Elevated WBC in urethral swab, link to reactive arthritis

Dear Dr HHH,

Got very drunk a few days ago and stayed an hour with a FSW. Don't believe we had sex, but definitely fooled around unprotected (me playing with her vagina mainly). Very foolish.

Had a test today (4 days later). No gonnorhea (Gonorrhea) found, but moderate wbc count urethral swab. Could be a sign of chlamidya, although seems early after just 4 days. Dn't have any discharge or pain, and all looks fine on my penis.

I normally have an elevated wbc count anyway, as i have reactive arthritis. Do you think the urethral count could be driven by my arthritis? I am treated with Humira.

I also have had diarrhoea and sore throat for last few days (possibly stress related after this event), so that would indicate mild infection. Would that also lead to an elevated wbc in urethra?

Thanks,

[Edward W Hook, MD]

Welcome to the Forum. As I suspect you know, Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

You ask an interesting question.  As your probably know, reactive arthritis is not a particularly common problem.  For the syndrome however, urethritis is part of the presentation and does not benefit from specific antimicrobial therapy.  Given that there was no penetration during the encounter that you describe and that you are aware that you have had elevated urethral WBC counts in the past, I see no reason for worrying that this is an STD, as long as the chlamydial test which should have been taken at the time you were tested is negative as well.  Without penetration there is no reason for concern about sexually acquired NGU, at least from the (non-)partner that you mention (on the other hand, if there was true penile-vaginal penetration, just to be on the safe side, I would probably err on the side of treatment), even though,  if the chlamydial test is negative, the clinical significance of non-chlamydial NGU is unknown. Thus, I would see no need for treatment.

Sorry if the reasoning seems a bit circular. It is based on the fact that you have a good alternate explanation for the presence of elevated WBCs.

I hope this comment is helpful. EWH

[mjm1980]

Hi Doctor Hook,

Thanks for the quick reply.

Just want to clarify i've never had a urethral wbc test before... Just my general blood test shows moderate wbc, consistent with reactive arthritis. If you have an elevated blood wbc (which i have) does that translate into an elevated urethral wbc?

I have not had the proper chlamydia test yet, as the testing centre said it was too early.

Thanks,

[mjm1980]

Further info... I am 32. Had reactive arthritis since 20.
Initial episode was linked to diarrhoea, rather than sti.

Thanks

[mjm1980]

Hi Dr. Hook,

Wasn't sure i replied correctly, copying you (am new to the forum).

I just wanted to clarify that i have never had a urethral swab before, nor was my original bout of Reactive Arthritis triggered by an STI, but rather by diarrhoea.

I have had reactive arthritis for about 12-13 years, since i was 20. Inam one of the unlucky ones that has it chronically. For this reason my WBC count is usually moderate, even after taking Humira.

My follow up question is does a high blood wbc always translate into a higher urethral swab wbc?

Also, given my immune system is weakened by reactive arthritis and humira, does that increase my chance of infection?

Thanks

[Edward W Hook, MD]

Thanks for the clarification.  No an elevated blood WBC does not necessarily translate to an elevated urethral WBC.  That slightly modifies my response.  

Garden variety NGU in persons without reactive arthritis can be asymptomatic but if discovered at the time of STD screening the recommended approach is to treat it. Presuming that you have had past unprotected sexual encounters and have not been checked for urethral WBCs, even if your chlamydial test is negative, the best approach at this time is probably to treat you with either a single 1 gram dose of azithromycin or 7 days of doxycycline, 100 mg twice daily.  Further, I would suggest that any partners whom you have had unprotected sex with in the past three months be treated as well.  This may be over treatment but this is a situation where it is probably better to over treat than not.

I hope this comment is helpful. EWH