STDs Expert Forum
After treatment for Chalmydia/Gonorrhea
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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After treatment for Chalmydia/Gonorrhea

Hello,

My question is actually for after receiving treatment.  About 10-14 days after sex i was experiencing a very subtle completely clear discharge from my penis i called my friend who is a doctor.  i told him that i was having a clear discharge that was very subtle and would only occur a couple times a day very lightly.  I have read that Chlamydia/Gonorrhea cause more of a thick whitish or yellow discharge and painful urination so i was a bit confused...

I took antibiotics for Chalmydia (azithromycin), Gonorrhea (Cipro), and Trich (can't recall the med).  Well, i took them all on Monday or Tuesday afternoon.  Today it is Thursday morning and i am still getting that slight clear discharge from my penis...i can see it when i squeeze the tip.  It is odorless and i'm sure it isn't urine.   I've read that some strains of gonorrhea are resistent to Cipro here in CA, so was curious about that too.

I'm not a worry-wort trying to find something wrong with me, but just wanted to ask if this sort of thing is normal.  you would think the meds would have cleared up everything quickly, but for some reason i still have the slight discharge which seems to be more prevalent when i have an erection or after i come home from work for the day.

i asked if the meds may not have worked and he said it was highly, highly unlikely that that would happen.  Could this be something normal?  i'm 30 years old and in good health.

do you think that the antibiotics didn't work?  could it be something else?  maybe it'll take a couple more days for symptoms to disappear completely, but wanted to inquire.  i haven't seen any whitish or yellow discharge ever.

thank you.
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The clear, scant nature of the discharge is good evidence you didn't have gonorrhea, for the reason you mention.  However, either chlamydia or trichomonas could cause such mild symptoms.  It would have been best to be examined and tested for STDs before being treated.  At this juncture, you're never going to know for sure whether you were infected and, if so, with what.

Nevertheless, the symptoms of chlamydia, gonorrhea, or trich would have cleared up within a week of starting treatment, so the persisting symptom is strong evidence against those infections.  It's also a good indication that you didn't have nonchlamydial, nongonococcal urethritis (NGU), although once in a while some cases of NGU are resistant to the treatments you received.  Therefore, it is unlikely you had any STD.

Many cases of such scant clear discharge may be physiologically normal; or might be evidence of a prostate gland problem.  As suggested above, NGU also remains a slight possibility, and could be checked out by an examination to determine whether there is evidence of inflammation (white blood cells) in the discharge.  Most prostate problems that cause such symptoms are not due to infection and don't respond to antibiotics, so the continuing symptoms tends to favor this explanation.

If the discharge clearly is new and different for you, and especially if it continues, you should see a provider to check out the possibility of a prostate problem or NGU.  In the meantime, don't be worried.  These sorts of prostate problems, and even sexually acquired NGU not due to chlamydia, are not known to cause any long term health problems in either affected men or their sex partners.  This should be viewed as a health-related inconvenience, not a serious threat.  But check it out to be maximally safe.

I hope this helps.  Best wishes--  HHH, MD
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Hello Dr. Handsfield,

I took your advice and went to a very reputable STD clinic...I guess the doctor there is one of the best authorities on STDs in the country.  He did a urinalysis and also a swab test on me and the urine test he said came back negative for everything and the Chlamydia/Gonorrhea tests also came back negative.  

However, he has a lab actually at his clinic and performed the analysis there.  He said that there was definately legitimate inflammation in my urethra, which he said was attributed to non-chlamydial NGU...he actually said he sees it every day even though most people think Chlamydia/Gonorrhea is all there is.

Anyway, he prescribed me 7 days of doxycycline (can't recall the dosage, but twice per day) and also 7 days of cipro (500 mg, twice per day).

My symptoms are so mild that unless i really look i can't detect the perfectly clear discharge and i see nothing in the morning when i wake up (mostly the afternoon)  Pain during urination, i.e. that stinging or strong burning is still not there either.

I've read of chronic NGU requiring months of treatment and i'm a bit on edge about it.  How long should it take for symptoms to subside when on Doxy or Cipro and should i expect relief in a couple days regardless of the prescription duration? what's your opinion on the drugs he prescribed?  Thought i'd get your feedback on the matter.

Don't know if i have to make another donation or not to solicit your feedback, but happy to if required.

Cheers.
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As I suggested, most people with the mild symptoms you had turn out not to have urethritis -- but clearly it can occur and I'm glad you got it checked out.  It sounds like you were given accurate information and that your provider probably knows as much about this as I do; I agree exactly with the information he gave you.  It seems likely we know each other; there aren't very many nationally prominent STD specialists.  (Most of us would have given you doxycycline without ciprofloxacin, but that's a judgment call and I can't say it's wrong.)

I wouldn't worry about "chronic NGU".  It is true that some men have persistent or recurrent urethritis in this situation, but it's a small minority.  Most such cases probably are not due to infection at all, but to residual inflammation that doesn't mean anything and doesn't due harm.  Nonchlamydial NGU has never been reported to be associated with long term important health outcomes in either affected men or their sex partners.  This really isn't an issue to lose sleep about.  I'm sure your STD specialist will confirm this if asked.  In any case, he is the best source for any continuing questions.
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Thanks Dr....

Glad you replied and i've definately learned my lesson and don't want this to happen again.  This sort of thing i've learned affects every socio-economic group and nobody can assume "they'll never get anything" no matter how lucky they've been in the past.

It wasn't easy walking in that clinic, but i guess the valuable lesson learned made it worth it in the end...

Best regards, sir.

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Hello Dr. Handsfield,

Just to update you, as you know i was diagnosed with Nonchlamydial NGU and was prescribed with Azithromycin (single dose) and then Doxycycline (one week) after the azithromycin failed.  Well, my treatment is now over for the Doxycycline and i still have symptoms of NGU which include scant perfectly clear discharge and perhaps a slight discomfort when urinating.

I know you've mentioned that sometimes inflammation can persist even after bacterial infection has been erradicated but i just wanted to ask how common this is and whether what's going on with me is rare or normal.

Is there any other antibacterial medication you could recommend for me to discuss with my doctor that has been proven to work well in your experience?

I know there are no long term health risks, but at this point i'll try anything...and i just don't want this to cause any more stress in my life as its been a very sobering experience and taken its toll on me personally.  At this point i'll try anything to make it go away.

Thank you, whatever information you give i will discuss with my doctor.
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It has only been 2 days since your last follow-up comment; you cannot yet know whether your symptoms are going to persist.  It is unlikely that continuing infection explains your ongoing symptoms and therefore no antibiotic is likely to help.  The only long shot would be treatment against trichomonas, which probably has not yet been done.  Otherwise, I suggest just living with your symptoms for at least several weeks.  Most likely they will fade away with time.  If not, personal care from a knowledgeable provider is where the answer lies, not in distant opinions from me or other online sources.

That will have to end this thread.  Take care.
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