Recurrance of Symptoms

[concerned238]

In May 2007, I traveled to the UK on business.  3 days prior to the trip, I received unprotected oral for 1 - 2 minutes.  While in the UK I came down with symptoms of frequent urination, burning, itching, and discharge.  I immediately found a clinic, tested, and treated (Zithromax, 1 dose; and second, 4 doses but I do not recall name).  The symptoms subsided after 2 weeks while back in the States and then cleared up.  The clinic called and I tested negative.  Prior to my trip, though, I had been treated with antibiotics for a sinus infection/sore throat unrelated to this incident.

Periodically since that time, I've noticed increase dribble of urine, some discharge but not recurring and little/no pain.

In the beginning of March, I began experiencing similar symptoms all over again.  Urgency to urinate, burning, itching and tenderness of the testicles and even itching in my rectum.  One day of discharge thus far.  It started out mild and was treated for a urinary tract infection.  It seemed to help for a bit but never got better.

I made an appointment with a urologist, explained my situation, and he started me on Levaquin for prostatitus.  And, he has also re-tested me for STDs.  It's important to note that I am involved in a monogamous relationship.  My partner and I do have unprotected sex.  I have not had an encounter with anyone and neither has he.

I'm still waiting for the results, but as my symptoms become worse, I'm becomming increasingly concerned that I do have an STD.  Is it possible to not have completely cleared the original infection from my body last year (I now know I should have been re-tested, I didn't fully understand the risk nor the impact taking antibiotics may have had on my test in the UK) and my partner and I have been sharing this back and forth?

Your insight greatly appreciated and also any specific questions I should ask my doctor during my next visit would be greatly appreciated.

[Edward W Hook, MD]

The treatment for chlamydia and gonorrhea is more than 97% effective.  Thus there is a slight chance that you failed therapy but, since your initial tests were negative, I doubt that this is what you had.  There are also what are called "ping pong" infections in which STDs are passed back and forth within a couple.  Again however, the problem is that your initial tests were negative making this rather unlikely unless I have misunderstood the circumstances.  EWH

[concerned238]

Thank you, Doctor.  

And, out of curiousity, can STDs such as chlamydia or gonorrhea recur if my initial treatment was not completely successful?  Or, could it be possible that my partner was infected and we have shared this for the last several months?

Regards,

[Edward W Hook, MD]

It sounds as though you were treated with antibiotics either before or at just about the time that you received your antibiotics.  If that was the case, then your tests are accurate.  Current tests for gonorrhea and chlamydia are very, very good.  What you may have had was nongonococcal urethritis (NGU) from having received oral.  This syndrome is caused by a wide variety of STDs including chlamydia (which, given negative tests, you are very unlikely to have).  The azithromycin treatment you received is the mainstay of therapy for NGU.

So, then, what is going on here?  Well, although relatively rare, your progressive symptoms are compatible with prostatitis.  While it used to be thought that much prostatitis was caused by STDs, that now appears to be only a minor contributor.  Levofloxacin (Levaquin) is a good starting point for treatment.  Sometimes, it takes several weeks of therapy to resolve.  

It sounds as though you are doing everything right.  Congratulations. Continue to work with your urologist.  EWH