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Gonorrhea/NGU

Hi Doctors,

I posted earlier on the HIV forum where Dr. Hook was very helpful.  Sorry to post back, but I wanted to follow up on this forum because I guess my focus is now more STD related.  My concerns are unprotected oral from 2 high risk women and also the effects of having finished a course of cipro treatment 40 - 48 hours before my encounters.

I know Dr. Hook said that my completing a course of cipro 40-48 hours before my exposure could cause gonorrhea and NGU symptoms to not appear.  3 days after my exposures, I noticed that inside the opening to my urethra (pee hole) was definitely more red than normal.  Since then I have experienced mild burning when I first start to urinate (not excruciating burning, and sometimes there is no burning) and the redness areas/spots inside the opening to my urethra are still there. I noticed today that the opening to my urethra looks more closed than normal, and my urine stream is pretty weak.  When I spread open the pee hole, the inside looks more closed/swollen than normal, as if you can't see the path. So far, however, I have not seen any discharge.  Today is 7 days since my exposures.

Since my first chance to get tested is this coming week, I just wanted to ask your opinions on:

1) Taking into consideration that I completed the cipro 40 - 48 hours before my exposures, do my symptoms sound like I was infected with either gonorrhea or NGU?

2) Could having completed the cipro prior to my exposures cause me to not experience discharge but experience the symptoms I mentioned (mild burning, redness areas inside the urethra opening, swolleness inside the urethra, and weak urine stream)?

3) Could the swollen opening to the urethra that makes the pathway look more closed be the result of a urethral sticture since I haven't received treatment in the 7 days since these exposures?

4) Will getting tested this coming week be ok, or does it sound like these are complications that require urgent care?

Thanks a lot
7 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Please don't waste any money on gonorrhea testing if you have been on ciprofloxacin, which would cure most cases anyway -- so the test woudl be negagive.  Do not get tested Thursday or any other time.

You are seriously over-thinking a non-risky situation. Let it go.  You have no STD; or if you did, the cipro would have cured it.  End of story, and end of this thread.  I'll have no further comments.
Helpful - 0
Avatar universal
Hi Doctor,

Thanks very much for your reply.  I guess the reason why I have been waiting to get tested for gonorrhea is because I recently came off the cipro, and I thought that may cause a false negative test, if I had been infected.  I'm also a bit affraid that having completed cipro prior to my exposure could have caused discharge to not occur, only making the other symptoms appear.  I will have a gonorrhea test on Thursday at PPH. By the way, would doxycycline cure gonorrhea and is the dipstick test that showed minimal white cells a good sign against gonorrhea?  Thanks very much again for your responses, they have been very helpful.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
I'm glad you saw your doctor.  Unfortunately, it is not possible to confidently diagnose NGU (same as nonspecific urethritis, NSU) by the urine dipstick test for white blood cells.  And it seems the doc was not convinced your urethral meatus is abnormally red or inflamed.  While he is obviously well meaning, probably he treated you as a precaution, not because of a confirmed diagnosis.  Based on what is known at this point, I would not have prescribed doxycycline and do not expect it to make any difference in your symptoms.  But it won't hurt, so maybe it's worth a try.  Even if your symptoms continue after treatment, you should not be worried.  NGU following oral sex is not known to be harmful either to affected men or their sex partners.  And as I have said, I doubt you have it anyway.

As for gonorrhea testing, I see no need.  Gonorrhea without discahrge of overt pus from the urethra is rare.  That said, testing won't hurt -- but why are you waiting?  Gonorrhea testing is valid within a couple days of sexual exposure, so there is no obvious reason for a delay.  But taking doxycycline beforehand will make the test invalid.
Helpful - 0
Avatar universal
Doctors,

Your advice has reassured me. I just wanted to give you an update. I went to my general doctor today because Planned Parenthood said they wouldn't have anyone there who examines men until next week, however, I can go this Thursday for a urine test. I told my doctor that I have moderate burning (perhaps psychological) and the opening to my urethra seems red.  He had me give him a urine sample in a dixie cup. He was looking at a long strip that had a rainbow spectrum of colors on it and said my urine looked clean. He said there were a few white cells in the urine but not very much. I showed him my urethra and he said it was a little red but not too concerning- he said he was more concerned about the urine than anything else, which he said was pretty clean.  He said it was most likely non-specific urethritis and gave me a prescription for Doxycycline.  I just wanted to see, in your opinion, if this makes sense and to see if I should wait on the Doxycycline until after I test for gonorrhea on Thursday?  Thanks again, and my sincerest apologies for appearing as if I didn't appreciate the previous advice of you or Dr. Hook's- I certaily do appreciate it.  
Helpful - 0
Avatar universal
Hi Dr. Handsfield,

Thank you for your quick response, and I apologize for coming across the wrong way- I certainly respect and value both you and Dr. Hooks advice and expertise, along with being most appreciative of the assitance you provide here.  I have certainly been feeling very guilty about my recent episode, which probably factors in to my worrying.  When Dr. Hook said that cipro could decrease the likelihood of symptoms appearing, I wasn't certain if that meant infection could still take place but the cipro would hide it, or if infection just would not take place because of the cipro?

Thanks again and sorry to both you and Dr. Hook for being thick headed about it.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
And by the way, the answer about urethral stricture is definitely no worries.   That is a very rare complication, and only follows severe gonorrhea untreated for many weeks.  In my 4 decades in the STD business, I have never seen a patient with an STD-related urethral stricture.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Dr. Hook had to forcibly terminate your previous discussion because you were unable or unwilling to accept his advice.  In the absence of symptoms, no STD testing was needed after this sort of exposure.  And as noted below, I do not think your current symptoms are significant.

1) You symptoms are most suggestive of genitally focused anxiety, making you notice body sensations that are not abnormal.  Similarly, the "changed" appearance to your urethra or penis sounds like you are simply examining yourself too closely and noticing normal variations in appearance that are not abnormal.  None of this is very suggestive of any STD.  And yes, cipro that recently would have protected you against gonorrhea and NGU.

2-4) See my opening comment above.  I am inclined to doubt your urethra in fact is swollen.  But if this or other symptoms continue that you are convinced are significant or you otherwise remain concerned, see a doctor or clinic.  I see no urgency in doing so, however, and no need for urgent care over the weekend.

All things considered, my main advice is that you mellow out, stop worrying about STDs from this low risk event, and definitely stop examining yourself.

HHH, MD
Helpful - 0

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