Male Gardnerella & Treatment

[bonzauk]

A few months ago I had unprotected vaginal\anal sex with a woman. Within a few days I had a lot of discomfort in my urethra and minor, clear discharge with no odour. I'm in the UK so went to the local GUM clinic, I've been tested for everything under the sun and all tests are negative. One swab test did show some pus cells so I was treated with Ofloxacin for 2 weeks which made no difference to my symptoms.

In the end the clinic had done all the tests they thought relevant so I went to a private clinic to see if they offered any additional testing. So I was screened for all manner of things and the only test to come back positive was gardnerella. I know my local clinic doesn't screen men for this because (apparently) there's no benefit in treating men, it actually says that on their site.

Finally my questions are (a) could you expand on why screening men may be seen as pointless, (b) given every other test is negative would it be safe to assume gardnerella is a likely cause of my symptoms, (c) given I've now had 3 months of these symptoms would I require a more intensive treatment regime? I believe typically in the UK treatment is a single, large dose of metronidazole but this appears to be for more "superficial" infections.

Thanks.

[anouchka]

A related discussion, why not treat gardnerella in men if they show symptoms and a postive test? was started.

[bonzauk]

Thankyou, you've been a great help.

[Edward W Hook, MD]

If re-evaluation shows no white blood cells in a urine specimen or gram stain of secretions from your penis, then the symptoms are unlikely to be due to STD  They are likely to resolve withtime.  In the interim, having been treated and re-evaluated, you can be comfortable that you are not infectious for sexual partners.  Beyond that, further work up is unlikely to be fruitful.  EWH

[bonzauk]

Thanks for the response - that helps greatly. I did actually have the azithromycin dose, they treated pre-emptively.

Out of interest given I've had all the tests at least three times (all negative as noted before) what avenues would you suggest a re-appraisal would follow? Both clinics are confident I'm STI free (other than the Gardnerella and I hear what you've said about that) - would\could there be other bacteria I contracted that wouldn't be identified on a typical STI screen that could explain the symptoms?

Thanks and I promise to try not to badger you further.

[Edward W Hook, MD]

Gardnerella is a normal component of the bacteria present in the genital tract.  At one time it was thought to be a cause of a common cause of vaginal discharge in women now called bacterial vaginosis however more recently its role in causing discharge (in men or women) has been disproved.  Treatment of gardnerella has not been shown to benefit persons found to have it.

The problem you describe sounds like non-gonococcal urethritis, the most common cause of urethral discharge in men.  Recommended treatment for NGU is either doxycycline 100 mg twice daily for 7 days or a single 1.0 gram dose of azithromycin.  About 85% of men treated with either regimen get better.  The others may need re-appraisal and retreatment.

As for your questions:

1.  See above.  Most would no longer have tested for it.
2.  No
3.  You may need re-treatment. I would suggest you go to one of the very good GUM clinics in the UK.  Metronidazole may be a part of re-treatment if warranted.

Hope this helps.  Good luck.  EWH