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STDs  (Expert Forum)
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CANT SEEM TO GET A DEFINITIVE ANSWER
Answered by
H. Hunter Handsfield, M.D. -
University of Washington Seattle - WA
This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection.

IMPORTANT

This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum

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MedHelp Member's Question

CANT SEEM TO GET A DEFINITIVE ANSWER

by need2know15, Mar 21, 2006 12:00AM
Doc,



My scenario is as follows:



I am a heterosexual male and as of last Saturday(03/18/06) I started noticing a clear discharge on my penis(I have no pain and urinate normally).  It looks watery and clear(not puss-like).  I have masturbated to see if I would feel any pain but I do not but I do have yellow urine when I used to have a light(close to clear) color urine due to the amount of water I drink(if that has anything to do with it).  I have NEVER had unprotected vaginal sex and havent done oral(gone down on a female in over 2 years).  I have received oral within the last two weeks however this person I have been having relations with for over 2 years(just casual sex however).  My questions are as follows:



1) What are the chances this could be a STD given my situation?



2) What tests do you recommend I take?



3) How long should I wait to take it(I'm not sure if I have to wait to get a conclusive result)?  



Thanks,



Need2know15
Doctor's Answer

by H. Hunter Handsfield, M.D., Mar 22, 2006 12:00AM
Totally clear discharge might be normal, or could be due to urethritis, such as NGU or chlamydia.  Urine color is dictated only by food and fluid intake, never by an STD, and pain during ejaculation (or its absence) means nothing; no STD causes such a symptom.  The risk of catching an STD from oral sex is low, but sometimes it can result in NGU or gonorrhea (although gonorrhea is extremely unlikely with clear, painless discharge).



1) So the answer to no. 1 is I can't be sure.  If the discharge is new and you are pretty sure it is abnormal (for you), then you need to see a health care provider about it.  Visit your local STD clinic. 2) Specific tests are up to the provider you see.  3) Standard STD tests typically take 3-5 days to get results, although the provider may be able to provide preliminary information immediately, before you leave the clinic.



Good luck-- HHH, MD
Member Comments (10)

by whyme2006, Mar 22, 2006 12:00AM
To: HHH, MD
Hey Doc-



I read in a previous thread ("penile discharge, maybe?" enquiringmind 03/11/2005) where a man was concerned about chlamydia after an episode of insertive oral - he said he found a site that stated it was possible to get it this way - you asked for the site so you could send them a note ("Tell me what web site(s) say chlamydia can be acquired by oral sex and I'll send them a message. It doesn't happen.")



Now check out the CDC site regarding clamydia:

Chlamydia can be transmitted during vaginal, anal, or oral sex.

Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection.

Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.



So who's right?????????????

by H. Hunter Handsfield, M.D., Mar 22, 2006 12:00AM
To: Everyone, whyme2006
My guess is that whoever wrote those words is working on a CYA philosophy; if there is any possibility at all, however small, warn people about it.  Also, the people and division at CDC who do the educational message don't always communicate as well asl necessary with the scientific side.



Be clear:  chlamydia has been found in the throat, but it is so rare CDC (in its own treatment guidelines--i.e, from the science side) recommends against testing for it, and that recommendation will be stated even more strongly in the coming revision of those guidelines, due for release ~June.  Oral to genital transmission of chlamydia has never been documented, to my knowledge.  And in data reviews in the Seattle STD clinic, men with NGU who say they have only received oral sex in the preceding 2 months--i.e., no vaginal or anal--rarely have chlamydia.  (Those that do are mostly carrying chlamydia for longer than the 2-month time frame covered by the question.)



But thank you for the opportunity to address this.  I am going to forward your message and this one, and the quote from CDC's website (after I confirm it) to my CDC colleagues.  I will ask for a response/explanation and will post it on this forum.  It might take a couple of weeks, but stay tuned.



HHH, MD



by whyme2006, Mar 22, 2006 12:00AM
To: HHH, MD
Doc-



The CDC site is:  "http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm"



And let me state:  "YOU ARE AWESOME !!!"



by whyme2006, Mar 22, 2006 12:00AM
To: HHH, MD
Doc -



Just one clarification - set me straight please:

I have read on other sites that NGU is "urethritis due to organisms other than gonorrhea, most usually chlamydia" - when NGU is due to NEITHER gonorrhea NOR chlamydia, the urethritis is termed non-specific urethritis (NSU).  

Why wouldn't NGU due to chlamydia be called just chlamydia?  Is there a difference between chlamydia and NGU caused by chlamydia?  Can you "catch" NGU caused by chlamydia via insertive oral.

I wish you Docs would get it straight!  I'm going to be hospitalized with migraines soon!

by H. Hunter Handsfield, M.D., Mar 22, 2006 12:00AM
To: Everyone, whyme2006
What website?  I have never heard anyone make a distinction between NGU and NSU based on presence or absence of chlamydia.  In general, NSU is used more commonly in the UK and former commonwealth countries than in North Amercia, but in normal usage it is synonmyous with NGU.  (I prefer NGU, as do most North American colleaguess, because the term "nonspecific" seems to imply the causes not only are unknown, but perhaps unknowable.)



Your proposed wording is rational, and sometimes I use it for ease of syntax, i.e. I refer to chlamydial urethritis and [nonchlamydial] NGU as separate conditions, exactly as you suggest.  But in proper usage NGU is all urethritis not due to gonorrhea, whether caused by chlamydia or anything else.  Of course there are millions of medical and nonmedical words or phrases that don't make literal sense.  Gramatically and from word origins, "bacterial vaginosis" means bacteria with too many vaginas; bacterial overgrowth in the vagina really should be "vaginal bacteriosis".  And you might have noticed that many gentlemen are not gentle men.



HHH, MD

by whyme2006, Mar 23, 2006 12:00AM
To: HHH, MD
Sorry-

I think i read into it a little too much.

(site:  http://www.health.nsw.gov.au/health-public-affairs/mhcs/publications/5515.html - Non-gonococcal urethritis (NGU), also known as non-specific urethritis (NSU) is one of the most common sexually transmissible diseases. It can be caused by a number of different organisms, the most significant one being chlamydia. NGU not due to chlamydia may be due to exposure to normal vaginal or throat organisms)



I think I made the jump from "NGU not due to chlamydia" IS "NSU".  Sorry to waste your time





Also can across this article "http://www.webmd.com/content/article/117/112461" on webmd.  In the beginning of the article, it seems to imply that chlamydia can be transmitted via oral sex ("Oral sex raises the risk of a common sexually transmitted disease (STD) called nongonococcal urethritis (NGU) in men, Australian researchers report.  NGU is a type of urethritis, an infection of the urethra, the tube that carries urine from the bladder to outside the body. One of the most common causes is Chlamydia...") but then it clearly states that most NGU via insertive oral is due to other organisms ("Oral sex was linked to less common infectious causes of NGU in heterosexual men and men who have sex with men.")  I guess this is another example of the "science people" not communicating with the "education people" or maybe in this case in the reported not understanding what was said.

Our hero HHH,MD was quoted in the article:  "The study is 'a good interim step in understanding this common and often frustrating syndrome,' but more work needs to be done to understand NGU, writes editorialist H. Hunter Handsfield, MD."



props doc