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STDs (Expert Forum)
Persistent Discharge
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
Persistent Discharge
by confused_23m, Oct 17, 2009 10:15AM
Dear Doctor Handsfield;
I am 23 y.o. heterosexual male from Istanbul,
Everything has started about 2,5 months ago, I had protected vaginal sex and unprotected oral sex with an Ukrainian prostitute. Two days after the encounter I started to feel an extreme burning sensation inside my urethra and on the 4th day morning I had a dense yellow discharge
1g im Ceftriaxone and 4 x 500 mg Ofloxacin. 1 week without symptoms after 1 week again yellow discharge (this time without any burning or discomfort)
1g in Ceftriaxone and 4 x 500 mg Ofloxacin. Again 1 week without symptoms after 1 week again yellow discharge.
2x14 docxycyline. Yellow discharge cleared but there is a sticky cloudy one instead.
1x3 azithromycin, antifungal cream for 1 week, same problems exists.
After 4 cycle of antibiotics, my symptoms are; colorless and sometimes cloudy discharge during the day with a small pain on the tip of my penis. The discharge is yellow in the mornings due to oxidation i guess. I had my urine tested and had swab test for ureaplasma urealyticum, gonorrhea and chlamydia, all negative.
When I urinate to the beaker for the test I have noticed white lines floating in it. I think they are the dead cells from the infection. I don't think that I have urealyticum, gonorrhea or chlymidia anymore although my first infection was gonorrhea because it can be transmitted from fellatio (and the symptoms were pretty alike). I think there are three possibilities in my case;
1. chronic bacterial (due to ngu or gonorrhea) prostatitis - i have no problem in urinating of ab pain.
2. some kind of healing process which is still goin on.
3. HPV, HSV or some kind of yeast or opportunity seeking infection. Although I have no pain in urethra most of the time or any sores.
What might this be ? Will i ever going to be healed. I saw 3 urologist and 1 infectious diseases doctor, no solution.
best regards.
I am 23 y.o. heterosexual male from Istanbul,
Everything has started about 2,5 months ago, I had protected vaginal sex and unprotected oral sex with an Ukrainian prostitute. Two days after the encounter I started to feel an extreme burning sensation inside my urethra and on the 4th day morning I had a dense yellow discharge
1g im Ceftriaxone and 4 x 500 mg Ofloxacin. 1 week without symptoms after 1 week again yellow discharge (this time without any burning or discomfort)
1g in Ceftriaxone and 4 x 500 mg Ofloxacin. Again 1 week without symptoms after 1 week again yellow discharge.
2x14 docxycyline. Yellow discharge cleared but there is a sticky cloudy one instead.
1x3 azithromycin, antifungal cream for 1 week, same problems exists.
After 4 cycle of antibiotics, my symptoms are; colorless and sometimes cloudy discharge during the day with a small pain on the tip of my penis. The discharge is yellow in the mornings due to oxidation i guess. I had my urine tested and had swab test for ureaplasma urealyticum, gonorrhea and chlamydia, all negative.
When I urinate to the beaker for the test I have noticed white lines floating in it. I think they are the dead cells from the infection. I don't think that I have urealyticum, gonorrhea or chlymidia anymore although my first infection was gonorrhea because it can be transmitted from fellatio (and the symptoms were pretty alike). I think there are three possibilities in my case;
1. chronic bacterial (due to ngu or gonorrhea) prostatitis - i have no problem in urinating of ab pain.
2. some kind of healing process which is still goin on.
3. HPV, HSV or some kind of yeast or opportunity seeking infection. Although I have no pain in urethra most of the time or any sores.
What might this be ? Will i ever going to be healed. I saw 3 urologist and 1 infectious diseases doctor, no solution.
best regards.
Doctor's Answer
by H. Hunter Handsfield, M.D., Oct 17, 2009 11:52AM
, Oct 17, 2009 11:52AM
Welcome to the STD forum. I'll try to help.
I agree gonorrhea was probably the initial problem, acquired by the unprotected oral exposure. Chlamydia is unlikely, since it rarely infects the throat and therefore is rarely transmitted by oral sex. It is unknown whether M. genitalium or U. urealyticum can be transmitted by oral-genital exposure, but probably not. But in any case, any of those 3 organisms should have responded to the antibiotics you have received.
Trichomonas explains a few percent of cases of NGU, especially when symptoms persist after treatment. However, trich is not known to be acquired by oral-genital exposure. Nevertheless, the standard recommendation is that antitrichomonal therapy (metronidazole or tinidazole) be included in treatment for persistent/recurrent NGU, so you should discuss this with one of your 4 doctors.
But most likely there is no continuing infection of any kind. Despite many research studies that have attempted to sort out the cause of persistent symptoms after repeated antibiotic therapy, none have found any infectious cause of the problem. Although it is possible there is some as yet undiscovered microbial cause, the most likely explanation is that some (most? all?) such cases are due to some sort of ongoing irritation or immunologic reaction that is not directly infectious and therefore can never respond to antibiotic therapy. Whether such problems are centered in the prostate or urethra is unclear. Viruses (HSV, HPV) almost certainly are not the explanation.
Of course it is also important that any sex partners since the commercial exposure also be treated, if you had sex afterward and they have not been treated.
Perhaps the most important take-home message is that this problem appears to be entirely harmless. There is no indication that it results in complications of any kind, either in affected men or their sex partners. When I have patients like you, my standard advice is to just sit tight and not worry about it. Over time, my experience is that in most men the symptoms gradually fade away.
Bottom line: Discuss the possibility of trichomonas and treatment for it with one of your several physicians. But don't get your hopes up; I don't expect it to make any difference. Assuming it does not, just go forward with your life with no worries about it, in the expectation that the symptoms probably will clear up over time. And don't worry about continuing unprotected sex with current or future partners.
Good luck-- HHH, MD
I agree gonorrhea was probably the initial problem, acquired by the unprotected oral exposure. Chlamydia is unlikely, since it rarely infects the throat and therefore is rarely transmitted by oral sex. It is unknown whether M. genitalium or U. urealyticum can be transmitted by oral-genital exposure, but probably not. But in any case, any of those 3 organisms should have responded to the antibiotics you have received.
Trichomonas explains a few percent of cases of NGU, especially when symptoms persist after treatment. However, trich is not known to be acquired by oral-genital exposure. Nevertheless, the standard recommendation is that antitrichomonal therapy (metronidazole or tinidazole) be included in treatment for persistent/recurrent NGU, so you should discuss this with one of your 4 doctors.
But most likely there is no continuing infection of any kind. Despite many research studies that have attempted to sort out the cause of persistent symptoms after repeated antibiotic therapy, none have found any infectious cause of the problem. Although it is possible there is some as yet undiscovered microbial cause, the most likely explanation is that some (most? all?) such cases are due to some sort of ongoing irritation or immunologic reaction that is not directly infectious and therefore can never respond to antibiotic therapy. Whether such problems are centered in the prostate or urethra is unclear. Viruses (HSV, HPV) almost certainly are not the explanation.
Of course it is also important that any sex partners since the commercial exposure also be treated, if you had sex afterward and they have not been treated.
Perhaps the most important take-home message is that this problem appears to be entirely harmless. There is no indication that it results in complications of any kind, either in affected men or their sex partners. When I have patients like you, my standard advice is to just sit tight and not worry about it. Over time, my experience is that in most men the symptoms gradually fade away.
Bottom line: Discuss the possibility of trichomonas and treatment for it with one of your several physicians. But don't get your hopes up; I don't expect it to make any difference. Assuming it does not, just go forward with your life with no worries about it, in the expectation that the symptoms probably will clear up over time. And don't worry about continuing unprotected sex with current or future partners.
Good luck-- HHH, MD
Post Comment
My urologist said that if I had trichomonas, it would have been detected in the microscopic evaluation of my urine and discharge.
Almost 5 weeks have passed over my last antibiotic cycle and still waiting for the symptoms to stop.
My observation is that symptoms did give a response to each antibiotic cycle I had but reoccurred in a weaker way.
My current symptoms are;
1. A little tingling sensation inside the tip of my penis, this happens like 10 times a day totally but it really is not normal and never happened to me before all these.
2. Colorless and sometimes cloudy and sticky discharge (looks like precum) during the day, and in the mornings it is a bit yellowish and white. Anyway my discharge had reduced very much but didn't stop completely. It only comes out if I milk my penis and comes in only one single small drop. There is usually one small circle of wet stain on my underwear. The yellow color makes me worrying.
3. Although urination during day time has no symptoms, in the mornings after the first urination of the day, I feel a piercing pain inside my urethra for a minute or two and then it disappears.
Do you think that it is worth to have a prostate massage and make a culture of it to see if any thing exists ?
No sores, no constant pain, no visual change in and on my penis.
This situation does not affect my life and I can live like this.
But just want to know if there is a problem or not and take care of it.
You told me to go forward with my life and the symptoms will fade away in time.
How much time will this be ? Can it be like 3-6 months ? 1 months wasn't enough as much I see. But if you say that I have to wait longer I will wait without receiving any treatment.
Best Regards.
In any case, the proper response to persisnt or recurrent NGU -- which most likely you have -- is to use antibiotics as I suggested above. Or you might indeed have prostatitis, which might require different drugs. It might take a couple of tries, and metronidazole or tinidazole, for trichomonas, should b e among the drugs used at least once. In the meantime, this is unlikely to be harmful, so don't be overly worried.
Massage is no longer considered usefult herapy for prostatitis.
That's all I'll have to say. Good luck.
By the way I even read the book 'Medical Clinics of North America, 1978 in which you are the author of the urethritis part. It is amazing to have a reach to such an experienced doctor via medhelp. So I am so grateful.
Anyway, I really appreciate and thank you for your kind help doc.
I will follow your advise.
Best Regards.
I couldn't visit my urologist yet due to my business trip, got an appointment for Saturday though.
I have recently noticed one small red bump (almost 1mm) and I think there might be more of them as it goes through my urethra.
Do trichomonas cause such red lesions ?
Or, can that be urethral HPV ? Can HPV's cause colorless discharge and urethritis ?
And maybe urethral HSV ?
No other lesions, abnormalities on my penis.
It's been 3,5 months since my urethritis started...
Any clarification would be really great.
Best Regards.