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Clear Discharge

Dear Dr's
I posted a question about herpes in August last year following an unprotected oral sex exposure in January of last year, 18 months ago. I was treated with multiple antibiotics following that exposure for suspected NSU (no discharge neg tests for Chlamydia and gonorrhoea). Symptoms largely settled but for persistent soreness around the anus. I was concerned that this was herpes but have established that it isn't through neg tests. No cause has been found, some small hemerroids but the consultant did not think them worth treating, possibly stress? Unfortunately this is something that is still there and I am learning to live with.

My question this time is regarding penile discharge. I have not had any exposures at all to anyone since this episode 18 months ago.

For the last month I have been noticing first thing in the morning a clear sticky wetness on the tip of the penis. It is occasionally possible to milk something out. It is always clear and mucus like and there is no pain on urination. I do NOT notice it any other time of the day including when straining for number 2's. I am concerned that it is a NSU flare up. I went to my doctor who did another swab test for C + G and this was neg. He did a first catch urine culture that was negative for white cells and showed only enteric and skin flora. He also did a swab which also showed no white cells and the same flora as above. This swab was not looked at on site but sent to the lab for testing the next day.

Is it possible to have a flare up this long after?
Was this swab test reliable for diagnosis of NSU? It was not analysed on site.
What do you think this discharge is? I have never noticed it before.
Is it possible to have an undiagnosed STD after all this time and multiple negative tests? Could it have spread to the prostate?

Many thanks in advance.
6 Responses
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300980 tn?1194929400
MEDICAL PROFESSIONAL
1.  WBCs should still be detectable in swabs sent away for microscopy.  they do not get "lost" in transport medium.

2.  My suspicion is that you are examining yourself closer than ever before however, indeed, just like secretions at other body sites, genital secretions can vary in quantity over time.  The reason for this are no known.

Finally, while the FIRST thing that one should think of in a sexually active man with newly noticed urethral secretions is the possiblity of STDs, as noted above, all urethral secretions are not due to STD.  

Try to move forward, it's time. EWH
Helpful - 1
300980 tn?1194929400
MEDICAL PROFESSIONAL
Your clear discharge, when combined with the absence of white blood cells and negative tests pretty much rules out an STD, even if the swab was sent away.  The specimens do not need to be looked at when fresh.  

As for your early am fluid production, I would also point out that many men experience what are called "spontaneous morning erections" in the hours just before awakening.  It is at this time that gential fluid is most likely to be produced.

I see no need for further evaluation.  EWH
Helpful - 1
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome back to the Forum.  It appears that this question is a manifestation of your lingering concerns that you might have acquired an STD of some sort in relationship to your exposure of concern.  The symptoms of soreness that you describe in the anal area are consistent with hemorrhoids which can cause symptoms which do come and go over time.  I'll make a few comments:

1.  NGU does not follow a chronic relapsing course.  When persons have NGU that recurs it does so within a few days or, at most a week or so, following treatment and initial resolution of symptoms.  In your case, there was no evidence of NGU at that time and there is none at this time.
  
2.  The definitive test for NGU is the swab test. Between your swab test and your urine test, there is no evidence of NGU.

3.  Men have a small amount of normal genital discharge which comes from different places in the genito-urinary tract including the prostate.  These secretions vary in amount and over time and are most apparent in the morning on awakening.  Further, your situation suggests that your secretions are prostatic in origin as it is not uncommon for straining at stool to elicit expression of prostatic fluid which tends to be clear an a bit sticky.

4.  No, there is little in this post or your former one to suggest an STD of any sort.

I hope my comments are helpful to you.  EWH
Helpful - 1
Avatar universal
Thank you for your last update. The "symptoms" have continued pretty much unchanged since our last interaction, scant sticky clear fluid present at the tip of the penis on waking but no other time during the day.

I want to stop worrying over this but I am sure these secretions were not there previously. Everywhere I look online suggests STD but I cannot think what other than NGU. All others are comprehensively ruled out. The suggestion seems to be that a swab should be taken and examined microscopically immediately because diagnoses could be missed otherwise.

Is the accuracy as good if sent away for examination, would the WBC's get "lost" in the transport medium?
If these were normal secretions, why would one suddenly start producing these? Could it be in response to another underlying problem?

Many thanks and hopefully this can provide me some closure.
Helpful - 0
Avatar universal
Dr Hook,

The above comment was directed to you, I did not enter the name correctly in the "to" box. Sorry.
Helpful - 0
Avatar universal
Thank you for your response it has been most helpful. Could you clarify a couple of points to hopefully give me closure. I don't want to endlessly continue this.

The soreness anally does not really come and go, it is there every day but not as bothersome as it was. I think it is settling slightly, very slowly. I realise that it could not have been herpes due to the persistent nature.

As to the clear discharge, I have never noticed it when straining at stool (I think you read this the other way), only first thing in the morning. I can wake at 3 am and it is not there and then it is at 6. A similar interval. I never used to have it though! It is disconcerting when reading in medical information / internet that any discharge is abnormal and usually a sign of std. This is what has made me worried. Do you still think this is prostatic?

Is it a rule of thumb that clear discharge, as mine, is not likely to be an infection? I have seen Dr HHH state something similar.

Should I have had the swab done of the discharge or do you consider the one done definitive. I was concerned that it was not done on site, is the analysis of wbc's as good with a swab sent away?

Do you think it warrants prostate investigation or should I just ignore it?

I was interested in your comment about NGU, I was under the impression from other sites that relapses / recurrence could occur a long time later. In any case, after this time would you have expected resolution even without antibiotics?

The service you provide is really appreciated.
Helpful - 0

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