Recurrent Gonorrhea after treatment?

[greentea79]

Hello Doctor,

I posted several months ago regarding what I thought was a case of NSU that eventually revealed itself to be Gonorrhea following a test. I was prescribed cefixime and azithromycin by the doctor, went back for a test of cure a week later and was found to be negative.

Now, this week after 3 months had elapsed since my exposure, I went back to the clinic for a full panel STD check. I was negative for all except for Gonorrhea, which was detected with the same gram stain testing that had declared me clear a week after my treatment. Since my test of cure cleared me for gonorrhea, I had only had protected sex, with someone who I know is uninfected as they have been tested. so, this result came as a whopper of a shock. I had had no symptoms in the last weeks other than some odd tingling, but no discharge. Now, 3 days following ceftriaxone treatment, I feel more of a 'rawness' or dull burn around my foreskin.

What I would like to know is: in your professional opinion:

1. do you think the cefixime + azithromycin might have been effective enough to prevent the gonorrhea from being picked up in the 1 week test of cure, but not enough to fully eradicate it, allowing it to make a slow comeback?

2. Is it more likely that the test of cure swab sample taken was a false negative?

3. Was my initial treatment with cefixime detrimental to my prospects for recovery from ceftriaxone + azithromycin (which I received after the last diagnosis)? i.e. could that have aided the virus to evolve more resistance to that branch of antibiotics?

Thank you for your time and attention

N.B. I live in southeast asia. hetero male

[Edward W Hook, MD]

As I said, this is a rather strange occurrence.  I suggest a second opinion and better testing than a mere gram stain.  EWH

[greentea79]

Thanks for your answer Doctor. Yes it has been 100 percent condom use and I do not think I have been exposed again. My 'test of cure' was indeed just a gram stain if I am not mistaken. This was at a private clinic in a southeast Asian metropolis. I prefer not to reveal the city for anonymity.

I am scheduled to go back to the same clinic for another test which I presume will be a gram stain, as well as to receive a vaccination for hep B, as they said I lacked antibodies. However, after looking at my records, I can see that I have received three vaccinations for hep b in the last 3 or 4 years.

Should I change clinic? I trust the doctor, who is German.However you have correctly put me in doubt of their lab's accuracy.

Is it also possible that the latest gram stain was a false positive? What is more likely? They said I had elevated WBC from the swab too.

[Edward W Hook, MD]

Welcome back to the Forum. I remember your prior post and there were atypical elements to your post and that continues to be the case as this moves forward.  For you to have failed treatment with cefixime and azithromycin is unusual but not unheard of but for you to have a negative follow up test ( I presume this is a laboratory test such as a culture or nucleic acid amplification test) and then with 100% condom use to subsequently remain asymptomatic but have a positive follow-up test is virtually unheard of. Something is wrong here. Either you have been re-exposed or the tests are wrong.  I think you need a second opinion and testing from a different lab.  Can you tell me where this is all occurring?  

With regard to your specific questions:
1. do you think the cefixime + azithromycin might have been effective enough to prevent the gonorrhea from being picked up in the 1 week test of cure, but not enough to fully eradicate it, allowing it to make a slow comeback?
Possible but not likely.

2. Is it more likely that the test of cure swab sample taken was a false negative?
I am having trouble putting things together for you. If the only follow-up test you had was a Gram stain, then it certainly could have been falsely negative. TOCs should be done with biological tests such as culture or nucleic acid amplification tests.

3. Was my initial treatment with cefixime detrimental to my prospects for recovery from ceftriaxone + azithromycin (which I received after the last diagnosis)? i.e. could that have aided the virus to evolve more resistance to that branch of antibiotics?
No, your initial treatment would not reduce the likelihood of successful treatment with ceftriaxone.

As I said above, I think you need a second opinion and repeat testing.  EWH