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STDs (Expert Forum)
The nightmare continues!
Answered by
University of Washington
Seattle - WA
This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection.
IMPORTANT
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
The nightmare continues!
by dazed, May 19, 2007 12:00AM
Hi Doc, I’m a 26 year old male and the following is my history:
Week 1: Encounter.
Week 2: Diagnosed with gonorrhea via urethral swab/stain test. Treated with 250mg IM Ceftriaxone and 1000mg Zithromax.
Week 3: Symptoms got better.
Week 5: Start experiencing mild pain in left testicle.
Week 6: Went to my doc...said nothing wrong b/c they weren’t swollen and/or tender to the touch. Did a urine-analysis test, which came out negative. Did a urine amplification test for gonorrhea/Chlamydia, which were both negative.
Week 6: Also went to Planned Parenthood (about an hour and a half before going to the doctor mentioned above). Examined testicles and did urine amplification test for gonorrhea/Chlamydia and blood test for syphilis. All results were negative. They gave me a 7-day prescription of Doxy anyway.
Week 7: Went in for a full STD panel (HIV, hepb, hepc, hsv1, hsv2, gonn/chlam, syphilis). Everything was negative including amplification test for gonn/chlam.
Week 8: Started taking the Doxy given to me by Planned Parenthood. Pain got a little better, but wasn’t sure if it was already getting better.
Week 9: Saw urologist and told him my complete history. He collected urine, did an ultrasound of my testicles, and also collected prostate fluid. He came back and told me my prostate fluid was infected. Didn’t specify whether it could be gonorrhea or anything else. Prescribed a six-week course of Trimethoprim.
Week 1: Encounter.
Week 2: Diagnosed with gonorrhea via urethral swab/stain test. Treated with 250mg IM Ceftriaxone and 1000mg Zithromax.
Week 3: Symptoms got better.
Week 5: Start experiencing mild pain in left testicle.
Week 6: Went to my doc...said nothing wrong b/c they weren’t swollen and/or tender to the touch. Did a urine-analysis test, which came out negative. Did a urine amplification test for gonorrhea/Chlamydia, which were both negative.
Week 6: Also went to Planned Parenthood (about an hour and a half before going to the doctor mentioned above). Examined testicles and did urine amplification test for gonorrhea/Chlamydia and blood test for syphilis. All results were negative. They gave me a 7-day prescription of Doxy anyway.
Week 7: Went in for a full STD panel (HIV, hepb, hepc, hsv1, hsv2, gonn/chlam, syphilis). Everything was negative including amplification test for gonn/chlam.
Week 8: Started taking the Doxy given to me by Planned Parenthood. Pain got a little better, but wasn’t sure if it was already getting better.
Week 9: Saw urologist and told him my complete history. He collected urine, did an ultrasound of my testicles, and also collected prostate fluid. He came back and told me my prostate fluid was infected. Didn’t specify whether it could be gonorrhea or anything else. Prescribed a six-week course of Trimethoprim.
Doctor's Answer
by H. Hunter Handsfield, M.D., May 19, 2007 12:00AM
, May 19, 2007 12:00AM
I'll try to help, but your urologist probably knows more than I do; prostatitis isn't an STD and I'm not an expert in it.
The only actual STD problem you have had is the gonorrhea. The only other slight possibility may be trichomoniasis, which commonly is acquired simultaneously with gonorrhea. Trichomonas probably (??) can get into the prostate and/or might mimic prostatitis. It's almost impossible to diagnose in men without special research tests, so the usual approach is to give treatment just to be safe. Therefore, you should talk to the urologist about trying treatment with metronidazole (Flagyl); or even better, the newer drug tinidazole (Tindamax), which is more active against trichomonas. Tell him you don't want to rely on the commonly used single-dose treatments; a proper trial should include treatment for a week or so. You could also speak with the woman you caught your gonorrhea from, to see if by any chance she has had trichomoniasis; it's much easier to diagnose in women than men.
But don't get your hopes up about trich. Most likely the diagnosis of prostatitis is correct. Nonbacterial prostatitis is more common than bacterial, and is a mysterious condition. Most cases are probably not due to infection at all, but some sort of non-infectious inflammation--generally not well understood. However, if your urologist is certain you have a bacterial case (e.g., a positive culture for one of the typical bacteria that cause it), that probably is reliable. Even for nonbacterial or uncertain cases, most urologists and other experts assume infection as a possibility and treatment with antibiotics is the norm. However, antibiotics often make no difference in symptoms. STDs might sometimes trigger such problems, but this also is a matter of uncertainty and some controversy. However, prostatitis itself is not due to STD and is not acquired sexually.
This all sounds like bad news. But it's important to know that nonbacterial prostatitis does not appear to be harmful, only uncomfortable. There probably isn't any serious risk of anything really bad--no infertility, no cancer, and nothing you can transmit to a current or future sex partner, assuming trichomonas isn't an issue. In the long run this whole business is likely to be an inconvenience for you more than a significant health threat.
To the specific questions from your follow-up comment below:
1,3) Although gonorrhea may have triggered your current problem, gonorrhea always responds to the treatments you had and you can be sure it's no longer an issue. Ditto for chlamydia, if you happened to have it.
2) Most likely your prostatitis is nonbacterial, if only because it's more common than the bacterial variety. Either way, there is no known risk of harm to your girlfriend.
4) Gonorrhea isn't an issue, so at this point the specific test doesn't matter. NAAT is the test of choice, and can be done on either urine or a urethral swab.
5,8) No medical problem, for practical purposes, and no antibiotic, changes the reliability of HIV testing. You really don't need further HIV testing, but if you do it, you can rely on the result.
6) Prostatiis does not commonly cause infertility, but this is a question for your urologist; not my area of expertise.
7) There are many options for antibiotic trials, and trimethoprim is reasonable. If a culture has shown a specific kind of bacteria that is known to be responsive to trimethoprim, then you're definitely on the right track. Also see above about trichomonas and possible treatment for it.
9) Most likely it wouldn't hurt to have sex at any time, but you should follow your urologist's advice.
As a cross-check, you might consider printing out your questions and this reply and taking it to your urologist. Let me know if we disagree with each other. I'll bet not.
I hope this helps. Best wishes-- HHH, MD
The only actual STD problem you have had is the gonorrhea. The only other slight possibility may be trichomoniasis, which commonly is acquired simultaneously with gonorrhea. Trichomonas probably (??) can get into the prostate and/or might mimic prostatitis. It's almost impossible to diagnose in men without special research tests, so the usual approach is to give treatment just to be safe. Therefore, you should talk to the urologist about trying treatment with metronidazole (Flagyl); or even better, the newer drug tinidazole (Tindamax), which is more active against trichomonas. Tell him you don't want to rely on the commonly used single-dose treatments; a proper trial should include treatment for a week or so. You could also speak with the woman you caught your gonorrhea from, to see if by any chance she has had trichomoniasis; it's much easier to diagnose in women than men.
But don't get your hopes up about trich. Most likely the diagnosis of prostatitis is correct. Nonbacterial prostatitis is more common than bacterial, and is a mysterious condition. Most cases are probably not due to infection at all, but some sort of non-infectious inflammation--generally not well understood. However, if your urologist is certain you have a bacterial case (e.g., a positive culture for one of the typical bacteria that cause it), that probably is reliable. Even for nonbacterial or uncertain cases, most urologists and other experts assume infection as a possibility and treatment with antibiotics is the norm. However, antibiotics often make no difference in symptoms. STDs might sometimes trigger such problems, but this also is a matter of uncertainty and some controversy. However, prostatitis itself is not due to STD and is not acquired sexually.
This all sounds like bad news. But it's important to know that nonbacterial prostatitis does not appear to be harmful, only uncomfortable. There probably isn't any serious risk of anything really bad--no infertility, no cancer, and nothing you can transmit to a current or future sex partner, assuming trichomonas isn't an issue. In the long run this whole business is likely to be an inconvenience for you more than a significant health threat.
To the specific questions from your follow-up comment below:
1,3) Although gonorrhea may have triggered your current problem, gonorrhea always responds to the treatments you had and you can be sure it's no longer an issue. Ditto for chlamydia, if you happened to have it.
2) Most likely your prostatitis is nonbacterial, if only because it's more common than the bacterial variety. Either way, there is no known risk of harm to your girlfriend.
4) Gonorrhea isn't an issue, so at this point the specific test doesn't matter. NAAT is the test of choice, and can be done on either urine or a urethral swab.
5,8) No medical problem, for practical purposes, and no antibiotic, changes the reliability of HIV testing. You really don't need further HIV testing, but if you do it, you can rely on the result.
6) Prostatiis does not commonly cause infertility, but this is a question for your urologist; not my area of expertise.
7) There are many options for antibiotic trials, and trimethoprim is reasonable. If a culture has shown a specific kind of bacteria that is known to be responsive to trimethoprim, then you're definitely on the right track. Also see above about trichomonas and possible treatment for it.
9) Most likely it wouldn't hurt to have sex at any time, but you should follow your urologist's advice.
As a cross-check, you might consider printing out your questions and this reply and taking it to your urologist. Let me know if we disagree with each other. I'll bet not.
I hope this helps. Best wishes-- HHH, MD
1) If the infection in my prostate was due to gonorrhea wouldn’t 3 separate urine amplifications tests, as well as one urine-analysis test detected the gonorrhea or at least shown some sort of an infection? In another words, can I rule out gonorrhea as the source of infection?
2) If I do have bacterial prostates as diagnosed, does this mean that I could have transmitted it to my g/f? (only had protected sex with her twice since the encounter except for oral all 12 days after my initial treatment)
3) Shouldn’t the original treatment with ceftriaxone/zithromax have killed off the gonorrhea/Chlamydia bacteria? (Note: I had one beer during treatment)
4) Which is a better diagnostic tool for gonn? NAAT vs. Swab?
5) Would this new diagnosis (prostatitis) have any affect on the reliability of my 7 week negative HIV test or the other STDs?
6) How long does one need to have bacterial prostatitis until infertility becomes an issue? Does infertility ever become an issue?
7) Do you believe that Trimethoprim is the right treatment in my case, or should I be treated with ceftriaxone once again?
8) If I took my 6 week course of Trimethoprim, would that have any affect on an HIV antibody test I plan on taking in 6 weeks again?
9) Doc advised meThe Dr. advised me that I could start having sex 7 days after I begin taking Trimethoprim. Is this true or should I wait the full 6wks?
1) Can I transmit trich to my gf by her giving me oral sex?
2) What are the long-term consequences of untreated trich?
3) You're contention was that the 3 negative naat urine tests for gonorrhea and chlamydia are 100% indicative that I no longer have those stds??
I'm not sure if you do answer follow up questions, but I would really appreciate it if you could. Thank you!
#1. No Sex of any kind while your healing for a month
#2. No drinks or drugs for a month
#3. If you execise like my no squats for a month
#4. ! month of Doxy 100mg cap 2 a day
#5. Work eat and sleep for a month, this is the only way
I'm sorry to hear about your situation, but I don't think i have what you have. I don't have any discharge. I just have pain