Persistent Urethritis aggravated by antibiotics

[polik]

Hello,
I had unprotected sex (oral and vaginal) on 4/10 and ~8 days later noticed a clear urethral discharge. It is overt before and after I urinate. After the last drop of urine dribbles out, the discharge begins forming a viscous globule that doesn’t shake off easily yet is easily wicked into a piece of toilet p. Also, it evaporates quickly as it never leaves a stain on my boxers. It has been very intermittent.

So I was Rx’d doxycycline b.i.d and given a swab to test for chlamydia because no discharge could be milked. I was impatient and was told to swab before starting the Rx so I just swabbed inside the urethral opening. It came back as normal flora but the discharge persisted.

2nd visit: I was given a 1 g Azithromycin and 1 g Tinidazole. I noticed the discharge became more profuse when under antibiotics. I felt it dripping almost constantly throughout the day.

3rd visit: the doctor decided to treat it as gonococcal and gave me IM ceftriaxone. This had the same effect as before where the discharge noticeably gets worse (more flow, less intermittent but no change in color/consistency). I had no systemic symptoms, no urethral burning or tingling), no difficulty urinating. I did notice right-sided non-tender, movable inguinal lymphadenopathy in terms of a palpable node that can exert pressure when lying down but that has passed.  

I spent ~ a week waiting because I know urethritis will resolve with time and the antibiotics so far seem to cover the likely culprits. The discharge became barely noticeable except before and after urinating.  Last visit: I was given ciprofloxacin (1 g b.i.d.) for two weeks. Ever since starting, the discharge has been constant with the only respite being before taking the day's first dose. I'm ~ halfway through the Rx and want to know whether I should stop. Is the discharge a sign of the colony’s last throes? Are the antibiotics wiping out commensals that have been keeping the infection subacute? I would love any insight and advice.

[Edward W Hook, MD]

Your terminology suggests that you have a medical background so I will be as direct as possible.  The discharge you are experiencing is not an STD.  While the onset of your symptoms is compatible with an STD-related urethral discharge (gonorrhea, chlamydia or non-chlamydial NGU) you have now been treated a total of 3 times with therapies which would assure that, were your infection an STD, it would have been cured.  At this time you have nothing to worry about, STD wise.  My guess is that this is either some sort of physiological variation or nothing at all.  It is not an STD, it is not a risk to future sex partners and it is not something to worry about - this has been studied and I say this with confidence.  If the discharge becomes problematic, you could go see a urologist but I worry that sometimes when our clients go to urologists they do what they are trained to do - procedures and more treatment, each of which might put you at risk for complications from un-needed therapy.  I am not sure this is in your best interest.

Hope this helps.  This is not an STD.  EWH

[polik]

I am a 24 year old male. I apologize for the odd syntax but the 2000 character limit required some unconventional edits. -polik

[polik]

So, is it safe to stop the cipro?