Chlamydia and Gonorrhea Question

[ConcernedGuy8001]

Doctor:

I am a sexually active gay male who is concerned over Chlamydia and Gonorrhea infection. I have had three sex partners this year (one in February, one at mid May and the last at the end of June). The partner in June has become a regular sexual partner and potential long term relationship. In February, I received oral sex, in May we only had mutual genital touching but no oral sex, but the recent partner (June) I have given and received oral sex, along with engaging in genital touching and mutual masturbation. About a week ago my most recent partner gave me oral sex. A few days after I noticed an odd, almost tingling sensation around and inside my urethra/penis. I have a very faint burn or stinging sensation after I urinate. However, this is not like "pissing razor blades," but rather a minor nuisance which resolves. It seems as though the stinging/burning is more pronounced when I wake up and take my first urine of the day. The "funny feeling" appears sporadically. I have no visible discharge that I've noticed. I have had some minor redness/irritation around my urethra also.

I went to Planned Parenthood and the attending told me that it could be Chlamydia, but it could also be regular oral bacterium which has irritated my penis. She said Gonorrhea is most likely transmitted orally, but she didnt feel there was enough evidence to treat me. They performed a urine test and gave me Doxy for possible Chlamydia. She stressed that a shot for Gonorrhea based on my "symptoms" was not advisable.

1. Does this sound like a possible STD? I
2. Could over-thinking possibly be causing the symptoms?
3. The attending did not seem concerned at all over Chlamydia or Gonorrhea based on what I told her. Should I abstain from oral sex with my new partner until the results come in 2-3 weeks from now?

[Edward W Hook, MD]

At this time, your symptoms ahve improved and your STD tets are negative.  I would not take the doxy.  If your symptoms recur, I'd work through it with your doctor who sounds to be quite level headed and well informed.  FYI and for better or worse, the non-STD genitourinary tract infections in men tend to be more difficult to treat than the STDs, sometimes requiring repeated treatment.  EWH

[ConcernedGuy8001]

I really appreciate your patience in answering my questions. You’ve been most helpful. I wanted to quickly give you an update and ask an additional question.

My lab results came in and I tested negative for both Chlamydia and Gonorrhea. The tests were run 3 days post-exposure and my doc said this was ample time to get a good reading. He told me to trust the results fully. He then recommend that I remain on the Bactrim and consult a Urologist. A few days after my test, I started experiencing a clear, sticky discharge mostly after an erection and in the morning. Sometimes I’ll get it after urination. I also have testicular pain. My doctor told me this was absolutely not an STD (tests ruled it out) and I should consult the specialist for other possible problems. After being on the Bactrim for a few days the symptoms have mostly ceased (or I am atleast not noticing them). I took a UTI test using the strips purchased at the drug store. Prior to the Bactrim the results were dark purple (a major UTI), now almost finished with the meds it shows only a slight trace of infection.

I still have the Doxy provided by Planned Parenthood “just in case.” Should I take this after the Bactrim? I know you said something about being an NGU.

[Edward W Hook, MD]

If this is an STD, i would not use Bactrim. If you have urethritis and your gonorrhea test is negative, the appropriate therapy for the problem we call non-gonococal urethritis is either azithromycin 1 gram as a single dose of 7 days of doxycycline 100 mg twice daily.  EWH

[ConcernedGuy8001]

I was able to get into my primary care today and he ordered another Chlamydia and Gonorrhea test, which will be ready by Thursday. He told me that Chlamydia is not transmitted thru receiving oral and that Gonorrhea is more likely. However, he said without a discharge he is still uncertain. He did an in-office UTI test that showed positive for Leukocytes and negative for nitrates. He then told me it was most likely a UTI caused by an anatomical defect and is referring me to Urology (I have a fairly small meatus and often "dribble" when I urinate no matter how much I "shake" it). He ended up prescribing me Bactrim DS. He noted that given my Z-pack and a normal Urinalysis in March (not STD check but Urinalysis) that an STD was probably not my issue. If it turns out to be an STD will the Bactrim clear it up or will I need to go get another script? He wasnt too specific on this and told me not to worry much about it. I'm not too sure on his assessment.

[Edward W Hook, MD]

Yes, some NGU is caused by STDs such as chlamydia but in most men the cause is less obvious. One cause however appears to be the introduction of normal bacteria into places where they do not normally reside, such as the introduction of oral (or rectal) bacteria into the urethra. These are not technically STDs in the sense that they are not typically transmitted to others and typically resolve with therapy (despite this, perhaps taking a "better safe than sorry" perspective, the official recommendation, which we endorse, is that partners of person with NGU should receive the same therapy as the symptomatic person. This is a bit of a disconnect from what the attending told you - I understand this.)

As far as the Z-pak is concerned, while azithromycin is recommended as treatment for NGU, it is not given in the dose form recommended for chlamydial infection and NGU and, as a result, while it may have cured a pre-existing infection, one cannot be as sure as if they had received the proven, recommended 1.0 gram, single dose. EWH

[ConcernedGuy8001]

So sorry, but I forgot to add one more piece of information. In early April I was prescribed a z-pack for an ear infection. Would this prescription eliminate my possible STD being anything prior to taking the dose? I have only had two partners since taking the z-pack. One was just mutual masturbation and the other was receiving the oral. I am just trying to weed out which of the three it could have come from. Thanks.

[ConcernedGuy8001]

Thank-you for the quick response. I am a bit confused on the NGU aspect of your response. Is this the normal oral bacterium the attending was referring to? She told me if the Chlamydia and Gonorrhea results came back negative then I was okay and my partner did not infect me with an STD and I can move on. Is this correct? She prescribed me Doxycycline at 100mg 2x a day for 7 days. This was her precautionary just incase it was Chlamydia but she expected negative on both since I have no discharge. I'm a bit confused. Thanks.

[Edward W Hook, MD]

Welcome to the Forum.  It sounds to me like the attending you say was on target and knowledgeable. Chlamydial infection is quite rarely transmitted by oral sex while gonorrhea and non-chlamydial NGU, possibly caused by introduction of oral organisms into the urethra, is more common.  I am not sure if the urine test you had was for gonorrhea and chlamydia, for white blood cells (signs of inflammation seen with NGU) or both.  Most probably and based on your symptoms,  I would have treated you with either doxycycline or azithromycin for the problem you describe


1. Does this sound like a possible STD?
Yes, what you describe could be NGU or less likely gonorrhea a acquired through oral sex.  If you were tested for gonorrhea and the tests were negative I would not have treated you with the shot for gonorrhea.

2. Could over-thinking possibly be causing the symptoms?
Hard to say.  I think going for evaluation was reasonable and appropriate.  

3. The attending did not seem concerned at all over Chlamydia or Gonorrhea based on what I told her. Should I abstain from oral sex with my new partner until the results come in 2-3 weeks from now? .

I think the attending’s reaction and assessment sounds pretty reasonable.  If you were treated for an STD, your partner should also be.  He can go and simply tell them that you were treated for NGU and then he too should be evaluated and get treated with the same meds you were. The safest, recommended course of action is to treat sexual partners of infected persons, whether they have infection or not.  That way there is no delay in treatment.  

Parenthetically, I should mention that it should not take 2 weeks for test results to come back. They should be back in less than a week.  I'd call and check.

Hope these comments help. EWH