Thank you for your advice Dr. H. I appreciate your objectivity as well as your sensitivity to polemic posts by forum crusaders (let he who is without sin cast the first stone, eh?).
Anyhooz, I arrived at the hospital yesterday and managed to see a young but quite knowledgable doctor. After asking quite a few detailed questions he requested a urinalysis and a Gramm? stain test. After the results came back negative for gonorrhea, he concluded that most likely what I dealing with was a chlamydia infection that was not dealt with by the "specialist's" treatment regimine. You were correct in assuming that I had been previously been treated with Ceftriaxone (saw my chart while there). Is chlamydia immune to both Ceftriaxone as well as Ciprofloxacin?
So, I am currently on doxycycline (100mg 2xdaily) for a week and have my fingers crossed. As for why I decided not to take the Flagyl, chalk it up to my own stupidity I guess. I did mentioned my breach of prescribed treatment to the doctor. Without making a statement directly contradicting the initial doctor (a huge cultural no-no here in Thailand, as the 1st doctor is his elder) he did indicate that he did not believe that medication was necessary.
Thanks again.
One more personal or moralistic comment on this forum, like the one you made to CSunday (which I deleted) will get you banned from any comments on any MedHelp forum.
HHH, MD
I cannot compete with the opinion of a provider who actually has examined someone, especially a provider who is knowledgeable about STDs.
1) As speculation, it sounds like you might have recurrent NGU, which is a fairly common problem. For quite a bit more detail, see my response in the thread "Recurrent Urethritis" just a couple of days ago. It can be inconvenient, but is never serious. If the doc you saw really is an STD specialist, he will be very familiar with this problem and might prescribe more prolonged antibiotic therapy.
Another possibility is trichomonas. Your original provider undoubtedly prescribed metronidazole (Flagyl) for a reason. Why didn't you take it? Perhaps he even diagnosted trich; or perhaps he is aware that it's particularly common in men he sees with gonorrhea? Or in sex workers in that area of town?
2) Some gonorrhea strains are relatively resistant to antibiotics, but almost never to the treatments you received (my bet is the injection was ceftriaxone, to which resistance is extremely rare or nonexistant).
3) You can be sure the original gonorrhea didn't pop up again. But you could have been infected at the same time with bacteria that can cause NGU.
4) I cannot comment on your condom removal technique. But most likely you were fully protected against new infections.
5) No sex is obvious--to avoid any risk of reinfection during treatment. Avoiding alcohol probably is a myth, the legacy of old theories (50 years ago and more) that alcohol and spicy foods could cause NGU or interfere with antibiotics. Today it is understood that you have to not get so drunk you forget to take your medications, but that's about it.
6) I never make a specific diagnosis or recommend treatment. Those require professional evaluation in person. Make sure your provider knows you didn't comply with the original treatment (metronidazole).
Good luck-- HHH, MD