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white blood cell count and STD
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by etet, Mar 04, 2011
In 2009, I had a panel STD test done by tSTD for about $250 where I gave blood and they tested me for a long list of STDs. In Jan 2011, I had protected intercourse with a CSW. Over the past couple of weeks, I felt like there was a genital wart that had appeared. After stressing over it, I went yesterday to a local STD clinic where they said it wasn't HPV. However, they did do a urethral swab and took blood for a Syphillis test which they said is required of all patients. While I was there, they came back and said the swab from my urethra showed a white blood cell count of 5 which could indicate either NGU or chlamydia. She said they don't test for chlamydia there. Anyway, she said the white blood cell count was not overly high but in the range where they see it as an indication of something going on. They gave me these two pills right there - I was trying to process all of this and honestly can't remember what they were - but it was an anti-biotic that should kill the NGU if that was there and I'm guessing chlamydia (is this typical?).

I've had no symptoms (burning urination, etc..) over the past year or so but I understand that doesn't mean much.

My question is: Not having had unprotected sex since that 2009 "clean bill of health" I'm trying to understand how definitive the white blood cell count is? I have been sick lately but it sounds like the presence of white blood cells in the urethra indicate some sort of STD. I will have results in a week from the blood test for the Syph.

Are those tSTD test accurate? Maybe that was money not well spent.

Thanks.
Answer:
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Welcome to the forum.

First comment is that even if you had had a wart, it could not have come from exposure a couple weeks earlier.  Warts take an average of 6 months to appear, never sooner than 2 months.

As for the main problem, entirely normal folks can sometimes have excess WBC in the urethra.  In my STD clinic, if someone with no symptoms has elevated WBC in the urethra, and no abnormal discharge is seen, we do not treat at that time.  We wait for the chlamydia and gonorrhea test results, and ask the patient to return in a few days for repeat exam.  If WBC are absent, we consider the patient uninfected and provide no treatment.  If either the gonorrhea or chlamydia test is positive, or if WBC are still present, we treat accordingly.

There are no good data for this approach, and I am not criticizing the clinic you visited.  Many STD experts would treat for presumed NGU/chlamydia, as you were.  The drug you received was azithromycin, 1.0 gram, and is standard therapy for these condidions.

In other words, the odds are strong that you had no STD, and since your most recent exposure was condom protected, there was little or no risk.  You can expect your syphilis blood test result to be negative.

Your STD panel back in 2009 undoubtedly was accurate; most online testing services use highly standard and reliable test methods.  Most likely you were tested for some things that weren't necessary and paid more than you would have if you had seen a knowlegeable provider -- for example, normally hepatitis testing isn't necessary.  But the results were reliable.

All things considered, it is unlikely you had an STD as a cause of the WBC in your urethra; it is unknown why some men have that finding from time to time.  But under the better-safe-than-sorry philosophy, the treatment will have done you no harm.

Regards--  HHH, MD
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