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tests aHaving symptoms, but re negative. What could it be?
Hi, doc hopefully you can give me some insight cause right now I'm totally lost...
I'm a 27yo bisexual male. I do have a history of STDs as I caught both chlamydia and gonorrhea several years ago.
About 4 weeks ago, I had unprotected oral and anal sex, both insertive, with a semi-regular male partner. On the morning of 9/23 I started to notice discomfort in my urethrea and upon miking my penis I got a slightly cloudy discharge. I went to a local clinic to get tested. While there they brought my results from when I was there in March after an oral encounter with an unknown male partner a few weeks prior and said I tested negative for gonorrhea, chlamydia and syphilis although I had symptoms which went away after treatment...
They did a swab of my urethrea and gave me a gram of Azythromycin, which I took immediately, and told me to come back in two weeks for my results. After a week things seemed to be back to normal, but last Wednesday (10/7) upon waking up I noticed a stain in my underwear which after milking my penis produced a signifigant ammount of discharge which was fainly yellow in color. Knowing my results were tomorrow I decided to wait until then to figure out what was wrong.
Upon returning to the clinic, they tell me my test results for gonorrhea and chlamydia were again negative! I was stumped and told them of my discharge so they did another swab and this time treated me with a shot of what I believe to be ceftriaxone and another gram of azythromycin. They didn't want to at first as my last two tests came back negative so they are thinking it's another problem not STD related. I go back for my results at the end of the month.
It's been 5 days since my treatment and I'm still having a fair ammount of discharge, especially in the morning upon milking my penis, and from time to time a tingling sensation or dull ache in my urethrea. no pain or discomfort while peeing though. Is it possible that I could've gotten two false positive tests?
I'm a 27yo bisexual male. I do have a history of STDs as I caught both chlamydia and gonorrhea several years ago.
About 4 weeks ago, I had unprotected oral and anal sex, both insertive, with a semi-regular male partner. On the morning of 9/23 I started to notice discomfort in my urethrea and upon miking my penis I got a slightly cloudy discharge. I went to a local clinic to get tested. While there they brought my results from when I was there in March after an oral encounter with an unknown male partner a few weeks prior and said I tested negative for gonorrhea, chlamydia and syphilis although I had symptoms which went away after treatment...
They did a swab of my urethrea and gave me a gram of Azythromycin, which I took immediately, and told me to come back in two weeks for my results. After a week things seemed to be back to normal, but last Wednesday (10/7) upon waking up I noticed a stain in my underwear which after milking my penis produced a signifigant ammount of discharge which was fainly yellow in color. Knowing my results were tomorrow I decided to wait until then to figure out what was wrong.
Upon returning to the clinic, they tell me my test results for gonorrhea and chlamydia were again negative! I was stumped and told them of my discharge so they did another swab and this time treated me with a shot of what I believe to be ceftriaxone and another gram of azythromycin. They didn't want to at first as my last two tests came back negative so they are thinking it's another problem not STD related. I go back for my results at the end of the month.
It's been 5 days since my treatment and I'm still having a fair ammount of discharge, especially in the morning upon milking my penis, and from time to time a tingling sensation or dull ache in my urethrea. no pain or discomfort while peeing though. Is it possible that I could've gotten two false positive tests?
MEDICAL PROFESSIONAL
There is no way to tell whether the symptoms returned because the doxycycline did not completely cure the infection, or because you were reinfected from your partner. The former probably is a bit more likely, but either is possible. The standard approach now would be to treat both you and your partner at the same time, most likely with a combination of azithromycin + a drug against trichomonas (metronidazole or tinidiazole). I agree that a gynecologist's exam of your partner is unlikely to reval anything helpful. I suggest you and your partner return for simultaneous visits at the health department clinic. I also expect any repeat test results to remain negative, i.e. no gonorrhea or chlamydia, and probably no sign of trich on examination. This is a typical situation for recurrent or persistent NGU.
So return to the clinic, with your partner, and follow their recommendations. Feel free to print out this response to show them. But be aware that they may have good reasons not to follow my suggestions exactly; they are in charge here, not me. In the meantime, you need to look at this entire situation as an inconvenience, not as a serious health risk. No long term bad outcomes are known to result from recurrent NGU -- no urethral stricture, no cancer, no prostate problem, no health problems in female partners.
So return to the clinic, with your partner, and follow their recommendations. Feel free to print out this response to show them. But be aware that they may have good reasons not to follow my suggestions exactly; they are in charge here, not me. In the meantime, you need to look at this entire situation as an inconvenience, not as a serious health risk. No long term bad outcomes are known to result from recurrent NGU -- no urethral stricture, no cancer, no prostate problem, no health problems in female partners.
Well I'm back with more good news/bad news.
The day after my last post I went to the health department and got another screening. When I was seen they looked around to see if there were any unusual bumps or sores but instead of just swabbing my urethra they had me milk it and took a swab of the discharge directly. They put it on a slide to look at it under a microscope and after about 15 minutes came back and said it didn't look like chlamydia but would send it in for more tests to determine if it was that or something else. They gave me a week of doxy, which I started later that day.
After finishing it, things started to clear up, the discomfort as well as the discharge. A few days later I had sex with my girlfriend. But as of last night (about a week later) the discharge came back. Is it quite possible that this could be a virus of some sort? I know it's possible that I might've gotten reinfected from her. She's got a gynecologist appointment so I'm sure that will reveal more. But on the off chance that they don't find anything what else could it be? I'm going to try to go in later today and see if I can get the results from my last screening, although I'm sure they'll come back negative like the first three times...
The day after my last post I went to the health department and got another screening. When I was seen they looked around to see if there were any unusual bumps or sores but instead of just swabbing my urethra they had me milk it and took a swab of the discharge directly. They put it on a slide to look at it under a microscope and after about 15 minutes came back and said it didn't look like chlamydia but would send it in for more tests to determine if it was that or something else. They gave me a week of doxy, which I started later that day.
After finishing it, things started to clear up, the discomfort as well as the discharge. A few days later I had sex with my girlfriend. But as of last night (about a week later) the discharge came back. Is it quite possible that this could be a virus of some sort? I know it's possible that I might've gotten reinfected from her. She's got a gynecologist appointment so I'm sure that will reveal more. But on the off chance that they don't find anything what else could it be? I'm going to try to go in later today and see if I can get the results from my last screening, although I'm sure they'll come back negative like the first three times...
MEDICAL PROFESSIONAL
It sounds like you need additional antibiotic treatment. The CDC recommendations for recurrent NGU are to treat with a different antibiotic (i.e., doxycycline if azithromycin was used first time) plus metronidazole (or tinidazole) to cover the possibility of trichomonas. You might discuss those guidelines with the nurse who believes additional antibiotics would not help. She could be right -- it might not work. But most STD experts would certainly give it a try.
Alternatively, you might see a true STD expert -- which your current provider might not be. Some urologists qualify, but most really are not STD experts. Your local health department STD clinic would be a good bet.
Alternatively, you might see a true STD expert -- which your current provider might not be. Some urologists qualify, but most really are not STD experts. Your local health department STD clinic would be a good bet.
Well I just got back from the clinic and sure enough, tests came back negative. Three strikes, so I guess it is a NCU/NGU of some sort. I talked to the nurse there about possibly getting some doxy but she wouldn't do it as they think it's a deeper issue than what antibiotics will help me with.
In the last two weeks it seems almost as if it's getting worse. I tried to ignore it in hopes that the antibiotics would kick in. I had sex with my girlfriend Saturday and upon waking up a few hours later with pain in my urethrea I milked and had a yellow tinted discharge. Now on top of that I get pain that comes in goes in my urethrea and in my testicle and discomfort while urinating. They said at the clinic they could refer me to a urologist, should I wait for that or do you think I should try another clinic?
In the last two weeks it seems almost as if it's getting worse. I tried to ignore it in hopes that the antibiotics would kick in. I had sex with my girlfriend Saturday and upon waking up a few hours later with pain in my urethrea I milked and had a yellow tinted discharge. Now on top of that I get pain that comes in goes in my urethrea and in my testicle and discomfort while urinating. They said at the clinic they could refer me to a urologist, should I wait for that or do you think I should try another clinic?
MEDICAL PROFESSIONAL
I understood that.
MEDICAL PROFESSIONAL
Welcome to the STD forum.
This isn't really a mystery. In fact, you describe a very common problem. Almost certainly you have recurrent nongonococcal (also nonchlamydial) urethritis (NGU).
NGU is the single most common STD syndrome in men. Having said it "isn't a mystery", that's not entirely true: the exact causes of most NGU cases in fact remain mysterious. One possibility is that some cases are due to entirely normal oral or rectal bacteria, i.e. nothing that shows up on STD testing. Other causes include definitely sexually transmitted bacteria that are not included in STD test panels (except in research studies), such as Mycoplasma genitalium. About 30-40% of NGU cases are due to chlamydia, but like most cases, yours clearly is not chlamydial.
Of nonchlamydial NGU cases, up to 20% recur after routine antibiotic treatment -- so that aspect also is quite common. The CDC recommendations for treatment, which I endorse, are that recurrent cases should be treated with a change in antibiotics. In particular, when the problem recurs after azithromycin, doxycycline should be used; and ideally metronidazole as well, to cover the possibility of trichomonas. (Trich is unlikely in gay men -- primarily a heterosexual problem. But still probably a good idea to include it, just to be safest and to stick with the CDC advice.) Most recurrent cases stop happening after such treatment.
In other words, your negative tests are true negatives -- i.e. you don't have either gonorrhea or chlamydia. You should speak with your health care provider about a course of doxycycline (usually 100 mg twice daily for 7 days, although some experts -- especially in the UK -- recommend 10-14 days) plus a single dose of metronidazole, usually 2 grams.
In the meantime, don't be too worried. Nonchlamydial NGU generally seems to be harmless, with few if any serious outcomes or complications. In the long run, all will be well.
Best wishes. I hope this helps-- HHH, MD
This isn't really a mystery. In fact, you describe a very common problem. Almost certainly you have recurrent nongonococcal (also nonchlamydial) urethritis (NGU).
NGU is the single most common STD syndrome in men. Having said it "isn't a mystery", that's not entirely true: the exact causes of most NGU cases in fact remain mysterious. One possibility is that some cases are due to entirely normal oral or rectal bacteria, i.e. nothing that shows up on STD testing. Other causes include definitely sexually transmitted bacteria that are not included in STD test panels (except in research studies), such as Mycoplasma genitalium. About 30-40% of NGU cases are due to chlamydia, but like most cases, yours clearly is not chlamydial.
Of nonchlamydial NGU cases, up to 20% recur after routine antibiotic treatment -- so that aspect also is quite common. The CDC recommendations for treatment, which I endorse, are that recurrent cases should be treated with a change in antibiotics. In particular, when the problem recurs after azithromycin, doxycycline should be used; and ideally metronidazole as well, to cover the possibility of trichomonas. (Trich is unlikely in gay men -- primarily a heterosexual problem. But still probably a good idea to include it, just to be safest and to stick with the CDC advice.) Most recurrent cases stop happening after such treatment.
In other words, your negative tests are true negatives -- i.e. you don't have either gonorrhea or chlamydia. You should speak with your health care provider about a course of doxycycline (usually 100 mg twice daily for 7 days, although some experts -- especially in the UK -- recommend 10-14 days) plus a single dose of metronidazole, usually 2 grams.
In the meantime, don't be too worried. Nonchlamydial NGU generally seems to be harmless, with few if any serious outcomes or complications. In the long run, all will be well.
Best wishes. I hope this helps-- HHH, MD
oops! I meant to say two false negative tests.
You are reading content posted in the STDs Forum
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