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How long should it take...
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How long should it take...

A couple of days after unprotected, penetrative anal sex, I noticed a slight discharge from my penis. Went to the doctor, had a culture taken, and was administered ceftriaxone 125 mg via injection (in case of gonorrhea) and azythromicin 1 mg orally (in case of chlamydia). The test came back "suspicious" for gonorrhea, whatever that means, and I was told they'd have to run more tests to see if that's what it really was. In the meantime, 72 hours after the antibiotics, the discharge has not abated, and I'm having increased discomfort during urination, as well as increasing frequency.

So, is it normal for ceftriaxone to take several days to eliminate symptoms of gonorrhea? Or could I possibly in fact be dealing with some other sort of bacterial urinary tract infection besides (or in addition to) gonorrhea? Are there any known incidents of ceftriaxone resistance in gonorrhea?

Any help would be appreciated.
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Avatar_m_tn
Ceftriaxone is a cephelasporin antibiotic and as far as I know, there are no strains of gonorrhea that are resistant to it. If you have gonorrhea, that shot should clear it for you. It can take between 2 to 7 days for the antibiotic to clear the infection and sometimes, you may need a second round depending on your body weight and how you process the antibiotic. I personally required 250 mg to clear my infection. You may experience some discomfort after the infection clears because of the inflamation (inflammation) left behind. That should pass too.

Make sure your doc runs another gonnorhea (Gonorrhea) test to ensure that you're clear. You should never have to hear "suspicious" in your diagnosis, especially when its concerning an STI. It is possible you may have picked up another form of  bacteria resulting in a UTI, but most male UTIs don't produce discharge...rather they increase frequency and painful urination is common.
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Avatar_m_tn
I was thinking about the "suspicious" result.. and that may happen if you went into the doctor too soon. Most gonorrhea infections manifest in 3-5 days... but can take as long as 10. So, you may have had gonorrhea, but it wasn't prevelent enough to register on the test.
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Avatar_m_tn
Thanks so much for the answer. I should hear a follow-up early this week about the "suspicious" test result. I'll wait til seven days after the initial treatment and go back for another test. If the symptoms have not abated by then, I'll ask the doctor to prescribe a 250 mg dose of ceftriaxone.

No more unprotected sex for me. The gonorrhea part of it is remarkably inconvenient, and I'm a bit nervous as I wait til it's been long enough to get an HIV test.
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Avatar_m_tn
So I heard from my health care provider today, and they told me that the "suspicious" gonorrhea result, after further tests, turned out to be negative, and also negative for chlamydia. Their suggestion? It could have been too early for the result to be positive, so I should wait six weeks and come back for another test. Six weeks seemed ridiculously long to me, so I insisted on going back this week. 10-12 days after the initial possible exposure should be plenty of time to get a positive test, shouldn't it? And if the discharge isn't being caused by gonorrhea, shouldn't the doctor be suggesting further tests to find out what kind of infection is causing my greenish-yellow urethral discharge? I think the level of care I have gotten is absolutely dreadful.
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207091_tn?1337713093
Actually, testing now after you've had the antibiotics makes no sense to me.  Your test results won't show you now what you had then, if it was gonorrhea.  Either the antibiotic is working to cure you, and you won't have enough bacteria to test positive, or it will slow down the growth of another bacteria enough that it wouldn't show either.

However, if you are still having a discharge, you could have that tested, using a test called a gram stain.  I don't know if it will have enough bacteria to show on a test, but its worth a try.  You just wouldn't be able to trust a negative result.

If you are still having problems a week after taking the meds, then you need to see your doc, and if you feel you aren't getting a good standard of care, ask to see a urologist.

AJ



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Avatar_m_tn
Or switch to a doctor specializing in infectious diseases or STDs.
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Avatar_m_tn
I would say any infection capable of producing "gleet" should be able to be swabbed and gram stained for immediate identification...particularly if it gonorrhea. AJ is right. The idea of waiting 6 weeks for isolating and identifying gonorrhea is ridiculous, especially when the incubation period is usually no more than 10 days max. Antibiotics will certainly make a second diagnosis more difficult and they may be saying to wait 6 weeks in order for all of that to clear your system and potentially allow enough time for a relapse to occur (if infection is present)...thus being testable again. But I'd definitely shoot for a swab/gram stain if you're still discharging.

As for your HIV concerns, yes, unprotected anal is a high risk. Its further amplified if you were truly exposed to gonorrhea. I'm not trying to frighten you, but gonorrhea would cause inflammation in your partner's rectum, thus increasing the number of potentially hiv infected cells to that area of his body.  Granted, for him, its even worse if he has rectal gonorrhea and is receiving unprotected anal... he's gunning for and HIV infection. You being top has some reduction of risk, but not enough to not warrant testing. If you are uncertain of your partner's status, I'd definitely recommend testing 90 days past exposure.
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Avatar_n_tn
try getting tested for trichonomiasis, if the yellowish-green drip is non- gonococcal (not caused by gonorrhea)
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207091_tn?1337713093
Yes, if you have a discharge, that absolutely needs to be checked under a microscope.
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Avatar_m_tn
This is absolutely ridiculous. Yesterday, the doctor's office contacted me and announced that the gonorrhea test was negative. After I raised hell and complained about the 6 weeks suggestion, they told me to come back tomorrow, when they'll conduct more tests, including the gram stain, the regular culture for gonorrhea/chlamydia, a urine test, and a urine culture. However, to make things more confusing, the lab once again revised its results on the original test, back to "suspicious" for gonorrhea and wants another specimen. The chlamydia test remains unequivocally negative.

Antibiotics should have cleared gonorrhea, if that's what it was, so I'm puzzled as to why I still have a slight (although steadily lessening) discharge. And since no one has identified any ceftriaxone-resistant strain of gonorrhea, the culture now should be negative either way (unless the 125 mg dose somehow did not clear it). Someone mentioned trichomoniasis, but I've read that that's almost exclusively transmitted via vaginal to penile sex, and I was having anal sex with a man, so I doubt that's what I'm dealing with. The frustrating thing is just not knowing what the hell is going on.

As for the comments about HIV, yes, I was aware that his having gonorrhea would increase my risks as the top, if in fact he was HIV positive, which he insists that he's not. Still, if he's letting me do it without a condom, who knows who else he's letting do that too, right? I got a negative test yesterday to provide a baseline, and I'll get tested again at 30 and 90 days. I figure I am probably all right, but it's still a concern for sure.
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207091_tn?1337713093
Aww I'm sorry this is so frustrating.

Ask your doc about NGU or NSU (non-specific infections in the urethra), and LGV (a form of chlamydia).

AJ
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Avatar_m_tn
Yeah, LGV generally causes a painless ulcer on the genitals and swollen lymph nodes in the groin that burst and drain through the skin, and I don't have any of those symptoms, so that's one infection I probably don't have to worry much about.

I had thought of NGU or NSU as distinct possibilities. Anal sex is rather dirty, considering all the bacteria in the rectum, and there's all sorts of non-gonoccocal bacteria that could have gotten in my urethra.

Still, I have an appointment tomorrow morning where I should be able to get enough tests to figure out what, if anything, is going on. I have noticed that my discharge is no longer really greenish-yellow like it was before. Now it seems thinner and is closer to  being clear or cloudy. Weird.

Thanks for the answer, AJ. Much appreciated.
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Avatar_m_tn
Sorry to resurrect an old post. A week after a 125 mg dose of ceftriaxone to treat a suspected gonorrhea infection (the test never came back positive - the most they would say was "suspicious"), my symptoms finally went away. I had a second test, which came back negative. A urine test a week after treatment also indicated no blood in the urine, and a urine culture also came back negative.

However, just this week, about 10 days after the 125 mg shot of ceftriaxone, my urethral discharge has returned. My doctor at my university's student health center (who admits he's clueless about sexual health for MSM) doesn't really know what to do and suggests I see a urologist. They made an appointment for me with a urology PA, who I'll have to wait four weeks to see. In the meantime, they expect me to continue to live with a urethral discharge as though nothing were wrong.

Does this seem like a sensible option, to wait a month to see a PA? Or should I perhaps make an appointment at my county health department or with a private primary care physician to get tested for gonorrhea again? Or go back to the student health center and see someone else, hoping I finally find someone competent? I'm utterly confused as to why my discharge should have returned after a 125 mg ceftriaxone injection, particularly when urine culture ruled out any bacteria in the urine at all. Or have my questions now exceeded the expertise of the members of this forum?
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207091_tn?1337713093
Hi there -

You need to move on from the gonorrhea suspicions.  All your tests are negative, and you have taken more than enough of the correct antibiotics to cure it a few times over.

Something else is causing this, and you don't need more gonorrhea testing.

I would call the urologist's office and ask to be put on a cancellation list, or see why its going to take so long.  

MSM health isn't totally different from MSW health, but a urologist will be able to do more tests to see what's up.  I think a urologist is better than the county health dept or the student health center for you at this point.  Just try and see if you can get in sooner.

If you are having pain, it wouldn't hurt to play that up some to see if you can get in earlier.

AJ

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Avatar_n_tn
Hi, I'm experiencing an identical situation with the scenario you've laid out here.  I was wondering what the final diagnosis and treatment was for your promblem.

thanks
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