STD testing and antibiotics

[uncertain30]

Dear Doctors,

I finished a prescription of Cipro 9 days ago because I was going to the bathroom a lot.  I want to get tested for gonorrhea and chlamydia tomorrow.

1. If my urine test results for both stds come back negative, will this be an accurate and definitive result?

My exposure is: Had brief unprotected sex a few times with a co-worker and we did not use a condom when she gave me oral. This happened on days 3, 4, and 5 after I finished the Cipro treatment. She is African American and from New York. The reason why I am concerned is because I have lately noticed some burning when I urinate- no discharge.  Also when I now ejaculate, hardly any semen comes out.

2. Do these sound like symptoms of an std (particularly not producing much semen at all)?

3. How long do I have to wait from my last cipro (9 days ago) until I can take a test for Gono that will give me an accurate test result that I can trust?

Regards

[H. Hunter Handsfield, M.D.]

NGU is possible but unlikely; dishcarge is the main symptom and it does not often cause burning alone.  My guess is your doctor's "most likely NGU" diagnosis actually meant to include "if it is any infection at all".

The causes of prostatitis is not known, but I agree it is not generally triggered by sex.

You need to stop over-thinking this.  At this point you can be confident you have no STD or any other infection from the sexual exposure described.  Whatever is causing your symptoms is probably non-infectious and not likely to be harmful.

[uncertain30]

Thank you for your additional information. I decided to go see my doctor instead of getting tested for gonorrhea, in light of what you commented and because I never had any discharge.  My doctor as well said that he didn't think that I would have gotten gonorrhea from this and said that he hasn't seen many cases of women with gonorrhea of the throat.  He also said that my timeline of A) having the oral exposures 2 days after finishing cipro and B) being tested for gonorrhea 13 days after the finishing of the cipro would definitely yield accurate test results.  He mentioned that it was most likely NGU; however, he did a dipstick urine test and he said it was "clean."  He wrote me a prescription for doxycycline just in case and told me to take it if the burning continues. Could NGU cause burning without discharge?

For some reason, he also didn't think it was prostatitis either, saying that prostatitis usually occurs from a lack of sexual activity.  How long would it take for gonorrhea or NGU to spread from the urethra to the prostate to cause prostatitis, if not treated for gonorrhea or NGU?  I ask this because, in the event I have caught gono or NGU, I would have caught it about 15 days before starting doxycycline.  Also, the buning is at the start of urination and then kind of subsides as I get toward the mid stream and end of urination. Does that mean anything?

If you can answer these final questions I have, that would be great.  Then, please feel free to end the thread with no further questions.  

Regards and thanks for great advice and for putting my mind at ease.

[H. Hunter Handsfield, M.D.]

I think that's obvious from my reply above.  You could have been tested any time more than 2 days after your last sexual exposure with the partner you are concerned about.  However, I do believe any testing is a waste of money.  The chance of gonorrhea from a few episodes of oral sex is very low, and the chance of gonorrhea without symptoms is even lower.  The odds that both unlikely events happened to you is too low to warrant testing.  But it's your money; feel free.

[uncertain30]

Thank you Doctor for your detailed and helpful response. Does this mean that I can get tested for gonorrhea tomorrow (10 days after finishing cipro) for an accurate result?

Thank you for al your help

[H. Hunter Handsfield, M.D.]

Sorry, I misunderstood the timing; I thought you were taking ciprofloxacin during your sexual exposures or afterward.  The cipro was entirely out of your system within a couple days of the last dose, so it would not delay onset of symptoms or the time to reliable testing.  That interval, for gonorrhea, probably is around 2 days after the last exposure.  For chlamydia it may be longer, e.g. 5 days or so, but as I said, chlamydia is not a significant risk from oral sex anyway.

Your symptoms indeed sound consistent with prostatitis.  They do not hint at prostate cancer or any othe rmalignancy; I believe you found unreliable online information or you misunderstood what you read.  In any case, prostate cancer is rare at your age.

[uncertain30]

Doctor, Thank you for your quick reply. I went to my doctor because I was urinating frequently. He took a urine sample and saw a small amount of white blood cells. I believe he said it could have been a prostate inflamation or something along those lines, and that is the reason why I took cipro.  

I know that you said if I had been exposed to gonorrhea while on cipro, it would have either eradicated or prevented it.  However, I would have been exposed 3. 4, and 5 days after finishing cipro. That is why I was considering testing and trying to see how long I would need to wait after taking the antibiotic.

As you indicated, I think that I can be experiencing prostate related symptoms. In trying to research prostate problems online, I think I may have made matters worse for me.  While I still have burning when I first start to urinate, I also have had upper outer thigh stiffness for about 6-7 weeks and just chalked it up to a muscle pull or something minor and incidental. Then, I saw online that burning urination and upper thigh pain or stiffness can mean cancer, and I have started to think the worst- sometimes the internet creates more headaches! Nevertheless, I am a 35 year old white male, and I'll follow up with my doctor on this.  But I just wanted to give you more of a background and clarify the timeline that I had those sexual encounters after finishing the cipro.

Regards

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

I'm puzzled by your explanation for being treated with ciprofloxacin.  "Going to the bathroom a lot" is not an indication for antibiotics, unless an infection is diagnosed, and an infection is an unlikely cause of such symptoms in men.  And non-STD urinary tract infections are rare in men, especially under agoe 40 or so.  Was this self-treatment or prescribed?  If the latter, what did your examination and testing show?

But perhaps all that is beside the point.  Regardless of the reason for taking ciprofloxacin, there is no point in getting tested for STDs at this time.  Either gonorrhea or chlamydia, if present before treatment or if you were exposed while on the drug, would be eradicated or prevented; a test at this time will be negative for sure, either because you were never infected or were cured.  So I recommend you not spend the money.

Also, it sounds like you had a low risk exposure anyway.  The wording implies you did use condoms for vaginal (or anal) exposure, and only the oral exposure was unprotected.  Chlamydia is rarely if ever acquired by oral sex; and although gonorrhea can be so acquired, cipro is usually highly active against most strains of gonorrhea.   And if you had caught a cipro-resistant strain by oral sex, you would have had more typical gonorrhea symptoms despite the antibiotic, i.e. pus dripping from the penis, which usually would start within 5 days of exposure.  

Further, uncomfortable urination (or frequent urination), without discharge, generally is not an STD symptom.  And no STDs cause variation in semen volume.  It is conceivable you have a prostate gland problem, which could explain the symptoms both before and since taking cipro, but that would require professional evaluation to sort out.  Considering all these factors, you can be very confident you do not have any bacterial STD from the exposures described.

I think those comments cover all three of your questions.  At this point I suggest you stay off any and all antibiotics for a couple of weeks.  At that time, if any urinary symptoms are persisting (or sooner if they get worse), get professionally examined to check out a prostate problem or other explanations.

Regards--  HHH, MD