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[nukklehed23]

Hello Docs:

Thanks for the service you provide. Long story short, I received unprotected oral sex 17 days ago. I experienced urethral discomfort from the time it occurred. I went to a minor medical clinic 10 days following the incident. They ran chlamydia, gonorrhea, and another urine screening (don't really know what it was) that all came back negative. They also did a blood test for HSV which came back negative. I called my regular doctor and have an appt in 10 days. In the interim, they prescribed cipro, which I have taken for four days and symptoms are easing, but have not disappeared.

The only symptom I have experienced is the inflammation and redness as well as burning at the urethra. It also appears somewhat swollen or disfigured at the base of the urethra. Not that I noticed what it looked like prior!  No fever and no blisters or lesions. There has also been no discharge. However the discomfort, while not overwhelming and does not necessarily increase during urination.

I also spoke to the other person involved and they indicated that they were screened less than a month ago for all std's and HIV due to an upcoming medical procedure, and all were negative.

My question is: could there still be an infection not shown by the urinalsysis performed, such as NGU? Would the Cipro knock that out? Also would trauma to the urethra become infected, and if so would cipro be the answer for that? Should I call the doc and request a different antibiotic?

Sorry for the length of the post.

Thanks again for your help, I am trying to resolve some major anxiety as I am 45 and been married for 20 years.

[Edward W Hook, MD]

I would take the 0.5g dose today.  If your symptoms do not improve with the azithromycin thi sis a strong idicator that yo do not have NGU and your symptoms are due to some other, non-STD related problem ( adermatological problem?) and/or anxiety.  EWH

[nukklehed23]

Hey Doc:

One last post. The Z pack I received was 1.5 grams. I took the 1.0 gram dose yesterday afternoon. Should I take the remaining 500 mg this afternoon? Hate to see them go to waste. Also any idea how soon symptoms ease after taking the 1.0 gram dose?

Thanks again for your time and advice.

[Edward W Hook, MD]

Nope.  I'd still change meds and then stop being concerned.  The treatmetn is highly effective.  EWH

[nukklehed23]

Thanks for the speedy reply Doc!

I just noticed for the first time that I did have tiny amounts of discharge in my underwear. Does that change anything, or is it a common symptom of urethritis in general? By the way, the minor medical clinic said that my urine was not showing elevated white blood cell count.


Thanks again

[Edward W Hook, MD]

Thanks for your question.  You are focusing on the correct question as the tests you've already had do effectively rule out one of the two major concerns. Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   Your test effectively rules out gonorrhea but whether or not NGU ir ruled out is less certain.  Your symptoms are compatible with NGU and your partner could give you NGU not as an STD in the classical sense through oral sex. If the urine for urinanalysis was collected as an initial void specimen (i.e. just as you started urination) and did not show increased white blood cells, NGU is pretty much ruled out.  If it was not, all bets are off.  That you are now taking ciprofloacin makes further testing of little value but I would suggest a change in medication.  Cipro is well known to improve symptoms but not to cure this syndrome.  i would suggest a switch to either a single dose of azithromycin or 7 days of doxycycline, twice daily.  

Hope this helps.  EWH