I am a circumcised male, 30 years old, currently living in Asia.

Two months ago, two days after a foolish unprotected oral and vaginal
sexual encounter, I began experiencing irritation around the glans
penis, particularly around the corona and the meatus.  There was (and
still is) a mild but noticeable redness at the meatus.

The irritation around the corona slowly disappeared after two or three
weeks, which I am grateful for, but the irritation around the meatus
has persisted.  It is difficult to describe the sensation other than
to call it "irritated", although sometimes it is burning or painful,
something like a pinch.

The irritation is strongest after urination, after ejaculation, during
or after an erection, and after bathing.

In the last two or three weeks, the irritation has seemed to trigger a
propensity for spontaneous nocturnal ejaculation.  Moreover, the
ejaculate now has distinct yellowish globules that I am sure were
never there before.  I do not notice any difference in the odor,
however.

Naturally, when the symptoms first appeared, I went to the doctor, but
the doctors here are reluctant to help, to say the least.  My first
fear, of course, was an STD, but I had to beg to be tested.  STDs are
a "Western problem", I was advised.  But, they finally agreed to give
me blood and urine tests.  The tests came back negative, although they
did not have a test for gonorrhea.

They simply dismiss the possibility of contracting an STD here, which
makes it rather difficult, because I would like to eliminate that
possibility first.

Anyway, they told me I should take baths and that it would go away. 
Obviously, it hasn't, and when I went back last week, I was given a
"parasympathetic nerve suppressor", which achieved nothing, so far as
I can tell.  When I went back today, the doctor scratched his head and
said he was out of ideas, so he gave me some Motrin.

Finally, I should perhaps note that I have had some other medical
problems recently.  In the last year, I have had recurring problems
with jock itch, eczema (which I first had as high school student), and
gastritis, as well as an appendectomy in April.

I suppose my specific questions are the following:

- Considering that I was tested for STDs immediately following the
emergence of the symptoms, should I be tested again?  As I understand
it, blood tests test for antibodies, which take weeks to develop.

- If these symptoms were caused by an STD, can you suggest which one
or ones would be most likely?

- If it is not an STD, could you suggest other likely possibilities? 
During the course of this trouble, I have diagnosed myself with
herpes, syphilis, chlamydia, gonorrhea, UTI, bacterial prostatis, and,
of course, hypochondria.  My current favorites are balanitis,
psoriasis, eczema, and a yeast infection, although from my reading of
the web, these four conditions seem to be somehow interrelated.

- I guess my last question is, is there something that I should
absolutely not do?  Should I try an antifungal cream?  If push comes
to shove, should I try an antibiotic?  I am going to try yet another
doctor, but I am afraid that I am going to have to take things into my
own hands.  I've left it alone for two months, but that it has not
gotten me too far.  I'm starting to go batty.  Any assistance would be
dearly appreciated.

Thanks.

Hi  needhelpinasia,

 First, I must remind you that this answer is for informational
purposes only, and is not intended to serve as a diagnosis, treatment,
or replacement for sound medical advice. I urge you to seek quality
healthcare from a reputable urologist. Visiting a dermatologist may be
necessary as well, as urologists typically specialize in the internal
and dermatologists specialize in the external!  :-)
 
You have certainly done a fair amount of research into your own
condition! I am perplexed as to why a test for GC (gonorrhea) was not
performed, as GC is certainly to be included in your list of
possibilities! One of your questions asked about how you can treat
your symptoms. In answer to that, I?d like to stress that no matter
which course of treatment you and/or your doctor select, it is
important to follow through. It is vital that you take ALL oral
medications, and apply crèmes/ointments as prescribed, using all of
the medication, even if your symptoms subside. Recurrence of infection
is greater when the prescribed medication is not completed.



1)
- Considering that I was tested for STDs immediately following the
emergence of the symptoms, should I be tested again?  As I understand
it, blood tests test for antibodies, which take weeks to develop.

--- There are numerous tests for STDs. A Gram stain can provide rapid
answers to your health care provider by showing the appearance of
GNIDS (Gram negative intracellular diplococci.) Yeast will often show
up on a Gram stain as well. The doctor will insert a small narrow swab
into the urethra to collect a sample.  A wet prep or skin scraping can
show yeast hyphae, while a Tzanck prep can show the presence of
herpes. These are not definitive tests, but offer a good and rapid
lead. Culture is another way to detect chlamydia, gonorrhea and
herpes. Antibody tests for syphilis need to be run about 6 weeks after
exposure to show a positive result. For your peace of mind, I would
ask your doctor to order any indicated tests, even previously negative
ones. (Mistakes do happen) A relatively new test, performed on a urine
sample, is called NAAT, and can detect the presence of one gene copy
(An extremely small amount) of chlamydia and gonorrhea. The test is
manufactured by Roche Diagnostics, and is useful because it does not
require live organisms, as cultures do. NAAT is much faster, with a
turnaround time of 4-5 hours,  contrasted to cultures which can take
up to 72 hours to complete.   The urine can even be mailed to a
performing lab, and does not need to be fresh. It is more expensive
however.


?How urine specimens should be collected: 
? Specimens should be obtained as directed
by the test manufacturer in the package
insert.
? If possible, specimen collection should be
delayed until = 1 hour after the patient has
voided. *
? First-catch urine (e.g., the first 10?30 cc
voided after initiating the stream) should be
used.
Page 30 
http://www.ucch.org/CPS/std/CDC%20rec%20for%20chlamydia%20%20and%20GC%202002.pdf

?Our test can detect chlamydia approximately 30 hours after infection
and gonorrhea (GC) 48 hours after infection.?
http://www.indiana.edu/~health/labqa.html

??there may be a period of up to three
weeks following treatment during which the patient may remain positive on testing.?

http://www.ucsf.edu/castd/downloadable/chlamydia_diagnostic_paper.pdf



2)
- If these symptoms were caused by an STD, can you suggest which one
or ones would be most likely?


-- STDs:

Chlamydia
Symptoms often appear about1 to 3 weeks after exposure, but many men
do not have symptoms. ?Chlamydia is sometimes called the ?silent?
disease because you can have it and not know it.? ?In men the bacteria
can cause epidydimitis (inflammation of the reproductive area near the
testicles). PID (Pelvic inflammatory disease, in women) and
epidydimitis are two very serious illnesses.?
http://www.niaid.nih.gov/factsheets/stdclam.htm

Herpes
Your symptoms don?t sound much like herpes, but I am including it for comparison.
Sometimes sores appear on the scrotum, buttocks, or thighs. The sores
may appear about 4 to 7 days after infection. They usually begin as a
rash of red bumps. The bumps then turn into blisters. It is common for
the blisters to open up, sometimes causing severe pain. In time, the
sores will scab over and heal. The first outbreak of genital herpes
usually lasts 10 to 20 days until healing is complete.
During the first outbreak, many people have other symptoms: 
 	Swollen glands in the groin
 	Discharge from the vagina or penis
 	Painful or difficult urination
 	Fever
 	Headache
 	Muscle ache

http://www.genitalherpes.com/info/simplystated/genital_herpes_symptoms.jsp
http://www.genitalherpes.com/info/treating/expect/diagnosis.jsp

Very graphic pictures
http://www.genitalherpes.com/info/tools/toolsprivate/resources/photos.jsp
Images of herpes, syphilis,
http://www.healthac.org/images.html



Trichomonas
The urethra is the site of trichomoniasis infection.
http://www.menstuff.org/issues/byissue/trichomoniasis.html#whatis

?Most men with this infection do not have symptoms. When symptoms are
present, they most commonly are discharge from the urethra, the urge
to urinate, and a burning sensation with urination.?
A wet prep is an easy diagnostic test. Unicellular organisms with
flagella are easy to spot!
http://www.cdc.gov/ncidod/dpd/parasites/trichomonas/factsht_trichomonas.htm



Gonnorrhea (GC)
GC is known for it?s  famous ?drip?

I don?t know in which country you reside, but you can see by the chart
on this link, that STDs are prevalent world-wide. I don?t know where
your doctor got the notion that STDs are a Western problem, but
according to this chart, some forms of STDs are MORE prevalent in Asia
than elsewhere. This site quotes World Health Organization data from
1999.
http://www.avert.org/stdstatisticsworldwide.htm


?A yellowish or greenish discharge from the urethra is frequently a
sign of gonorrhea, a sexually transmitted disease (STD) that can be
cured with antibiotics.?
http://www.menstuff.org/issues/byissue/semen.html

?Yellowish or green color to your semen. Normal semen may have an
off-white or yellowy hint to the color. Where semen is
uncharacteristically yellow or greenish in color it is a sign of
infection, often due to the sexually transmitted disease, gonorrhea.
Go to your local STD clinic, treatment is simple with antibiotics.

?On the other hand, a discharge could be the sign of a sexually
transmitted disease(Chlamydia) and a yellowish discharge could be
significant for gonorrhea. This discharge could be mixed in with your
ejaculate but you would also see it at other times.? And ?Another type
of infection that can produce a discharge or different colored semen
is a prostatitis. This is an infection of the prostate gland that
often has multiple uncomfortable symptoms associated with it. You
would know if you had prostatitis (burning with urination, perineal
pain, fever and even back pain)?
http://www.medhelp.org/forums/urology/archive/1715.html

?Semen clots almost immediately after ejaculation, forming a sticky,
jelly-like liquid. It will liquefy again in 5-40 minutes. It is quite
normal for semen to form jelly-like globules and this does not
indicate any health or fertility problem.?

http://www.netdoctor.co.uk/menshealth/facts/semenandsperm.htm

http://www.advocate.com/html/goldstone/821_goldstone.asp





3)
- If it is not an STD, could you suggest other likely possibilities? 
During the course of this trouble, I have diagnosed myself with
herpes, syphilis, chlamydia, gonorrhea, UTI, bacterial prostatis, and,
of course, hypochondria.  My current favorites are balanitis,
psoriasis, eczema, and a yeast infection, although from my reading of
the web, these four conditions seem to be somehow interrelated.


--I?m not sure I would call any of the conditions you have listed
?favorites? , but you are on the right track! Some possible causes
*could* be: (Keep in mind that this answer is not intended to
diagnose, treat, or substitute as medical advice from a licensed
physician -- nor should this list be considered all-inclusive)

Prostatodynia:
  ?Patients with prostatodynia have symptoms of prostatitis but there
is no evidence of infection or inflammation.?
There are no specific tests to diagnose prostatodynia. The diagnosis
is made after other possible causes of symptoms, such as cancer,
systitis and kidney stones, are ruled out.
http://www.urologychannel.com/prostate/prostatitis/symptoms.shtml


?The term prostatodynia or chronic pelvic pain syndrome (CPPS) is used
loosely to designate any unexplained complaints of chronic pelvic pain
associated with either nonspecific voiding symptoms and/or pain
located anywhere in or around the groin, genitalia, or perineum or the
absence of pyuria and bacteriuria, with or without excess white cells
or bacteria, on results from Gram stain and culture of expressed
prostatic secretions (EPS) in male patients.?

Your doctor may have had this condition in mind when you were
prescribed the  nerve suppressor.
 
?Myofascial pain syndrome has been postulated as a cause for
CPPS/chronic prostatitis. Even in the face of clinical inflammation, a
reflex triggering of spasm in the musculature of the pelvic floor can
be a secondary, but clinically significant, source of much of the
symptomatology?
http://www.emedicine.com/med/topic1922.htm

http://www.healthynj.org/dis-con/yeast/main.htm

http://www.hasslefreeclinic.org/STDGuideMen.html


Candidal balanitis and other yeast infections:
Your mention of jock itch, which is caused by a fungus, may be
pertinent in your diagnosis. You probably live in a humid environment,
which fosters yeast growth. Diabetics are also highly prone to yeast
infections. Nonoxynol-9, a common spermicidal, found in some condoms
and lubricants can also predispose one to a yeast infection. Oral sex
can transmit candida (a form of yeast), gonorrhea, chlamydia and
strep.

Men may not experience any symptoms of a yeast infection, however, if
symptoms are present they may include:
·	burning sensation during intercourse
·	burning sensation of the penis
·	symptoms after intercourse if condoms not used
·	transient rash
Balanitis:
·	red patches and blisters at the end of the penis and around the foreskin
·	severe itching and pain
http://herpes-coldsores.com/std/yeast_infection.htm#Symptoms%A0%A0%A0

?Penile Candida infections most often affect men with diabetes or men
whose female sex partners have vaginal Candida infections. Usually the
infection produces a red, scaling, sometimes painful rash on the
underside of the penis. However, an infection of the penis or vagina
may not cause any symptoms.?

Yeast infection of the penis
http://www.healthac.org/images/yeast.html



Urethritis:
Urethritis can be caused by gonorrhea, chlamydia and trcihomonas, and
can be transmitted by rectum, throat and vagina, through unprotected
sex. Some men get urethritis following a catheterization, or after
using a condom or contraceptive that contains non-0xynol-9. One of the
most obvious symptoms is the meatus  sticks closed with secretions.
http://www.hasslefreeclinic.org/STDGuideMen.html

http://www.coolnurse.com/urethritis.htm

?Typically econazole would be appropriate treatment. If you are
uncircumcized, retract the foreskin daily and soak in warm water to
clean penis and foreskin.

Also cultures for the various causes of urethritis should also be
taken - to make sure that chlamydia or gonorrhea isn't the cause.

If the urology workup is not revealing, you may want to be seen by a
dermatologist for further evaluation.?

http://www.medhelp.org/forums/Urology/messages/30658a.html




Prostatitis and non-bacterial prostitis:
One is six men suffers from prostatitis, which may or may not be
caused by a bacterial infection. The prostate may be swollen, firm,
warm, and tender on physical exam.  Currently, the exact  cause of
prostatitis is not known. Suggested causes are viral, trichomonas or
chlamydia infections. A semen exam will reveal increased numbers of
white blood cells, and decreased numbers of sperm cells, most of which
will be non-motile. However, while the exact cause of prostatitis is
unclear, certain risk factors may make one more prone to this
condition.  Men with diabetes, having had urethral catheterization,
some STDs, being immunospuppressed and having unprotected sex are some
well known risk factors for acquiring prostatitis. Antibiotics are the
treatment of choice, and prescribed for 1 to 12 weeks, depending on
the individual case.

http://cpmcnet.columbia.edu/dept/urology/prostatitis.html#symptoms

http://www.emedicine.com/emerg/topic623.htm

Some men have no symptoms whatsoever, and others may experience some
or all of the following:
Chills 
Fever 
Frequent urination 
Incomplete emptying of bladder 
Joint pain (arthralgia) 
Lower back pain 
Muscle pain (myalgia) 
Pain in penis, testicles, and area between the scrotum and the rectum (perineum) 
Painful ejaculation 
Painful urination (dysuria) 
Sensation of having to urinate immediately, often accompanied by
bladder pain or spasm (urgency)
Tender, swollen prostate


Complications of bacterial prostatitis can cause an accumulation of
pus and infection to present, causing clumps, odor and discoloration
of the semen.

http://www.urologychannel.com/prostate/prostatitis/symptoms.shtml

http://www.andrologyaustralia.org/prostate/prostatitis.htm

http://www.andrologyaustralia.org/prostate/prostatitis/treatment.htm


You can see the prostate in this illustration:
http://health.allrefer.com/health/prostatitis-chronic-male-reproductive-anatomy.html


Unusual possibilities to consider:

Strep: Strep can be transmitted via oral sex from someone who carries
strep in their oropharynx. A gram stain and culture can rule this out.

A ?hickey? from oral sex. This can happen, and it can lead to further
penile irritation. You are prone to skin irritation and possible
allergy since you have eczema.

Some men seem to get penile irritations from receiving oral sex from
women who use corticosteroid inhalers for asthma!

Some men who take oral steroids can have yellow colored semen. The
globules you describe, are on their own, not indicative of a problem,
and are normal.



4)
- I guess my last question is, is there something that I should
absolutely not do?  Should I try an antifungal cream?  If push comes
to shove, should I try an antibiotic?  I am going to try yet another
doctor, but I am afraid that I am going to have to take things into my
own hands.  I've left it alone for two months, but that it has not
gotten me too far.  I'm starting to go batty.  Any assistance would be
dearly appreciated.



--The first thing you should NOT do, is have unprotected sex! Always
use a condom, and practice safe, responsible sex! I know you know
this, and this is just a friendly reminder!

 I would not recommend taking an oral antibiotic without identifying
the causative organism first. Not all organisms are sensitive to all
antibiotics, and you may not have a bacterial infection at all.
Antibiotics won?t help a viral infection. If your symptoms are due to
gonorrhea, your doctor will likely give you an injection, or two, in
the buttocks, although oral antibiotics may be prescribed! Should you
have a yeast infection, antibiotics may even worsen your condition!

For a yeast (Candida) infection, you might consider trying some
anti-fungals, such as Nystatin, Lamisil crème, and/or Lotrimin Spray.

Nystatin
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682758.html

Lamisil (terbinafine hydrochloride)
http://www.rxlist.com/cgi/generic/terbin.htm

Lotrimin (Miconazole Nitrate 2%)
http://www.drugs.com/PDR/Lotrimin_AF_Spray_Powder__Spray_Liquid__Spray_Deodorant_Powder__Shaker_Powder_and_Jock_Itch_Spray_Powder.html

You may be able to locate Gentian Violet easily in Asia. This was
commonly used over 50 years ago in the US to treat genital yeast
infections, and is very effective. It went out favor because it will
stain your clothing purple! (You could dedicate some old underwear
during your therapy!)

? Preparing a gentian violet solution (one or two teaspoons of gentian
violet to one litre of clean (boiled) water) and washing the affected
areas ? vulva and penis ? regularly, for at least three days. Gentian
violet may stain clothing and sheets
 Preparing a diluted salt and water solution (a teaspoon of salt in a
glass or jam jar of clean, boiled water), pulling back the foreskin
and soaking the penis in the solution for five minutes. Repeat two or
three times a day. A gentian violet solution will also work.?
http://www.afroaidsinfo.org/content/hivandyou/HivPosRelated/candida.htm

Triamcinolone 0.1% cream
This medicine is a corticosteroid used to reduce itching, redness, and
swelling associated with many skin conditions.
http://www.drugstore.com/qxn00168000415_333181_sespider/triamcinolone_acetonide/kenalogaristocort_a/triamcinolone_acetonide.htm

Fluconazole (diflucan)
http://www.rxlist.com/cgi/generic/flucon.htm    

Domeboro (Aluminum subacetate)
Used to soothe inflammation.
http://www.bayercare.com/domoboro/domofaq.html

http://www.sa.sc.edu/tshc/wcare/WEB-HERP.HTM

http://wguide.uchicago.edu/web/chap8/chap8.html



Other things that won?t cure you, but can help relieve symptoms: 
Drink plenty of water and cranberry juice to maintain an alkaline
urine, don?t smoke and cut back on coffee and caffeine. If it is a
yeast infection, wear loose clothing, and perhaps sleep in the nude.
You want the affected area to get plenty of air - wear loose
underwear, preferably made of cotton. Use laundry soap instead of
detergents, or at least detergents that are free of perfumes and dyes.
(These are known to irritate the skin in sensitive individuals. Try
oatmeal baths. Aveeno makes oatmeal bath products in the US, but
grinding whole uncooked oats in a blender to make a coarse powder
works well in a bath too. Use very mild soaps, such as Ivory, Aveeno
or Cetaphil.

http://www.drugstore.com/qxp44259_333181_sespider/cetaphil/gentle_cleansing_bar.htm

http://www.drugstore.com/search/search.asp?search=Aveeno&searchtype=1&trx=28198&trxp1=21189&srchtree=1&Go.x=0&Go.y=0

I would strongly recommend that you get checked for diabetes, and get
a complete prostate exam, along with a PSA blood test and blood,
urine, and culture tests for STDs.



I hope this helps you, needshelpinAsia!

If any part of my answer is unclear, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible.

I wish you the best in your quest for a cure!
Sincerely,
crabcakes

Search Terms:

Penile candidiasis 
STDs Asia
STDs
Penile infections
Yellow semen
Prostatitis
Balanitis
Prostatitis
irritated meatus

---

Clarification of Answer by crabcakes-ga on 25 Jul 2004 22:13 PDT

Hi again needhelp,

 I omitted the following in the original answer:

"Balanitis is an inflammation of the tissues at the head of the penis
caused by a bacteria or yeast infection. It is the most frequent cause
of penile swelling. It is seen almost exclusively in uncircumcised men
whose foreskin as well as penile head may be affected. It is usually
caused by poor or improper hygiene."

"Also improper hygiene can lead to an overgrowth of yeast, a secondary
infection sometimes associated with balanitis. In fact it is thought
that at times balanitis can be transmitted by sexual contact with a
partner who has a yeast infection. This is a disease that affects men
only -- of all ages -- though the incidence of infection in the U.S.
is not really known. What is known is that men who are sexually
active, uncircumcised, are diabetic or who have improper or poor
hygiene are at the most risk for getting balanitis."

"Itching, edema (water retention), swelling, pain and redness are the
primary symptoms of balanitis. Swelling of the penile head and
foreskin may occur simultaneously. Occasionally a penile tip ulcer or
an erosion of the head of the penis may be present. Rarely, there may
be discharge from the penis from the balanitis itself, but discharge
is more typically because of a candidia (yeast) infection or a
strep/staph infection."
http://alwaysyourchoice.com/ayc/adult/general/balanitis.php

Please forgive my omission.
Sincerely,
crabcakes

dear need help,
    i had/am having similar symptoms as you are,  did you ever get a
clear diagnosis of what it is?  if so please add a comment/
clairification as to what was diagnosed,  thanks    - pleasehelpp