multiple elements

[helpmeplease12121212]

I am a male, 29 years old.  About 6 weeks ago I had unprotected sex with a female I have had unprotected sex with in the past. Five weeks after I noticed some discharge from my penis and maybe some slight tingling and mild discomfort, but nothing painful and no pain / irritation when I urinated. I went to my doctor, he tested me for herpes, chlamydia and gonorrhea and at that time gave me an injection (I cannot remember the name) and a prescription for doxyclinne, 100mg, twice a day for ten days. About three days later he called and informed my tests were positive for chlamydia, negative for gonorrhea and positive for HSV-2 (2.11 with the IGG test). I took the entire 10 day prescription of the doxyclcine but the discharge did not stop. I went back to see my Doctor after the ten days was up and he told me it was too soon to test and to come back in two weeks (which is today) he did not prescribe me anymore medication. The discharge has not stopped (so in total, it’s been going on for about four weeks now), it’s usually noticeable in the mornings when I wake up but later in the day when I press my urethra I can see some slight discharge as well. Aside from the discharge I do not think I have any other symptoms (no soars, no lesions, no real pain or discomfort and no irritation when I urinate).  
Here are my questions:
1. It seems like the dosage of medication I took was fairly strong (e.g., ten days, twice a day), does chlamydia typically take more than one course of antibiotics to clear up?  Do you think the chlamydia has been cleared up but this continuous discharge is actually being caused by the HSV-2?.

2. When I see my Doctor is there anything specific I should mention to him to consider about a future course of medication/treatment?

[Edward W Hook, MD]

Welcome to the Forum. Your symptoms 6 weeks ago are typical of urethritis due to chlamydial infection.  The therapy you received would be expected to be curative for about 98% of persons with chlamydial infection, at least, if taken as prescribed.  Presuming that you partner was treated and that you have not been re-exposed to another untreated partner, it sounds like your symptoms are improved but not totally resolved.  There are three possible explanations for this.  The first is that you failed therapy. This is very unlikely.  The second possibility is that you may be among the 10% of men who continue to have a small amount of non-infectious urethral discharge following treatment for NGU/chlamydia.  If this is the case, a repeat test should be negative and then you should stop worrying- they symptoms will go away over time.  The final possibility is that you are examining yourself too closely and, as a result,. you are detecting the small amount of normal urethral secretions which is present and of no consequence in most men.  My guess it is the second or third possibility and that a repeat test will be negative.

As for the HSV.  I suspect that is something you may have had before and not know which may be unrelated to the symptoms you are experiencing.  you may wish to discuss management of this however with your doctor using chronic suppressive antiviral therapy.  You can find may discussions of HSV therapy on this site and get much additional information at the ASHA web site (disclosure, both Dr. Handsfield and I are on the AHSA Board of Directors)

Hope these comments help.  Beyond perhaps a repeat test and examination by your doctor, I see little else to do for the persistent possible discharge.

Take care.  EWH