CPPS symptoms after unprotected sex

[webslave]

There’s still discharge. I can see it during the day deep inside and more clearly in the morning. Clear and sticky discharge.

That's not discharge. Discharge makes a wet patch on your clothes.

How reliable are those multiplex PCR urine tests that check for 7 common STIs? Any information on that?

Very reliable. Too reliable, often seeing contaminants as possible infections.

"The potential for false-positive results from PCR amplicon carryover contamination is a major concern for the high-complexity platforms that involve manipulation of amplified PCR products."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5091344/

[amnesia]

There’s still discharge. I can see it during the day deep inside and more clearly in the morning. Clear and sticky discharge.

That's not discharge. Discharge makes a wet patch on your clothes.

Thanks. I didn’t know that. The reason I am worrying is because I know my penis quite well. I use to have a lot of sex (which is part of the problem, because it’s often unprotected) so I would regularly check my penis for any discharge. Normally when I look inside and squeeze there’s nothing. No indication of anything liquid or wet. Just dry. Now, even though there’s no discharge coming out, I can there’s something liquid down there. Some random mornings it’s enough to at least squeeze it up to the tip a bit. Only two mornings (though those mornings I had a morning erection) I could clearly see some clear sticky discharge coming out of the penis so that the tip would be wet.

I tried to search all over the net what normal types of such “discharge” there could be but I couldn’t find anything. Whenever it comes to discharge, all websites seem to point towards some sort of infection.

Other than that I like to think I actually feel better. Especially when I don’t drink too much, or space it out throughout the day evenly in smaller glasses. I can still feel some sort of pressure or having to pee sensation down there but rather mild. Not sure if part of the problem is that I never really used to drink much water throughout the day so now my bladder is not used to it.

On the other hand, I still don’t seem to empty my bladder fully. Today I already went to pee 5 times starting at 3am in the night, and between the last times I didn’t actually drink anymore water.

[webslave]

Get a grip on the hypervigilance (e.g. penis examinations, a classic sign) and a lot of your problems could fade away.

[amnesia]

One thing that’s really confusing me is:

Normally I would feel best the first half of the day from wake-up until early afternoon, especially or as long as I don’t drink too much water, maybe 0.3 liters every 90 minutes or so. Almost no urge to pee; almost no tickling in the urethra. Afternoon and evenings normally come with a lot of visits to the toilets.

But then there are these odd nights where I feel like all is gone. No urge to pee. No tickling or itching. No mild pain in the balls. Surprisingly two times this happened after playing football (and masturbating before football, if that matters). But then I cannot enjoy those moments because I feel like the fact that the urge to pee is gone means there’s a blockage and I cannot pee. I start to question whether everything feels just normal or there’s something blocking. Maybe I have unlearned how it feels when I don’t have this urge to pee. Maybe I should just relax and accept and enjoy. Maybe it even means things are improving. I don’t know. This whole story really is messing with my mind.

[webslave]

Most of your problem is psychological. You have elements of OCD. You should focus your efforts on sorting this out. You could start with 10 days of a benzodiazepine like Valium from your family doctor, and if that makes you feel better, think about seeing a psychologist or psychiatrist for help with anxiety and circular thinking.

[amnesia]

I don’t really like the idea of taking strong medicine such as Valium. What do you mean when you say elements of OCD and circular thinking? I agree that this whole thing is stressing me a lot.

Good thing is that the good feeling from last night lasts until today. I didn’t have any symptoms last night, and didn’t have to get up to pee during the night. I woke up with an urge to pee but one that felt normal after waking up. I could hold my pee until the hospital where I did some more tests including a prostate examination (I didn’t feel pain) and a bladder ultra sound (no results yet). When I peed in the hospital, it felt strong and normal.

Since then I didn’t have to go to pee too frequently and there’s no weird urge to pee. Maybe a slight bit of feeling but I was able to pee only every 2.5 hours so far. That’s an improvement.

I am now trying to understand what the triggers for this are:

1. Just a normal improvement as the two urologists told me (they said I have an irritation after the infection which would go away after some time)?

2. Playing football?

3. Specific foods? (I didn’t eat throughout the day yesterday, and only some fish and veggies after football, and today only salad and chicken breast. The other days I had sometimes things which I thought are good for the prostate but listed as bladder irritants.)

[webslave]

OCD is a subset of the anxiety spectrum, and many CPPS patients have it. They focus obsessively on the syndrome, down to the smallest symptom. What's down my urethra? How often am I urinating?

Valium is not harmful if taken in short bursts. Suggest you try it.

[amnesia]

The improvements didn’t last long. In the evening the urge to pee and tickling in the urethra came back. I didn’t what triggered it. Maybe it was the food I had (wheat? tiny bits of tomato and onion in the guacamole? Ricotta cheese?) or that I masturbated again. Who knows. I woke up in the night to pee. Saw a lot of discharge coming out of the penis. Or maybe it’s just urine leaking. Who knows.

I’m glad I went to an ID doc for another PCR test and culture. He actually collected two samples this time, first void and midstream. The MicrogenDX test kit also arrived. At least I will know for sure then whether it’s an infection or not.

I read from guys who where diagnosed positive for Mycoplasma Genitalium after negative tests. Apparently it’s a very difficult to detect bacteria. Not sure if it slipped through the first two PCR tests I did because I either didn’t collect the first urine of the day and/or was still on antibiotics. The symptoms are the same, and it could it explain why I got rid of it the first time when I took three days of Azithromyzin (5 days Azithromyzin is the first line treatment). I’ll know in some days.

[amnesia]

I got back the urine culture and PCR test results. All negative. Though the urinalysis showed high WBC this time. The bladder ultrasound after having emptied the bladder shower some 75ml urine left which the doc said is not extremely much but still significant.

The ID doc suggested it could be bladder stones, a problem with the liver, or a stricture. He said there’s definitely no infection. He said the discharge and urine flow could mean it’s a stricture. I wouldn’t be surprised given the many UTI I had over the years (guess that’s the price you pay). It’s also in line with what the first Uro mentioned who said I should come back if symptoms persist because it might require more “invasive” diagnosis then.

Surprisingly I think the symptoms are getting better. Most of the time during the day I feel almost normal. Only when I drink a lot I have to go pee often and some evenings the tickling in the urethra comes back. And the discharge got more.

Not sure if it’s still just an irritation that will go away as the two Uro docs suggested. How long can that take? It’s more than two months now since taking the antibiotics. I read conflicting information online, with most websites saying a Urethritis will rapidly improve within two weeks after taking antibiotics whereas some websites say it might take 3-6 months. Should I still wait a bit and see if things improve further?

[webslave]

High likelihood that the sensations are ghost sensations caused by nerves (allodynia). That can take a while to settle. Just keep telling yourself it's nothing, and it'll fade.

[amnesia]

High likelihood that the sensations are ghost sensations caused by nerves (allodynia). That can take a while to settle. Just keep telling yourself it's nothing, and it'll fade.

If it was just pain and urge to pee it would be easier for me to calm down. But there are more tangible symptoms; the discharge in particular. The test results (slightly higher WBC and urine left in bladder) also can’t be ghost sensations right?

[webslave]

Firstly, there is no discharge. Secondly, nerves are capable of causing inflammation and higher WBCs. Don't believe me? Google CRPS (complex regional pain syndrome aka RSD) to see what nerves can do.

[amnesia]

The ID doc ordered a bigger ultrasound:
- kidneys look perfect
- bladder looks perfect
- Prostate gland looks normal
- Only abnormally again: retained urine of 70cc which the doc finds significant. In fact, my bladder was super full when I went there (as I had been instructed to do) and I went to the toilet three times again after “emptying” my bladder (half hour later, another hour later, and another hour later).

He’s sending me back to the Uro now for that uroflow diagnosis. Monday I’ll send my urine sample to MDX. Not sure if that changes anything.

Are there other causes for not emptying the bladder fully than urethra stricture? I asked the ID doc whether this all can still be an irritation from the initial infection (something the two urologists suggested) but he seemed very skeptical about that (same as I thought, he thinks symptoms should go away within two weeks after antibiotic treatment).

I guess not emptying my bladder fully could explain why I always feel that pressure on my urethra and why I generally feel good in the morning until afternoon/evening when I drink moderately (rather than 2 liters at once like this morning).

I’m still wondering why the initial Azithromyzin treatment cured things. It was a different dose than I took this time. Sometimes I’m wondering whether I should just give it a shot and take the same dose again.

[webslave]

Reasons for incomplete bladder emptying, in any order (not in order of occurrence):

1. BPH
2. Urethral stricture
3. Prostatitis (can swell prostate)
4. Hypotonic bladder (aka lazy or neurogenic bladder)
5. Muscles around bladder not relaxing properly (due to spinal cord injury, herniated disc, nerve infection, and pelvic surgery or fracture)
6. Shy bladder syndrome
7. Anticholinergic drugs used to treat overactive bladder can induce high residual urine and impaired bladder emptying
8. Diabetic neuropathy: the bladder gradually expands to large capacity due to sensory deficit

[amnesia]

Thanks. Which one can most likely be caused by an infection/unprotected sex?