4 Months of Penile Pain, Irritation, Dribbling, Rash - No STD or Diagnosis. Help!

Hello, I am seeking advice! I am 32 years of age and situation has lasted over 4 months. It started when a female at a strip club slid her hands into my pants and rubbed / grabbed my erect penis near the urinary meatus (opening). I felt a sharp pain at the time (not sure why honestly). I feel like perhaps it was due to her rubbing near the meatus.  The symptoms below started almost immediately from what I can recall.

Symptoms:

1. Slight rash on the top of the penis glans (head of penis). It is worse after a hot shower. It comes and goes, and can appear almost like a plaque covering, scaly at times. It sometimes starts at the top of the corona (where head meets shaft) and runs straight down to the urinary meatus (opening) like a stripe.

2. No visible lesions (or blisters) or warts on the exterior skin surface. Does not appear to be any internally as well and doctors have not been able to observe anything.

3. Slight purple on one side of urethra, when the meatus is opened to look inside. A small bump is near the top of the purple, or tip of the meatus; however, two urologists believe it is vein related.

4. After urinating, urine dribbles out of the bottom of the meatus. The meatus opens and closes (at the bottom) and urine drops drip / discharge. I have to wipe considerably. The glans around the meatus looks swollen (more one side) and when I press on it, urine will discharge. It is almost like urine gets stuck in the tip of the urethra.

5. No noticeable discharge, but the penis appears and feels “wet” inside, especially post urination. It seems that I am leaking / dribbling throughout the day, after urinating. Urine color is clear.

6. Pain consistently on the underside of the glans near the meatus. The pain can sometimes be very sharp and burn. I also feel a tickle or tingle sensation in the head of the penis that comes and goes. The entire glans is sensitive to touch. This is extremely irritating.

7. The meatus looks red and inflamed at times. It can be very sensitive or painful to the touch and irritated by clothing. This feeling comes and goes in intensity.

8. The bottom of the meatus opens wide (top remains closed) when the penis has increased blood flow and/or is erect. This is abnormal for my body. You can see directly into the urethra when this happens.

9. When erect, the glans / head region seems larger than it had previously and I would describe it as swollen. There is also an internal pain near the underside of the meatus, where it opens up near the bottom (as described). Feels like it is stretching / pins and needles.

10. The glans has a more prominent reddish rash, during and after an erection. The rash appears like I have scaly / dry skin. Post ejaculation my urethra appears red and inflamed as well, when looking inside the meatus. This subsides after some period of time.

11. Semen color seems to be more yellow that I remembered, prior to this incident. Sometimes I feel like there is pressure on the front of my testicles.

12. The pain and irritation increase throughout the day. When I wake up in the morning the symptoms are not as noticeable, besides a dull pain on the under-side of penis glans. Sometimes there is some redness on the top of the glans area.

Testing:

I have been well tested (multiple times) and am negative for the following STD's; HIV (RNA testing done as well), Chlamydia, Gonorrhea, Trich, HSV-2, Syphilis, Mycoplama & Ureaplasma, Hep A, Hep B, & Hep C. Again, all negative.

I found in this process that I am HSV-1 positive and likely have been for some period (so is a large % of the population).  I have had  blisters and a HSV like rash on the bottom of my nose in the past. I don’t think this is HSV-1 as there are no lesions in my genitals and this has gone on too long.

Due to viral load factors, I tested the viral infections (HIV, HSV-2, Hep) at 30 days and again at 95 days post exposure. I assume that I am in the clear based on statistics, but am certainly not a doctor. These tests were unlikely to be positive given the event as there was no intercourse.

Urine analysis looked okay. Red and white blood cell counts were okay, no bacteria infection or UTI found or diagnosed based on urine culture.

Treatment:

I have seen 5 urologists, 1 dermatologists and 1 family practice doctor. I have had 2 cystoscopies, and nothing was found (same urologist).

A family practice doctor thought it was due to some soap or lotion, but referred me to the 1st urologist. He thought nothing was visually wrong.

The 1st and 2nd urologist  said they have no clue as there was nothing outside of normal visual tolerance. The 2nd urologist gave me the 2 cystoscopies (camera up the urethra to the bladder) and nothing abnormal was found.

2nd urologist thought it was contact dermatitis due to the rash as nothing surfaced in either cystoscopy. My prostate was examined physically and was ruled to be okay. He referred me to another urologist and also said I should see a dermatologist.

The 3rd urologist confirmed the inflammation in the glans. He suggested to try Quercetin (there are clinical trials which have shown it has helped the prostate) and then potentially Doxy over a longer period as a next step (can be anti-inflammatory). My fear is taking an antibiotic without having a bacteria pathogen diagnosis could be pointless.

The 4th urologist (who the 2nd urologist referred me to) believed that this was related to nerves in the penis. He is a pain specialist and put me on Nortriptyline.

The dermatologist (urologist said I should see one) also saw inflammation and diagnosed the rash as a non-infectious seborrheic dermatitis. He prescribed a topical antibiotic / corticosteroid, which I used. I also tried a steroid. It has reduced some of the redness but not relieve any of the described pain or urine dribble. I am concerned about the use of a topical for an extended period (skin thinning) and have stopped using it. I have a follow-up visit with him scheduled.

Medication:

1. Doxycycline 100mg x2 times a day for 10 days, initially when symptoms started. No relief.

2. Topical cream for rash: Ala-Quin initially for 4 weeks, then tried another steroid cream. Has somewhat resolved the rash issue (not totally).

3. Metronidazole (Flagyl) 2g, x 1 dose for Trich as there is not a great test for this (urine apparently has weak sensitivity). Trich can cause swelling, come and go symptoms, etc.

4. Nortriptyline 20mg every day to resolve nerve issue. I just started this.

5. Supplements currently taking: 1g of Quercetin daily (shown to reduce inflation in clinical trials), Multivitamin, AHCC, Folic Acid, Vitamin E and B12.

The symptoms continue to persist and these treatments have not worked.

My Questions:

1. Does this sound like an STD? Could it be another bacteria pathogen or NGU?

2. If this nerve related due to some trauma, would it cause the rash?

3. Are there any ideas regarding further testing or a diagnosis? I was considering a semen culture but don't know where to have this done.

4. Would a HPV virus cause these symptoms? In men, I believe the HPV virus is typically asymptomatic and/or presents itself with warts.

5. How can I test for HPV other than a biopsy of the penis or penis scrape (which most doctors don’t perform)?

6. Could this be yeast related based on the symptoms? I have noticed an increased coating on my tongue which scrapes off and dry mouth symptoms. I have also noticed the coating and dry mouth is much worse after drinking alcohol or eating sugar (yeast related).

I should mention that my anxiety over this is through the roof and am aware of some changes in my body as a result of it (anxious, no hunger at times, weight loss, etc.). I also think the dry mouth could be related to anxiety.

Please, I am looking for some help! I know there is someone out there that can help me as this has gone on for so long. This is such a struggle and always on my mind.

Further, I am terrified about infecting a new person who I just started dating. A couple doctors indicated that I was safe to have intercourse as I was well tested, but I don’t feel right about having intercourse with the symptoms persistent.

Thanks all for your help. - Steve

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