Complications from STD

Dr. Handsfield,

I recently had a bout of urethritis, and tested negative for chlamydia and gonorrhea at about 7-10 days after the incident, when I started to have pain. This was most likely do to condom slippage (I was insertive top)

Anyway my private doctor told me chlamydia doesn't always show up in the swab/urine test I had unless a discharge was present at the time. (It wasn't but it came later) So anyway when I had a clear discharge are urination, I called him and he got me on 10 days of antiobiotics (doxy) for 2 times a day. Now my symptoms have greatly improved and the discharge is 100% gone.

1.) However, is it normal to have some urehtral pain still? I stopped antibiotics probably 1 week ago today. I read some sites that say it's normal after the antibiotic clears after an STD, but wanted to ask you too. I have a small amount of nag pain in the urethra and immediate crotch area. This is nothing compared to the pain I had, but there's still enough pain where I can't get back to normal yet.

2.) I was a little bit curious about syphilis because a little bit of a red irritated sore appeared under the head of my penis and instead of having it swabbed my doc gave me an antibiotic for it, which I probably should have done. It was just like irritated red skin and it had almost like an odor to it. With the antiobiotic cream, it was pretty much gone in 2-3 days, very quickly.

However, you should also know that while that sore was there I tested negative at the 4 week mark for Syphilis (RCR) and HIV ELISA test, and all the other STD's Herpes, etc. My doctor gave me a full test. I'm going back at a later date for another HIV and Syphilis.

3.) My final question is: If a syphilis primary chancre was present before I treated it, would I most likely test positive for syphilis if that's what it was?

I know the chances aren't too too great. Because I checked my states STD statistics and the county I live in 5 people were diagnosed with primary/secondary syphilis in my county last year and 7 people in the county next to me. But the timing of the sore after about 3 weeks was curious.

Just trying to get to the bottom of the nagging pain. Does it usually go away right away after meds for Chlamydia or NGU? Or is it normal to be a little tender for a couple weeks after?

Thanks and hope your research in Africa is going well

[H. Hunter Handsfield, M.D.]

It sounds like you had nongonococcal urethritis (NGU), of which about 30-40% of cases are due to chlamydia.  Your doc wasn't exactly right; generally a urine test for chlamydia will be positive within a few days of onset of infection, with or without symptoms.

1) It is common for mild urethral pain to resolve more slowly than discharge.  Pain in the crotch (you mean the groin?) is not due to any STD; either it is unrelated to your NGU or might reflex anxiety over the event.  Both symptoms probably will resolve gradually, but if they persist for another 1-2 weeks, see your doc again.

2,3) A transiety "red irritated sore" that resolves so quickly is unlikely to be syphilis; and in any case, the antibiotics used for NGU generally would abort syphilis.  If syphilis is treated so early, the blood test usually never becomes positive.  The pain you describe does not suggest syphilis.

Finally, if the "red, irritated sore" really was an open (ulcerated lesion), I would be much more concerned about herpes than syphilis.  I don't know what herpes test your provider did, but you might ask him about that possibility.

Good luck--  HHH, MD

[terrified_brian]

Thanks for the info Doctor,

I tested negative for HSV Type 1 and 2 says here on my LabCorp sheet. This test was done at 4 weeks. Is it reliable?

Just also want to add that this irritated sore was very visible and had not yet been treated when i went for the blood test. Not sure if that makes a difference. It went away with 2-3 days of antibiotic cream. It was very small irritation and theoretically probably could be due to many things, but there was an odor coming from the irritation. Is that common in a herpes lesion? And it was 1 single irritation.

[terrified_brian]

I apologize for not being specific my doctor wrote on the lab sheet "herpes antibody type 2"

And I tested neg at 4 weeks. how long is the window period?

[terrified_brian]

Sorry- keep forgetting to disclose information

Not sure if this matters either, but the sore didnt appear until somewhere between 3 to 4 weeks after my risky exposure.

[terrified_brian]

Herpes Select was the name of the test. The Herpe hotline told me that no tests can be reliable until 12-13 weeks after exposure

[terrified_brian]

Last thing: Is it possible for herpes to be inside my urethra which caused the sticky discharge weeks ago?

The first time I went to the doctor (about a week after my incident) I just had urethral pain and was given precautionary dose of antibiotic (about 4 pills) about 3-4 days later is when the discharge started. Maybe thats because the antibiotic didn't treat the herpes?

[H. Hunter Handsfield, M.D.]

Herpes is an unlikely cause of the symptoms you describe.  I really can't say more; follow up with your own provider.

HHH, MD

[terrified_brian]

Doc,

One final question. I'm following up with my doc Monday.

The discharge is back. It's very semen-like and comes out after urination and almost looks yellow. It comes out very easily semen-like.

This is 5 weeks post incident and 2 weeks or so after antibiotics.

Could this be intra-urethral herpes?

[H. Hunter Handsfield, M.D.]

Sounds like recurrent urethritis, presumably NGU but conceivably gonorrhea (since the discharge is yellowish and apparently in fairly large amount). Probably not herpes; herpetic urethritis usually is very painful.

Stop trying to sort this out from online advice.  I will have no other replies unless/until you report what was found by professional medical evaluation.

HHH, MD

[Latina Concerned]

Yesterday I was diagnosed with genital herpes. I started my medications today (Valtrex & Vicodin for pain); would they interact with my diabetes. I didn