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Dicsharge and Fish Odour from Penis
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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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Dicsharge and Fish Odour from Penis

I'm getting watery discharge and a foul rotten-fish smell on my glans (glands), coupled with itching inside my urethra.

An STI screen found no microorganisms but did find wbcs in my urine. Based on that, I was given a single dose of zithromax which has not helped the symptoms (I have not gone back to get another wbc reading done).

I want to talk to my doc about trying a more aggressive course of antibiotics "just in case" there is anything still lurking down there.

I'm going to propose a drug protocol to my doc and wanted an opinion on whether or not this protocol would without doubt, clear everything with a bacterial cause (if I still have anything lurking there).

Days1-14: Cipro 500mg/2xday
Days15-21: Azithromycin 500mg on Day 1, 250mg on Days 2-5
Days22-29: Metronidazole 500mg/2xday

I realise this is an aggressive schedule, & quite possibly unnecessary, but want to take this precautionary step to exclude any bacterial infection from the diagnosis. If there is a less aggressive protocol I could use that would be effective in clearing up all bacterial infections I would love to hear it.

So, what I'm asking for is the professional, medical opinion on whether or not the protocol suggested will clear up all bacterial infections of the urinogenitary tract, if not then what needs to be changed, or if there is a less aggressive protocol of one or more drugs that once completed, I can be confident there is no bacterial infection.
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239123_tn?1267651214
Clearly you have urethritis, and presumably it is nongonococcal (NGU).  It might be chlamydia, unless a specific test was negative.  ('Found no bacteria' suggests that the statement is based on looking under the microscope, which can detect gonorrhea but nothing else.)

The lack of response to azithromycin is atypical for NGU - although you don't say how long it has been.  It often takes a few days for the discharge to clear up.  The foul odor suggests overgrowth of normal bacteria, and I suspect you are uncircumcized; if so, just foreskin retraction and soap and water 2-3 times daily probably is all you need.

Having said all that, you really need to follow a personal health care provider's advice and not devise your own unique treatment, and not rely primarily on my advice.  In 30+ years in the STD business, I don't think I have ever seen a patient with the sort of problem you describe.  Maybe in fact you have anaerobic balanitis (bacterial infection, not sexually acquired) and require more aggressive treatment; I simply do not know.

If the hygiene approach doesn't take care of it, get professional advice.  Or if it has been more than a few days and the discharge is continuing, you need medical follow-up for that part of the problem.  Even if you are medically trained yourself, get professional care; an old saying is that the physician who treats him or herself has a fool for a doctor.

I trust your sex partner(s) have been informed and treated.

Best wishes--   HHH, MD

3 Comments
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Avatar_n_tn
Thanks for the reply.

Chlamydia was specifically tested for via a swab test and came back -ve. So did Gonorrhea, ureaplasma and mycoplasma. Additionally, the microscopy came back with "no microogranisms seen".

If I had trich, would that have showed up in the microscopy?

It's been about 6 weeks since the zithromax dose.

Yes I'm uncircumised but have not had any problems with odour until now.

I have not had sex since start of symptoms so no partner that needs testing. The last person I had sex with (and presumably the person I picked this up from) was a casual encounter a while ago and I would not know how to contact her again. Another data point is that these symptoms (odour and what appears to be discharge) started a long while (+6 months) after the encounter.

I do like your quote about the fool who treats himself and will follow up with my health provider. Based on the added information above, is there anything else you can suggest I look into?

Thanks.
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Avatar_n_tn
The doc is right, a change of medication will help because some strains are resistant to certain meds. I also went to the doc with a list of meds (from research off of the web) I should try (I like you have constant and persistant NGU) and he felt belittled that I would suggest that I knew more about the STD relm than him and told me he might not be the best doc for me. Funny thing about that was he used a GUIDE book the whole time I was in his office to find out what I should take and how much for every infection it could be. So the old saying is that the physician who treats him or herself has a fool for a doctor is tested and proven.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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University of Alabama at Birmingham
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