Risk Question

Hello.  Thank you for what you do here.  

I had a lapse in judgment exactly 10 days ago.  I received unprotected oral sex from an escort.  It lasted less than 5 minutes.  I did not ejaculate in her mouth.  That same day I took a 500mg Cipro tablet that I had in my medicine cabinet from a staph infection I got a 6 years ago.  I noticed a slight dull pain in my right testicle 1 day after the encounter that has persisted but no sores or discharges for the first 9 days.  I did get tested for Gonorrhea & Chlamydia 7 days after the encounter.  Both came up negative.  In the past I've already tested pos for Herpes Simplex 1.  Today, I woke up and felt wet down below.  I ran to the bathroom and noticed a tiny discharge from my penis.  At first it seemed to be clear, but when I milked my urethra, I noticed that a little more came out and it seemed somewhat cloudy.  I couldn't be sure if it was clear or cloudy because of the lighting.  I went to speak with the doctor and he took a look and said that everything seemed normal to him, but to be safe he wrote me a script for 2 doses of azythromyocin 500mg to be taken at once.  I've had no other symptoms (sores, painful urination, etc.)  

1)  In your opinion, could NGU be the cause of the discharge since the other test came up  negative?  
2) Is 1 gram of azythromyocin appropriate?
3)  How long after the dose until I can have sex again?  
4) If no sores show up, how long until I need testing for syphilis, or HSV2 if any?  

Thanks for your help!

[Edward W Hook, MD]

The symptoms that you describe are suggestive of NGU.  that you had negative tests for gonorrhea and chlamydia do not rule out the possibility of NGU. The ciprofloxacin that you took would not be expected to prevent or cure it, perhaps because the medication was so old and certainly because a single doe is not sufficient to cure the infection. In contrast, azithromycin, 1.0 gram as a single dose is highly effective for NGU treatment and should resolve your problem if that is what you had.  

In answer to your questions:

1.  Yes it could.
2.  Yes, that it is the correct dose
3.  It is recommended until at least a week after treatment,  In addition, if you have had sex with a regular partner since your exposure, irrespective of her symptoms, she should be treated as well.
4.  The azithromycin is likely to prevent syphilis if you were exposed and it is unlikely that you were.  As for herpes, if you do not develop lesions within 10-12 days of your exposure, you need not worry and do not need testing.

Hope this helps.  EWH

[eesoto]

Thanks Doctor!  Anything else that I should be concerned about besides the common oral risks like gonorrhea/ngu/syphilis/herpes?  Thank you again.

[Edward W Hook, MD]

Nothing more to worry about. EWH

[eesoto]

That's what I thought.  Much thanks to you.

Lastly, tonight I had one beer at 10:30pm.  I took my 1 gram dose of azithromycin this morning at 10:00am.   I didn't even think about it at first but later I started to wonder if that would ruin azithromycin's effectiveness.  Did I ruin the drug's efficacy?

Thanks,

Eli

[Edward W Hook, MD]

No, your alcohol will not prevent the azithromycin from working.  Try not to worry.  EWH

[eesoto]

Dear Dr. Hook.  Thank you for your help.  I have one more question.  Tell me if I should pay again and I will do so.  

Today is 9 days after my treatment with 1 gr azithromycin for a possible, yet unconfirmed case of NGU.  This morning when I woke up to use the bathroom, I noticed a very clear tiny drop of fluid at the tip of my penis.  It looked like pre-***.  I don't know if this is normal to happen to a guy after a "wet" dream or if I should be concerned.  There is no painful urination or other symptoms.  FYI, the first time I noticed a drop of fluid was 9 days after exposure and I was treated on the same day (I couldn't tell if it was clear or somewhat cloudy that morning because of the lighting).

Let me know your thoughts,

Thanks!

[eesoto]

One more thing doc.  I did have a lot  of beer they day/night before because we were camping.  I still have not had sex.  I'm not sure if these facts help.

Thanks

[Edward W Hook, MD]

Have confidence in the azithromycin.  Most men have small amounts of this sort or discharge from time to time, particualrly on awakening.  If it persists you may want to get re-checked but I sincerely doubt that it is anything to be concerned about.  EWH

[eesoto]

I can't thank you enough!!!  I was concerned that the azithromycin didn't work.  You've relaxed my fears!

[eesoto]

I've developed pain around my rectum.  It hurts to pass a stool and I feel discomfort while I walk.  I noticed the pain a few days after my risk exposure and it has gotten a little worse.  During my risk exposure, there was no contact (that I'm aware) with my anal region whatsoever.  Could this be related or do you think it's a separate issue?

Thanks

[Edward W Hook, MD]

This is  a seperate issue.  It is also the end of this thread.  There will be no further answers.  EWH