What could be the reason for the burning sensation at the tip of the penis?

Question

Hi doctor,

I am a 33-year-old male with a normal BMI. I do not take any medication except topical Minoxidil for hair loss. I have increased urinary urgency or frequency, pain or burning sensation at the tip of my penis (which becomes worse after urination), a weak urine stream, and aching testicles.

I also have tailbone pain that worsens at night. I take the tablet Ibuprofen and stretching exercises to relieve the pain.

These symptoms started over a month ago. Initially, I had intermittent deep pelvic pain with ejaculation and mild testicular pain (bilaterally). I had a bad case of diarrhea (drinking contaminated water) three months ago, which lasted for three days. I also had urinary urgency, frequency, and burning in the tip of my penis. A few days later, I took an online consultation as I was concerned about UTI, and did a seven-day course of Cipro (500 mg, twice a day). The symptoms improved but were not cured totally.

After a week, the symptoms worsened. It was bad, especially at night. I went to see a urologist a couple of days later and did tests that included blood work, urinalysis, PSA, cultures, and ultrasound. All of my results were normal. I was advised a 14-day course of Levofloxacin (500 mg per day) and Azithromycin (500 mg, thrice a week). Again, I think this helped but never resolved my symptoms.

Towards the end of that month, I started having some issues with my urine stream. I can still empty the bladder, but the urine stream is weak, and difficult to start. I also have pain or burning after urinating, which is the most uncomfortable part. It becomes bad at night.

I was abstaining from alcohol and coffee for a month as I was unsure if these substances irritated my urethra. I drank a few pints of beer last night and felt that perhaps my urine flow was better or less painful. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Your first query consult is on us!

This looks like prostatitis and will require four weeks of appropriate antibiotics to settle. Sonography (attachments removed to protect patient identity) shows a 23 gm prostate, which is slightly higher than normal, suggestive of some swelling in the prostate gland. I suggest getting a urine culture and semen culture done, along with the following medication.

1. Tablet Moxiflox (Moxifloxacin) 400 mg once daily for 30 days. (It may cause joint pains).

2. Fosfomycin sachet 0.11 ounce twice a week for four doses. (It may cause one or two episodes of loose stools the next day).

3. Cranberry extract capsule twice daily for one month.

4. Tablet Tamsulosin 0.4 mg once daily for one month. (It may cause retrograde ejaculation, which is reversible).

5. Analgesics for at least one week.

Consult your doctor and take the medicines accordingly. Let me know the culture reports so we can change antibiotics if needed. Avoid unprotected intercourse for a month.

I hope this information helps provide some insight into your symptoms.

Please do not hesitate to reach out if you have any further questions or concerns.

Thank you.

Answer 2

Hi,

Glad to have you back!

I am here to help you get the best medical advice.

There is some rise in fluoroquinolone resistance. Also, the drugs were proper, but the duration was short. Moxiflox is also a fluoroquinolone. But you need to take it for one month. In addition, we have added another antibiotic Fosfomycin, which also has good penetration into the prostate. If the symptoms persist, we will get semen culture done.

I hope this information helps provide some insight into your symptoms.

Please do not hesitate to reach out if you have any further questions or concerns.

Thank you.