- Does it itch?
- Is it sore?
- Is it really red?
It’s very upsetting when something goes wrong down below!
Who should you ask? Where should you go for help?
Read on and find out just what you need to know.
Men attending a Sexual Health Clinic usually have one or more of the following symptoms:
- Pain passing urine
- Discharge from the tip of the penis
- Soreness, redness, itching and/or irritation
- Rashes or bumps on the penis
- Blisters or ulcers
Not all conditions affecting the genital area are due to STIs! So you don’t necessarily have an STI.
If however you may have been at risk of an STI, you should go to a Sexual Health Clinic, where you can be tested and treated. If you feel more comfortable, you could also go and see your GP.
Whatever the problem turns out to be, rest assured! A wide range of treatments are available, and you will get relief of your symptoms.
Don’t be embarrassed!
Try and think of your penis and scrotal area as just another part of your body. In the clinic, the doctors and nurses spend all day examining the genitalia, they are trained to do this and have seen it all before! They will be sympathetic, respectful, and put you at your ease. After all, if there were no patients in the Sexual Health Clinic, they would be out of a job!
What’s wrong with my penis?
Find out a bit more about common symptoms affecting the male genitals below.
Keep reading to find out what happens when you visit the Sexual Health Clinic.
Pain passing urine
The medical term is urethritis. The most common cause of male urethritis is a Sexually Transmitted Infection (STI) such as chlamydia. In men, pain passing urine is very rarely due to a urinary tract infection (UTI – cystitis).
Discharge from the tip of the penis
This is a sign of urethritis. It is a clinical feature of chlamydia, Non Specific Urethritis (NSU) or gonorrhoea. A clear discharge is more likely to be chlamydia or NSU. A cloudy / purulent discharge is more likely to be gonococcal. Sometimes a discharge may be due to a bacterial infection called anaerobic balanitis.
Soreness, redness, itching, and/or irritation
Common skin disorders can affect the skin on the penis and scrotal area, just like the skin anywhere else on your body. Eczema, psoriasis, dermatitis (often allergic), and local skin infections commonly affect the genital area. This means many penile conditions are not due to STIs.
Rashes or ‘bumps’ on the penis
Sometimes a rash may be the presentation of a common skin condition, such as eczema or psoriasis. There is also a list of conditions you can see on the genitalia which are of no concern – just innocent findings– known as normal variants.
It’s rare for lumps/bumps on the penis to be caused by serious diseases such as penile cancer, but it’s always important to have anything abnormal properly assessed by a doctor.
Blisters or ulcers
The most common cause of blister/ulcers on the genital area is herpes simplex. This is a viral infection, which starts out as a blister, but the top is easily rubbed off, to leave a painful ulcer.
However there are other cause of blisters and ulcers on the genital area, and it is important to have these assessed by a doctor. Although uncommon, ulcers on the genital area may be due to syphilis for example. When you visit the Sexual Health Clinic with any ulcer on the genital area, you will always be screened for syphilis.
If there is something wrong down below, it always best to go to the Sexual Health Clinic, or to see your GP.
What happens at the Sexual Health Clinic?
Details of how to access a local Sexual Health Clinic are available online.
You can choose from a Walk-in Clinic, where you turn up and wait, or a Booked Appointment.
If you have troublesome symptoms, you may not be able to wait and may need to go to the next Walk-in Clinic. You are advised to turn up as soon as the clinic opens as they are often very busy.
Important – do not pass urine for a minimum of 1 hour before you attend the clinic (preferably 2 hours). You will need to give a specific type of urine sample, called a First Pass Urine sample.
You will be asked to arrive about 10–15 minutes before a booked appointment time. This is so you can register with the clinic.
Is my visit confidential?
Yes. Your confidentiality is extremely important. However the clinic needs to be able to identify you in some way. So they need your name, address, and contact details held on file. You will be given a clinic number and this is used to call you from the waiting room, and to label all your specimens when they go to the laboratory.
Your records from the sexual health clinic are kept separately from your other hospital records.
When your results are back, they can then contact you and advise you about treatment and follow up. They will not inform your GP unless you give them permission to do so.
You will be asked how you want to get your results – by text, phone call, or returning to the clinic in person.
It’s particularly important that young people attending the Sexual Health Clinic are aware of the law about their clinic visits.
Sexual Health Clinics welcome young people and really want to help them. However they have a duty to help them to stay safe. If, during the consultation, they learn anything about you that makes them think you are at risk of harm, or exploitation, they are bound by law to inform the relevant authorities, such as your GP, or Social Services. This will be explained to you when you visit the clinic.
Who gets priority in the clinic?
Many clinics run a triage system. This means if you go to a Walk-in clinic, you will be asked to fill in a form about why you are visiting today, and if you have any symptoms.
Many people who have STIs have no symptoms at all. Hence there will frequently be large numbers of people in the waiting room, who will be there for STI screening, but be asymptomatic.
As the clinics can only see a finite number of people in any one clinical session, they try to make sure they always see the people with symptoms who need to be seen that day, as a priority.
If the clinic is busy, some of the people with no symptoms may be seen by an appropriately trained nurse, or asked to rebook for an appointment on another day.
You can also request to be seen by a doctor or nurse of the gender of your choice – however you may be asked to come back to clinic on another day if this is not possible at that particular clinic.
Triage systems in Sexual Health Clinics have been shown to be effective at directing patients to the most appropriately trained clinician and reducing waiting times.
You will be seen by a doctor or a nurse. All staff within the clinic have been specially trained in sexual and reproductive health. They will ask a lot of questions to find out all about your symptoms, but also about your general health, medication, drug allergies, etc. In particular they will ask about your recent sexual history, looking for risk factors for STIs.
They can then advise you when you can be tested, what you can be tested for, the meaning of the results and if any retesting is needed in the future. They can also signpost you to any other services that might be helpful for you.
If you have no symptoms, you do not need to be examined. As a male patient, you can simply pass urine, and this will be tested for chlamydia and gonorrhoea. There is no need for any swabs.
If you have symptoms, you will need to be examined – but try not to worry. The doctor or nurse will make you as comfortable as they can.
You will be offered a chaperone – it’s up to you if you want this or not. This is recommended in clinical practice across the UK. Some people prefer to have a third party in the room, for support, and to feel confident there is a witness present if this was ever needed. Some people want as few people in the room as possible and say no to the chaperone. It is up to you.
The doctor/ nurse will ask you to undress from the waist downwards and lie on a couch. They will place some paper towels over your genital area for some privacy.
They will wash their hands and put on some non-latex gloves.
They will ask your permission to go ahead – remove the paper towel and carry out the examination. During this process they may need to take some swabs, but they will explain to you what they are doing, and try to make this process as quick and as painless as possible. You can always withdraw your consent at any time if you do not want to continue.
For men, standard STI tests for most clinic attenders will be:
- A First Pass Urine test – for chlamydia and gonorrhoea
- A blood test – for syphilis and HIV
If you have symptoms, you will need to be examined.
In addition to the above tests you might need the following tests:
- If you have a discharge, a swab will be taken for gonorrhoea. This is an additional test for gonorrhoea. This specific test, called a gonorrhoea culture, is a test where the lab try to grow gonococcal organisms, so they can identify them and check their antibiotic sensitivity. (Contrary to popular belief, this swab is only taken from the tip of the penis and does not involve pushing the swab a long way down the urethra!) If you are a man who has male partners, you may need to also have swabs taken from your rectum, and your throat for gonorrhoea, and sometimes also for chlamydia.
- If a fungal infection is suspected, such as candida, a swab can be taken for this, and again this can identify the specific type of candida and sometimes fungal sensitivities. This is a standard charcoal swab, which is just gently rolled across the affected area.
- If ulcers or blisters are present, a viral swab can be taken to test for herpes and other viruses. A cotton tipped swab is gently rolled across the top of the affected area.
- Sometimes, you may be advised to be tested for hepatitis B or hepatitis C. These are blood tests, and will be taken at the same time as you are tested for syphilis and HIV.
Microscopy to diagnose STIs
In a Sexual Health Clinic, there is usually a facility to take specimens from the genital tract, which can be stained on the spot and then viewed under a microscope. To do this a tiny plastic loop is used to pick up some secretions from the tip of the penis, this is smeared onto a glass slide and the slide is stained with a variety of agents including iodine.
These slides are prepared and read on the spot. This means that on the day of your visit, the Sexual Health Clinic has a unique method of visualising the cells, and the microflora/bacteria from your genital tract.
Microscopy can be helpful to diagnose conditions in both men and women. In men, sometimes this shows the presence of pus cells from the urethra, which are indicative of urethritis. Gonorrhoea may also be seen on a male gram stain.
The Sexual Health Adviser
There are Sexual Health Advisors working in the Sexual Health Clinics. These are specially trained staff, usually nurses, who can support you if you have a positive diagnosis of an STI. They are also responsible for making sure that if you do have an STI, your current and any other recent sexual partners, are properly treated. This is called partner notification.
You can phone and speak to a Health Adviser if you have any questions or concerns.
Partner notification is vitally important, as if you test positive to an STI, but your sexual partner is not treated, you are likely to continue to pass the infection backwards and forwards.
If this STI has originated from a previous partner, and is not treated, they are able to continue to pass this STI on in the community. In order to stop STIs spreading out of control, finding and treating partners is vitally important.
Treatment for conditions affecting the male genital area
If you need any treatment from your clinic visit, this will be given to you free of charge.
It’s very important that if you have an STI, such as Chlamydia for example, you follow all the advice about treatment carefully, to make sure the infection is properly treated.
Sexual Health Clinics frequently also offer contraception – this is also free of charge.
Clinics also give out free condoms.
They also give out emergency contraception – the Morning After Pill. If anything has gone wrong with your contraception, for example a burst condom, it’s always important to get your partner to the clinic as soon as possible as emergency contraception has to be given within strict time limits, after which it is ineffective.
A word about STI tests
In an ideal world, if you had a test for an infection, and the test was positive, it would mean you did have the infection. However, unfortunately we don’t live in an ideal world!
Testing for infections is fraught with problems.
- Incubation period for infections – don’t test too early! Firstly, the infection needs to be in your body long enough to become detectable! For most STIs, you need to wait at least 10 days from the time you think you may have become infected, before a test is likely to be positive. If you do the test too early, the result is likely be negative, but this may be a false negative result, because the test was taken at the wrong time.
- Produce the correct sample for testing – in addition, the right specimen needs to be taken. The reason a first pass urine is used for chlamydia and gonorrhoea testing, is that when you pee, you wash away all the epithelial cells lining the urethra (the tube that runs down the middle of your penis). When you give a urine sample for a chlamydia test, this is spun down in the lab and the epithelial cells are sieved out. It is actually the epithelial cells which are tested for chlamydia – not the urine itself. So, if when you go to the clinic you have just peed, you will have washed away all those cells down the toilet! And if you give another sample too soon, the test will be negative, because actually when they spin the urine down in the lab, there will still be nothing there to test!
- Do not pass urine for a minimum of 1 hour before you do the urine test! To get a meaningful result from your urine chlamydia test, you must follow instructions, and not pass urine for at least 1 hour – preferably 2 hours – before you give your sample. When you do the sample, the first part of the urine you pass needs to go in the container – this is the first pass specimen. This is the part of the urine which is most likely to contain the most epithelial cells.
- False positive tests – The chlamydia and gonorrhoea tests are called DNA amplification tests. They are very sensitive tests. This means they often give a positive result even if only small amount of chlamydia or gonorrhoea DNA are present in the sample to be tested. In fact they can test positive too often – and these are called false positive tests.
- Different types of STI tests – swabs/urine for DNA tests versus culture – The best way to know if a bacteria is present is to grow it – culture it – in the laboratory, but chlamydia is very hard to grow. Gonorrhoea also requires a special technique and this is time consuming and expensive. So for mass population testing, cultures are not a practicable or possible way to test for chlamydia or gonorrhoea.
- A positive test should always be taken seriously – a positive test is treated as a positive test. If a chlamydia test is positive, it is always treated as a true positive, even though there are cases where in fact it is a false positive. It’s impossible to know how often this happens, or which specimens it might be, so it’s just accepted that sometimes we may be over treating, but because these are serious infections, it’s better to over treat than under treat.
- If you test positive, when should you be retested? If a chlamydia test is positive, and you have treatment, the chlamydia test may stay positive for several weeks afterwards. This is because the test detects dead organisms. If you take a recommended antibiotic for chlamydia and follow all the advice you are given correctly, you do not need to be rested for chlamydia. However if you did not comply fully with treatment, have ongoing symptoms, are pregnant, could not take a first choice antibiotic, were sexually assaulted .. etc… these are all reason to be tested. A retest after treatment is called a test of cure. If you need a test of cure, you must wait at least 5 weeks after treatment before you repeat the test.
HIV testing is extremely important. If you did test positive, treatments for HIV are now very effective. If you do carry the virus, the sooner you know about it the better, as you can get immediate advice about when and how to start treatment and stay well.
Specialists now say that having HIV is a bit like having diabetes – so long as you look after yourself and attend your clinic appointments, you should have a normal life expectancy.
If you are reading this and you have never had a test, why not book into your local Sexual Health Clinic and get tested?
Point of Care tests for HIV
It’s possible to have a finger prick test in the clinic for HIV. This gives an HIV test result within a few minutes. May people say they don’t want an HIV test as they can’t bear waiting for the results. This test gives an almost instantaneous result.
If it is positive – it does need to be confirmed with a conventional lab blood test for HIV antibodies.
Safe sex and STIs
When is sex ever totally safe? As soon as you mix body secretions, or have close skin to skin contact, bacteria and viruses will enter your system! Using a condom is the only way to prevent transmission of infection. However there are many reasons condoms do not give 100% protection. Using a condom carefully every time is the only way to protect yourself and your partner. However even people who always use condoms still need regular STI checks.
Risk factors for infection include having frequent new sexual partners, overlapping partners, high risk sexual practices, men who have sex with men, bisexual men, and not using barrier contraception (condoms).