ESR Levels

[BenG]

Hi Doctor, sorry to bother you.

I wrote last week about my case. Negative for all STDs but diagnosed with urethritis. Prescribed doxy for 6 weeks 100mg/day. No resolution (still stinging when urinating).

Now I am 11 weeks post sexual encounter. Started getting joint pains 2 weeks ago. Ankle is worst but still quite mild. Fingers, and lower back affected. Muscular pains as well.

I was worried about Reiters.

My family doctor said that in Reiters, ESR levels would be raised in the acute phase. So he tested my ESR (no tests for auto-immune) and it was in the 70s (high). I have yet to discuss with him the next steps but what is your impression on this?

1. Does this mean I have Reiters or does it mean I have some rheumatic condition?

2. Urologist prescribed Cipro 500m twice a day for 7 days to address the persistent stinging when urinating (doxy did nothing). Is this a good decision when all tests = negative?

3. I have been taking the Doxy for 4.5 weeks now 100mg per day (out of a 6 week course). Since it has not helped at all, can I stop taking them?

I am 29, male.

Thanks very much.

[Complex13]

A related discussion, ESR was started.

[mo_lives]

A related discussion, can hpv result in high esr levels was started.

[BenG]

Hi, GUM stands for Genito-urinary medicine. It is the name they give to doctors specialising in STDs.

Ben

[needsomehelp2]

I have been having simular symptoms... What is a GUM specialist?

[unknownSpace]

Thanks for your post.

[BenG]

Thanks so much. I am very grateful for your advice. I am seeing a Rheumatologist in 2 weeks.
Ben

[H. Hunter Handsfield, M.D.]

There is no point in being tested for mycoplasma or ureaplasma, because neither of those organisms is believed to cause disease (they normally inhabit healthy persons' genitals); and would have been eradicated by the treatment you had anyway.  You had plenty of doxy.  Yes, Reiter's itself probably causes an immunologically generated (not infectious) urethritis that could cause your symptoms.

You don't need a urologist; you need a rheumatologist or GUM specialist.  If you live in or near a city with a medical school, you would be able to rely on the expertise of an affiliated physician in either specialty.

HHH, MD

[BenG]

Thanks for your advice, the service you provide is amazing. I do have a few follow-up questions if you don't mind.

1. How would I re-evaluate evidence for urethritis? I was tested twice for chlamydia and gonorreah (negative)/urine test (negative).
There is a private clinic I know that tests for mycoplasma and ureaplasma but aside from that, what other tests can I take? My symtoms are significant stinging when urinating (not intermittent, every time).

2. If nothing is found on the myco/ureaplasma tests, isn't it still likely that I have an infection. If so, what other antibiotics would you recommend?

3. Would 4.5 weeks of doxycycline 100m per day get rid of any bacteria or is it too weak a dose.

4. Could the persistent symptoms be a result of Reiter's itself (it causes inflammation) - if I have it?

It's been 11 weeks and I'm really distressed about this. I don't have a doctor I can trust in London (the Urologists I have seen are not "in the know"). There are a few GUM Specialists but I don't know which one to see.

Thanks very much.
Ben.

[H. Hunter Handsfield, M.D.]

An ESR of 70 is very high, indicating a vigorous inflammatory response going on in your body.  Many things cause elevated ESR, but that high indeed suggests a rheumatologic condition. Reiter's syndrome would qualify, but so would other conditions.  There is a standard definition of Reither's syndrome, and you probably don't meet it.  But you should ask your family doctor to refer you to a rheumatologist or other specialist.

Six weeks doxycycline is major over-treatment of urethritis and ciprofloxacin is unlikely to add anything effective.  I don't recommend going against your doctor's advice, so I would discuss it with him; but if it were me, I would recommend stopping both antibiotics and reevaluating your for evidence of urethritis a couple of weeks later.

Good luck--  HHH, MD