questions about testing and curing

[jackruby1973]

Greeting doctor,
I have a couple of specificd questions that perhaps you can address.  Yesterday I went to our community health clinic because of some very slight symptoms of urethritis.  Very slight discomfort with urination sometimes (no burning or stinging and down towards the base of the penis), and also sometimes in the morning I can milk a cloudy whitish fluid that looks like semen out.  It never dishcharges on its own, and any fluid I can produce by milking for the rest of the day is clear.

Over the last couple of weeks I have had three swab tests for chlamydia all of which were negative.  Also, one for gonorrhea that was negative.  I asked the nurse practitioner how much I can trust these negative swab results.  She hesitated and said, "well I shouldn't say anything.." indicating to me that she does not always trust the results.  But she indicated that 3 negatives are pretty good, and the one g.c. is good (she says she has only seen 1 case of g.c. in all her years running the clinic).  She also gave me a choice of "just in case" medications: 2g of zithromax taken once, or 100mg doxycycline, 2x a day for 7 days.
1. Any comments on the accuracy of swab testing in general?  I understand it varies depending on swab technique, etc.
2. Are those 2 medications a good choice for treatment of the possibilities?
3. Nurse said that doxy is not effective against g.c.  But all the doxy websites indicate that it is, at the same dosage used for chlamydia.  Any thoughts?
4.Recently started seeing woman who is 4 months pregnant.  Given results and antibiotics, should I be ok

[H. Hunter Handsfield, M.D.]

The issue isn't so much whether a specimen is collected by swab or not; it's what test is done on the swab specimen.  The accuracy of those tests ranges from >95% to ~70%.   You can be pretty certain you don't have gonorrhea or chlamydia.  If you do, the treatment you received will have cleared it.  Doxycycline or azithromycin is only ~90% reliable for gonorrhea (neither is recommended  as standard therapy)--but together they are >99% effective.  Both drugs are excellent for chlamydia.  In any case, since you apparently had neither infection, you probably don't have anything that presents danger for your partner, pregnant or not.

In response to your follow-up post, yes, conceivably your symptoms could be due to prostate infection.  You are also right that prostadynia (prostate pain without infection, also called male pelvic pain syndrome) is more common than real prostatitis.  But if the sense of pain and swelling persists after your current treatment, get it checked out.  Prostate infections generally aren't sexually acquired or transmitted.

[jackruby1973]

Ran out of space, sorry. Last question:

5. The last couple of days it has felt like I've been sitting on a golf ball and I have also been having an achy lower back.  Could this be related?  Or perhaps prostatitis, which I have dealt with numerous times in the past (some urologist thinks its only prostadynia)?  Or perhaps unrelated?

I thank you very much.

[jackruby1973]

Thank you very much Doctor.  Your advice is invaluable.  I have two more questions if you get the time to answer them.

1.  Say I took the 2g zithromax exactly two weeks ago, and started the doxycycline today.  Would that still put me in the category of >99% effective?

2.  I understand that 2g zithromax isn't on list of standard things to proscribe.  But I always figured from my reading this was because of the potential stomach side-effects of it.  I have read that 2g is just as effective as other things.

Thank you again.

[HYPO20]

M.D. HHH-  I had to use an old thread because I could't get my question in any other way.  7-8 years ago I was naive and gave oral sex to 3 different guys. 1 of them I did it several times. Because I did not know what I was doing they never came in my mouth that I remember. I'm still stuck on it and disappointed in myself. About 4 years later I started dating my boyfriend of 3 1/2-4 years. My boyfriend is the first person I have had intercourse with and I want to be monogamous with him. But I am afraid of what could have happened. Since I started dating him I've had 4-5 pap smears(the last one included gon. and chyl.)and a blood test for HIV,syphillis,and hepatitus (hepatitis).  They were all clean. 1.My main question is: Because I have been tested vaginally and by blood for STDs, do I need to get oral STD testing done?  I talked to a nurse and she said that by now if I had an oral STD it would have transfered to my vagina. 2. Do STDs run in the blood? If not, how/why would they transfer to my vagina? 3.Is 7-8 years long enough for any symptoms? 4. In one forum you said you can not get STDs from hand-genital, but can you get STDs from genital-hand?

[H. Hunter Handsfield, M.D.]

jackruby:

1) Yes.

2) 2.0 azithromycin often works for gonorrhea, but that entire class of antibiotics (macrolides) is especially likely to actually induce antibiotic resistance in gonorrhea.  The next iteration of CDC's STD treatment recommendations is likely to have a strong statement advising against using azithromycin for gonorrhea in any dose.  Gastrointestinal intolerance also is a factor, but not the main one.

HYPO20:  Sorry, you'll just have to keep trying to post as a new thread.  New topics on old threads a) can't be indexed by keyword etc, ie the questions and responsible aren't searchable; b) get confusing to forum users who assume any particular thread has a single topic; and c) the limit on new posts in all MedHelp forums is intended to protect the time of the experts who respond.  Keep trying to post as a new question.  Sorry; hope you understand.

HHH, MD

[jackruby1973]

At least one of the swab tests I had done I saw "GenProbe" on the swab.  I can imagine that all three were the same, though they were done at three different places.  The final test...the only one for both g.c. and chlamydia was one I don't know.

Either way I feel pretty positive about the 3 negative chlamydia tests.  I imagine the odds of three false-negatives would have to be huge.  Its the g.c. I wish I had some back up on.  Though I guess I have to trust my relative lack of symptoms, my exposure (receiving oral) and my antiobiotics.

Thanks for everything.