Hi and thanks for writing in with your concerns. It sounds like you have been doing all the recommended things like seeking medical assessment, testing and treatment and returning when these haven’t relieved your symptoms. Urethritis is inflammation (pain, redness and/or swelling) of the urethra (tube where urine comes out). Sometimes it is called non-specific urethritis (often known as NSU) or non-gonococcal urethritis (NGU) when the cause is not yet known. There are many different causes. Some, but not all, are passed on through having sex. If you have nonspecific urethritis there may be more than one cause, and in some men a cause is never identified.
Tiny organisms called mycoplasma and ureaplasma can live in the body without causing symptoms but sometimes they multiply quickly, leading to inflammation of the urethra. Being ill or stressed could cause this to happen. It is thought these organisms may be transmitted sexually. Routine tests for mycoplasma and ureaplasma are not currently available in Canada.  The azithromycin you took would cover the mycoplasma but it might be worth considering taking a week of doxycycline to cover the possibility that these organisms are responsible for your symptoms.  You don’t say how much doxycycline you were given when you were overseas but if it was only a one day treatment then that would not be long enough.  The other recommendation is to again see the doctor so they know that you still have the symptoms and discuss possibility of referral to a urologist as you have taken all these other steps without any resolution. I hope this helps.  Health Nurse