Cause for concern

Hello,

Recently I made the stupid mistake of having relations with a prostitute and had unprotected oral sex. After a few days, I had pain during urination and discharge. My PCP performed a STD test with swap and blood and gave me 2 500mg Levaquin pills as well as a seven day supply of doxy. Needless to say, the test can back positive for gonorreah. Blood tests were negative. At the last day of the doxy dossage, I still noticed a little discharge in my shorts. However, the pain during urination and the swelling/redness around the tip of my penis subsided. My doctor presrcibed me a 10 day dose of 500mg Levaquin as a precaution. I am on my fifth day of the dosage and it appears the discharge is worse than after the doxy dossage. It also shows up when the urethra is milked and when I have an errection. My understanding is the original dosage should have cured the gonorrhea. Is there a possibility of another type of infection? Will the Levaquin clear it up? I am scheduling a follow up with my PCP, but was looking for another opinion.

Thank you.

[H. Hunter Handsfield, M.D.]

Gonorrhea symptoms should start to improve within a couple days and usually pretty much clear up within a week.  Gonorrhea resistant to the fluoroquinolone antibioitics, including levofloxacin (Levaquin) is increasingly common in the US.  It is especially a problem in gay men (was your prostitute partner a male, by chance?), but is increasing everywhere.  And many gonococci also are resistant to doxycycline.  So the most important thing is to make sure you don't have persistent gonorrhea.  (If you're not in the US, and especially if you are in Asia, you can definitely assume fluoroquinolone-resistant gonorrhea.)

If that's not the explanation, I'm at a loss.  Co-infection with chlamydia is a consideration, but not in this case.  Chlamydia is rare by oral sex, and in any case always responds to doxycycline and/or a fluoroquinolone like Levaquin.  Another theoretical possibility is trichomonas, but that isn't acquired by oral sex.  Most oral bacteria that might cause co-infection should have responded well to levo and/or doxy.

So all I can suggest is follow-up with your PCP as planned, making sure s/he checks for antibiotic-resistant gonorrhea.  If that's what it is, you should be treated with ceftriaxone by injection.  Otherwise, s/he probably will want to do a urine culture and perhaps check you out for less common infections, like yeast.  But I don't have any other bright ideas.

Good luck--  HHH, MD

[stupiddawg]

Yeah, I read some of the achived posts regarding Gonorrhea and noticed that strains resistant to the fluoroquinolone antibioitics are on the rise. I became concerned because it was with a woman and I am on the east coast.

Thanks so much for your responce.

[concerned86452]

A related discussion, burning sensation after urination not during was started.