Negative Test, Symptoms Persist

[samfloodinchicago400]

A few weeks ago, after unprotected intercourse, I started having itching and discomfort at head of my penis.  Very slight discharge. No pain when I urinate, just itching and discomfort. Urine dribbles out after finishing.  I had a battery of urine and blood STD tests. All negative.

Dr. thought it might be prosthititis. Took Cipro for 14 days.  No change in symptoms. Went on Azythromiacin for 5 day dose.  No change in symptoms. I finished the Azythro last week. I understand that it continues to work for a few days after the last dose. I went back to the Dr. this weekend. Left a urine sample and it came back negative for bacteria; culture was also negative. On Monday I peed on the home UTI test stick (Positive leukocytes and negative nitrites). Dr. thinks I am bacteria free and it will pass. Dr. told me home test is not as reliable as the lab test.

My sex partner has no signs of discomfort.  

I am worried about Mycoplasma Genitalium or Ureaplasma. I am in the Chicago area and am not aware of a physician or lab in the Chicago area that will screen/test for MG or UU. Lab Corp advertises a test, but it does not appear to be a PCR test. I am aware of the lab at UAB, but samples must be submitted by a physician. My Dr. is not going to go ahead and order the test. I am at loss to explain the different results between the Lab and home test.  The lab test sample was given midday and the home test was first urine of the day?    

If I had MG or UU, would it always show up as positive for bacteria on a urine test even though they are not able to idenitfy the specific type of bacteria?

I may just be working this up in my mind and Cipro and Azythro worked left the symptoms behind (the original test did not culture the bacteria).  

He put me on Bactrim for 7 days.  He does not think it will have any effect.

I am ready to ask for Avelox, but if it is not MG, it is a waste with alot of potential side effects. Any input is appreciated.  

[samfloodinchicago400]

Thanks again for your insight.  

[Edward W Hook, MD]

Like your doctor, I would trust the lab test over the result obtained by peeing on a urine strip.

The prior azithromycin will not effect things, other than having possibly cured an STD if present (which you know I already doubt).

I am not familiar with Lab Corps test for MG.  You would have to ask them.  There are reliable MG test kits which are used by many commercial labs.  Most experts however use them only for research since, as i already mentioned, the meaning of a positve test is contraversial.

If your symptoms have not changed, I see no need to wait to test.  

I think you are wasting your time. EWH  

[samfloodinchicago400]

Thank you for the response.  A few folow up questions. I am going to follow up with my Dr.  

I am concerned that the home UTI test still indicates positive for leukocytes, while the lab urine culture shows up negative for bacteria.  Could be a false positve? or the lab test could be a false negative?  

Would the fact that I just finished the Azythromiacin impact the lab urine test?

Also, if I were inclined to have a urine test for MG, are you familiar with the test offered by Lab Corp and whether it is reliable?  I am not worried about the cost, but want to be certain that it is reliable.

If the test is reliable, should I wait at least 1 week after having taken the last dose of Azythromiacin before testing?  That would be this Friday.  

Thanks again for the helpful information.

[Edward W Hook, MD]

Welcome to our Forum.  I think the internet may be fueling your concern.  Your initial symptoms, itching and discomfort at the head of your penis are not suggestive of a typical STD but are typical of what persons tend to notice when they pay a lot of attention and look for possible symptoms.  Most men have a small amount of normal urethral discharge.

Irrespective, you now have been treated repeatedly with antibiotics without any change in symptoms, making STDs and prostatitis still less likely (prostatitis might not be cured by the therapy you have had but it would have gotten better).  

Concerns about Ureaplasma and Mycoplasma genitalium are probably misplaced as well. the role of Ureaplasma as a cause of STD symptoms is doubtful- Ureaplasma is normally present in the genital tract so testing for it and finding it does not mean your symptoms are related to it.  As for M. genitalium, its significance is also debated and azithromycin cures the majority of cases.  Researchers who work with these organisms emphasize there important but most experts in the field are far less sure that this is the case.  If you were my patient I would evaluate you with a urethral smear for WBCs.  No WBCs, I would not treat you.  If there were WBCs present I might be willing to try moxifloxacin despite being skeptical that you have any infection.

I hope this helps.  I think you need to work with your doctor on this.  he sounds well informed and I agree with what he has done thus far. EWH