sticky white discharge questions

Dr:  I want to start out by thanking you for this service.  I think you really help a lot of people with your generosity.  And I'd also like to make you a promise that this is the last time that I will be bothering you.  I feel that I'm starting to mis-use this, as I'm sure you'll agree.  Its becoming clear to me that I have an exiety problem and am looking for some affordable help with it.  

Unprotected vaginal sex 5-6 months ago.  Negative chlamydial swab.  Unprotected oral sex 2 months ago (while on day 2 of 10 days of doxycycline for bronchitis). 4/4 was feeling some discomfort down there, but no pain or burning, just not right.  Clean UA at doctors, but it took them like no time at all. 4/8 glans (glands) around urethra became red, no burning, itching, lumps or bumps.  4/11 chlamydia swab which came back negative.  Figured just irritation, so 4/5 began to apply hydrocotizone.  4/6 Milked penis is morning.  Thick white substance came out.  Sticky and would make strands between fingers.  Continued throughout Saturday, better sunday, present again Monday.  4/14 back to dr. he milked it, looked and said it was normal glandular fluid.  Definitely NOT normal for me, but felt ok about diagnosis for day.  Next day great anxiety and what-ifs are back.  Still no burning or pain with urination, just some slight feelings of warmth in urethra farther towards base.

So what might this be?  I'm worried about accuracy of very quick UA, then chlamydia swab (negative).  I've read about false negatives yikes!  Should I have another?  For gon.?  When can I be assured I'm clean?  Thanks.

[H. Hunter Handsfield, M.D.]

It sounds like urethritis.  Your exposure and antibiotic history make it extremely unlikely you have an STD.  Possible yeast infection, which can be triggered by antibiotic therapy.  But I can't say more; you probably need to discuss further with the provider who examined you.

Good luck-- HHH, MD

[spacy]

Part of me knows I'm not being rational and that more than likely I'm fine.  But I can't quit worrying, and I can't quit obsessively reading everything (on this board and elsewhere).  I just want to know I'm ok and stop bugging you and get on with my life.  I wish I would have been more firm in my disbelief at my appointment when he said its normal glandular fluid...since I had never seen anything like that before.    I've got an appointment for a gon/chlamydia swab.  Should that be enough?  Whats the accuracy?

[monkeyflower]

It sounds to me like your anxiety just has the better of you. You've been repeatedly reassured that you're fine. I would strongly encourage you to talk with your doctor. Not about STDs, but about your anxiety. There are meds you can take, and talking with a therapist is an enormous help. You don't have to live like this.

[spacy]

Your assessment of me is right on the money, and I appreciate your advice and your concern.  So thank you.  Its really quite amazing how anxiety can effect a person.  So yes, a part of me knows this is probably more anxiety than anything else.  But then there's the what-ifs still, and that's what gets me.  The UA seemed way too quick to really tell anything...and how accurate are they anyway?  Also, I'm not sure how much faith I can put in with a visual inpsection and a "this is normal".  If its normal, why haven't I seen anything like that before?  And finally, I've just been reading about false negatives.  I'm just trying to figure out how much confidence I should have in them.

But again, you're totally right...and you can still see my anxiety in my message.  I'm broke, but I'm trying to find counseling that I can afford.  I can't eat, can't work, can't enjoy life.  Its pretty terrible.  But I'm working on it.  My first step is trying to ensure that I'm alright.

Thanks again Monkeyflower.  You're a kind and caring soul.

[monkeyflower]

That's the anxiety causing you to feel this way. There isn't really anything remotely scary about any STD, except maybe HIV. And even that has become pretty treatable :-)

Many counselors will work on a sliding scale, so don't let your financial situation or lack of insurance keep you from getting help. There's also likely a community services board in your area that can work with you. And finally, you might contact your local crisis line. Not only are they great folks to talk to, but can often help you find appropriate services. Anxiety is such an awful feeling, but things can be better for you. Be gentle with yourself. I wish you the best :-)

[spacy]

Yeah, I know it sounds like urethritis.  I guess my main question is about the accuracy of the UA and the swab testing.  How accurate are they, can I trust the results if they come back negative?

And do you really think it prudent to go back to a doctor who looked at the discharge and said I'm ok and sent me on my way?  Seems rather unscientific.  I mean have you ever heard of normal glandular secretions in the urethra being white?

[H. Hunter Handsfield, M.D.]

You might go to your local health department STD clinic.  No other kind of health care provider has more hands-on experience with urethritis and the things that can mimic it.

HHH, MD

[spacy]

Thanks doc.  That's where I got the swab done (county health department).  But I'm still just trying to find out the accuracy of swab tests for gon/chlamydia.  Like if they are both negative, should I feel pretty reassured and move on to another reason for it?  Anyone have any idea?

[spacy]

Went to Planned Parenthood today.  She did yet another chlamydia swab.  Said that they don't do gon. unless chlamydia is positive.  She also did a urethral swab which she looked at under a microscope.  She said she only saw some normal cells...no white blood cells, no anything else.

This is leading me to think that in fact what I saw upon milking my penis (which I know I shouldn't do) is probably indeed some kind of glandular fluid.  Perhaps from the prostate.  I've had trouble with prostatitis before.

[H. Hunter Handsfield, M.D.]

That's a very peculiar strategy, testing for gonorrhea only if chlamydia is positive. Are you sure you underrstood them correctly? That approach would miss most cases of gonorrhea.  In fact, I'm tempted to call it wacko, but don't want to accuse them of that without full facts.  (But I don't think you have gonorrhea.  Perhaps you are right about just looking too hard.  If there isn't enough abnormal discharge to appear on its own, anything you can squeeze out probably isn't important.)

HHH, MD

[spacy]

Yes, I'm pretty sure I heard her correctly.  Though it sounded pretty odd to me as well, I've never heard of that before.  I asked her specifically after the very painful swab, "will this check for gon. too?"  She told me that no, they it will only test for that if the chlamydia test is positive.  She said that is what "they" are now recommending.  Whoever they might be.  Something to do with the high false negative rate of the test.  She said she would have specifically requested it if I was in IV drug user or had contact with pro's (both of which I'm not or haven't).  It didn't make much sense to me at the time, but now I'm wishing I would have said something about it.  But the urethral swab under a microscope that was clean made me feel better.  I'm going to go to a walk-in place first thing Monday morning, hopefully before I urinate at all so they can see the white stuff that is there right away.  Thanks for all the help you have been though doctor.

[H. Hunter Handsfield, M.D.]

The theoretical concern is that the gonorrhea test might be falsely positive, not falsely negative.  But recently published research (by my own research team) shows that even in settings where gonorrhea is rare, a positve test result is reliable.  Even before that, there was no authoritative body (i.e., no "they") who recommend testing for gonorrhea only if the chlamydia test is negative.

That said, if you had no symptoms and microscopy of your urethral swab showed no sign of infection, you can be 100% certain you don't have gonorrhea.

HHH, MD