sensation for a little while interestingly enough. Anyway I'll see what my doctor thinks. Thank you for the response.

[Medical Lab Guy]

Originally Posted by indecisiveman

I've had two negative Mgen tests at this point. Also the thing that is tingly is my s.crotum, it was censored in the post. Love old school pboards. Anyway it's not really an irritation, just like a tingle sensation. Also yes it's really interesting because the symptoms stopped for a month after I used the penicillin but came right back. I also had a CT scan done on 2/22 and everything came back fine. I asked a doctor on JustAnswer and he believes it's related to prostatitis and anxiety. But my urologist said at my age (26, male) I shouldn't be having prostate issues. I'll see what my doctor can do for me on Wednesday. But I'm hoping all stds are ruled out at this point. Also, there is a very slight testicular ache, right testicle. It's intermittent but still there. And ejaculating actually does seem to help relieve this sensation for a little while interestingly enough. Anyway I'll see what my doctor thinks. Thank you for the response.

I think the key is that you are still having what you call tingly sensations along with slight testicular pain and the point that it is chronic along with all findings negative. Also several antibiotics were tried. Not sure which but like I said are more penetrative into the prostate than others and some like Flagly would target parasites like Trichomonas.

With regards to age,

"Chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) is a very common prostatic disease in those younger than 50 years and constitutes 8%–14% of urology clinic visits [1]. The impact of CP on the patients' quality of life (QoL) is severe due to its typical chronic pelvic pain and accompanying voiding symptoms [2]."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494351/

[indecisiveman]

I don't think I mentioned in the original post but I did go to the ER last sunday night since I noticed the symptoms starting up again. The doctor there saw my discharge and prescribed me Flagyl, hoping it would resolve my symptoms. I've been on the Flagyl, 7 day course 2 times a day since Monday and it hasn't helped much. Symptoms are still here. I even took a Zpak on 5/7 and it didn't do much so I was thinking because of that, it isn't anything to do with Mgen or hominis or ureaplasma which came back negative the other day.

Also one thing I forgot to mention was that in early march (and mid-march after I smoked again on the 16th) I started having constant wet dreams, like waking up to see s.emen in my underwear several nights in a row. It even happened a couple times during the daytime during naps. The past couple days I've been having to pee very frequently. I also have this strange sensitivity slightly above the base of the penis shaft, and slightly to the right. This was present in March and didn't reappear until just the past couple days. Ejaculating today has only provided slight relief. It still feels like there is pee 'sitting' in my penis a lot.

I also have had a slightly swollen lymph node below my right ear for two months now though it has gone down dramatically. s.crotum tingling is still here quite a bit. I'm not sure what to do next week because I can't see my urologist until June 14th. I'm not sure what to do, if I should go back to the ER or what now. When I had a CT scan done on 2/22 everything looked fine, all urinalyses come back fine even a microscopic exam done on 5/7. I'm just very confused. Thank you for the responses

[Medical Lab Guy]

Originally Posted by indecisiveman

I don't think I mentioned in the original post but I did go to the ER last sunday night since I noticed the symptoms starting up again. The doctor there saw my discharge and prescribed me Flagyl, hoping it would resolve my symptoms. I've been on the Flagyl, 7 day course 2 times a day since Monday and it hasn't helped much. Symptoms are still here. I even took a Zpak on 5/7 and it didn't do much so I was thinking because of that, it isn't anything to do with Mgen or hominis or ureaplasma which came back negative the other day.

Also one thing I forgot to mention was that in early march (and mid-march after I smoked again on the 16th) I started having constant wet dreams, like waking up to see s.emen in my underwear several nights in a row. It even happened a couple times during the daytime during naps. The past couple days I've been having to pee very frequently. I also have this strange sensitivity slightly above the base of the penis shaft, and slightly to the right. This was present in March and didn't reappear until just the past couple days. Ejaculating today has only provided slight relief. It still feels like there is pee 'sitting' in my penis a lot.

I also have had a slightly swollen lymph node below my right ear for two months now though it has gone down dramatically. s.crotum tingling is still here quite a bit. I'm not sure what to do next week because I can't see my urologist until June 14th. I'm not sure what to do, if I should go back to the ER or what now. When I had a CT scan done on 2/22 everything looked fine, all urinalyses come back fine even a microscopic exam done on 5/7. I'm just very confused. Thank you for the responses

That's all one can do. I would suggest the flavonoids again until the next shoe drops and something that's treatable presents itself. Based on your history it seems they have tried pretty much everything.

[indecisiveman]

An update: I received the results of my culture from 5/7 and here are the results:

Enterococcus faecalis - Heavy growth, susceptible to Penicillin and Vancomycin

Skin flora isolated - Scant growth

Prevotella loescheii - Moderate growth. Beta lactamase positive.
Studies at LabCorp Holdings have confirmed the observations of others
who have demonstrated that Prevotella, Porphyromonas and Bacteroides
species other than Bacteroides fragilis group are routinely
susceptible to Cefoxitin, Chloramphenicol, and Metronidazole and
are usually resistant to Penicillin.

How should I interpret these? Do I basically have 3 infections? Is it good that I've been on Flagyl because of the third result? And these aren't related to any stds no? I may try and go on the Vancomycin, I wasn't able to last time because my insurance won't cover it but I may pay for it anyway because I really want this taken care of.

[Medical Lab Guy]

Originally Posted by indecisiveman

An update: I received the results of my culture from 5/7 and here are the results:

Enterococcus faecalis - Heavy growth, susceptible to Penicillin and Vancomycin

Skin flora isolated - Scant growth

Prevotella loescheii - Moderate growth. Beta lactamase positive.
Studies at LabCorp Holdings have confirmed the observations of others
who have demonstrated that Prevotella, Porphyromonas and Bacteroides
species other than Bacteroides fragilis group are routinely
susceptible to Cefoxitin, Chloramphenicol, and Metronidazole and
are usually resistant to Penicillin.

How should I interpret these? Do I basically have 3 infections? Is it good that I've been on Flagyl because of the third result? And these aren't related to any stds no? I may try and go on the Vancomycin, I wasn't able to last time because my insurance won't cover it but I may pay for it anyway because I really want this taken care of.

First off I don't give medical advice. I answer in general terms to educate and fill in the gaps that doctors are too busy for. You have been doing fine working with your doctors and I suggest you continue to do so. Feel free to ask them anything you want. In general these are the way things are normally done.

You don't state the source of the culture, urine, urethral or wound. The source is everything with regards to interpretation. The source means what exactly was taken for the culture and exactly where. There are sterile body sites which should have no bacteria and then there's body sties where bacteria are normally encountered.
Voided urine is not considered sterile because it passes through the urethra which isn't sterile and contains small amounts of bacteria. Catheterized urine sample are considered sterile as are prostate secretions. Isolation of bacteria from any of those sites are considered medically significant. After that we know which organisms are truly pathogenic and which organisms are opportunistic. Pathogenic organisms are always considered to be causing disease. Opportunistic organisms may or may not cause disease.

So wasn't certainly a urine culture that was ordered because they aren't done that way. It wasn't a genital culture or I should say a gonorrhea screen. I presume the source was a urethral swab and performed as a wound culture. A urethral swab being cultured is a test for organisms that are causing urethritis. The bacteria listed do not cause urethritis. Enterococcus can cause UTI's and I guess some do cause urethral irritation but are not predominantly urethritis by nature. UTI's also have white blood cells present in the urine. A gram stain showing intracellular bacteria inside the white cells also is strong evidence that the bacteria is causing problems and discharges are predominantly white blood cells. That by itself can be diagnostic for gonorrhea.

In addition it appears they had to have done an anaerobic culture also because P loesheli is an anaerobe. To me that is strange because those would be treated empirically. One doesn't swab the skin or urine or any superficial surfaces and does an anaerobic culture. That's more for deep seated infections, skin sinus drainages or surgical specimens.

Polymicrobial infections are problematic with regards to interpretation because most clinically relevant infections are single predominant organisms. With that many organisms one isn't sure which one is the culprit if any or if the culprit wasn't cultured at all. The mixed flora isolated is reminiscent of decubitus ulcers ie bed sores. Normally one treats such mixed flora isolates empirically and then assess the treatment and one changes the treatment if it isn't working. The other option is to ignore the culture results all together because of the large variety of organisms isolated may mean contamination from adjacent areas. It appears they have tried many different types of antibiotics which means they were treating it empirically anyways.

I seriously doubt that the doctor would be giving you vancomycin. It is a serious drug with possible serious complications. It is for serious infections.

Because everything is coming up negative that would indicate that it isn't severe enough clinically with regards to testing. It appears the all the testing that has been done has included all of the classical pathogens associated with urethritis and UTI's.

[indecisiveman]

Thank you for the very detailed response. That's one thing that calmed me in all my research was that actual urethritis would have showed wbc in my urine, but all urinalyses have been negative. But you are correct, this was a urethral swab performed as a wound culture as listed on the website for me. Back when I had my first culture done for E. faecalis it listed 'moderate growth' and then later on 3/19 as 'scant' growth. But it just seems really perplexing to me as my symptoms went away all through April and then came back, and these are the exact symptoms I was feeling on my first culture. When my doctor first talked to me, she mentioned that it was 'stool contamination'. Overall today my urethra has felt oddly irritated along with my r.ectum as well after ejaculating. I have also had to pee frequently. I don't know if there's something structurally wrong but it's so strange to me that all this irritation seems to coincide with the E. faecalis being present in these amounts. And again there's nothing happening in my urine and tests for Mgen, mycoplasma hominis and ureaplasma came back negative, first void and first part of stream that I had done on the very same day. So if these were symptoms of those pathogens, they would have shown up on the test, no? I'm just very confused because this irritation is very present and I don't think it's just my anxiety.

Also is P loesheli some kind of pathogen? And you say that we aren't sure which one is the culprit. I know E. faecalis is part of the GI tract but I'm not sure what other contamination could be happening. It is also true I did not shower before getting the swab done. Anyway it seemed like the E. faecalis was the culprit to me as my symptoms have come back and it displays 'heavy growth'. So does that mean there's heavy growth in my urethra? Is that something that would show up in the urethra of other men? I get the sense its a contaminant. And my doctor originally wanted to treat me with the V, but my insurance wouldn't cover it. Anyway it really seems to me like an infection is present as my underwear always feels wet and I was having ED symptoms today and I haven't been having morning wood, when in April I was and in april my symptoms were not present. So that makes me think maybe the infection is in my prostate? My doctor also seemed very sure that this is indeed an infection.

I also don't think anything structural is going on as my CT scan on 2/22 of everything below my chest came back fine. I'm sorry, this has all been so confusing and I really appreciate the responses and insight. I'll see what my doctor thinks. I'm just very afraid I have something difficult to treat and that I might need multiple antibiotics. I've also never had pain while urinating or ejaculating which I may have mentioned. Maybe I have prostatitis induced from stress? Could the e. faecalis have infected my prostate? anyway thank you I appreciate all the input.

[worldcup]

OP, sorry not much help from me, but since you said you have swollen lymph node, do you have mild grade fever or fever at all?

btw, since you get all those tests done, might as well get an HIV test just in case. You did say you had 'unprotected' sex with a woman, just to be on the safe side you know.

And did you said your Gonorrhea test came out negative?