Type of STD

Hello Dr's.,

I first noticed my symptoms in Thailand on July 4th, 2 days after my encounter. I felt a burning inside my penis and several days after that noticed a slight redness around the opening. Aside from the mild burning, I had no other visible symptoms; no discharge, blisters, bumps, etc. It also did NOT burn when I urinated.

In Thailand and no where near a hospital, I was unable to see a doctor. I found a pharmacy (antibiotics are widely available over the counter in Thailand) and was given Amoxicillin. I took 2000 mg of Amoxicillin for the first dose, and then 1000mg a day for the next 9 days. No improvement.

I then purchased Norfloxicin. I took 800mg as the first dose, and then 800mg per day for the next 9 days. I did notice marked improvement. However, my symptoms did not completely disappear.

I got myself to a local STD clinic on July 23rd. I explained that I had been in Thailand, and that I was still on Norfloxicin. The clinician told me to finish taking the Norfloxicin. I was then given a urine and blood test, and told to return to the clinic for my results and treatment a week later on July 30th.

Upon my return to the clinic, I was taken into a room and given my test results. I tested negative for Gonorrhea, Chlamydia, and Syphilis (the blood test).

As of today, July 31st, I still have a burning sensation in my penis that is most definitely not normal. Ejaculation does aggravate the burning sensation greatly. Otherwise, do not have any visible symptoms, and it still does not burn when I urinate.

1. I have read that there is/are, antibiotic resistant strain(s) of Gonorrhea in Thailand. Would all strains of Gonorrhea show up in testing here, or, is it possible they missed it for that reason?

2. Did my taking Norfloxicin during testing mask the STD symptoms in my urine?

3. Can you recommend a treatment plan or course of action? Again, visiting my primary care physician is really my last choice

Thank you, RoyV

[Edward W Hook, MD]

While I understand your decision to take antibiotics when it was difficult to get medical advice and while such a course of action often does help in situations such as yours, when it doesn’t it makes things difficult to sort out.  I'll do my best to help with advice but the true resolution will have to wait until you've been off of antibiotics for at least a week and tested some more.  

Burning on urination is one common symptom of urethritis which is due most often to gonorrhea, chlamydia or a non-specific infection called nongonococcal urethritis (NGU).  The first two diagnoses are made by specific testing while the latter is diagnosed on the basis of the presence of white blood cells in a swab taken from the penis or the initial portion of a voided urine specimen.  Your antibiotic treatment may have masked what was happening.  While there is no evidence of meaningful antibiotic resistant chlamydial infection, gonorrhea resistant to either amoxicillin or norfloxacin are well described.  In answer to your specific questions:

1.  See above, possible.  Typically however, when the antibiotic does not work the tests remain positive although they can suppress evidence of infection.
2.  Possibly as well.
3.  What to do.  I would stay off of all antibiotics for a week.  If you develop penile discharge during that time you can get tested sooner.  If not, after a week, go get tested again (the STD Clinic is fine).  You should be tested for gonorrhea, chlamydia and white blood cells in your urethra (NGU).  If these are negative on only other common possibility is that  you might need treatment for trichomonas and should discuss this with the STD Clinic health care provider.  

Finally, I would be remiss if I did not point out that sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turns leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation.  

Hope this helps. EWH