Question on the efficacy of treatment for Chlamydia/Gonorrhea

[daggotht]

Hello Doctor,

After a risky sexual encounter, I woke up two weeks later with a white discharge and a severe irration in the bladder.  

I consulted a doctor.  No culture swabs were taken, only a quick urinary test and physical exam (the tip of my penis was very irritated).  

I was promptly given 400mg of suprax and 1g of azithromycin.

Now, I'm entering the 5th day of my treatment.  Bladder irritation is almost gone except for the occasional sting.  The tip of my penis looks a lot more healthy.  However, I still have A LOT of discharge.  Maybe a little less frequent but still the same pattern: white in the morning and more constant but transparent in the rest of day.  

Is it likely at this point that treament has not worked?  I'm gonna wait for the whole 7 days but I'm worried and would like to know if there are probabilities the treatment failed or if it could be something else and what could be the other causes.

Also, how risky is it to perform cullingus on my partner who MIGHT have been infected only a week ago and is also getting treated but shows no symptoms.  Is it low or high risk?  Should I abstain?

[H. Hunter Handsfield, M.D.]

I hope the urine test included lab testing for gonorrhea and chlamydia.  What were the results?  (If 'quick urinary test' means only an office exam, without lab testing for those STDs, shame on your doctor!)  Garden variety urinary tract infection ('bladder infection') is rare in men, and in any case doesn't cause discharge.  The 2 week delay in symptoms suggests chlamydia, but gonorrhea also was possible.  Or you could have had nonchlamydial, nongonococcal urethritis (NGU); or if you had anal sex, perhaps infection with fecal bacteria.

Most likely the treatment is working; your symptoms are improved and it often takes 7-10 days or even a little longer for all discharge to resolve.  However, I would have expected somewhat more improvement than you describe.  If you still have any symptoms at all 10 days after treatment, definitely return to your provider (or maybe a different one) for reevaluation.  It is rare for gonorrhea or chlamydia to persist given the treatments you had, but it's possible.  Or maybe you have trichomonas, although that doesn't usually cause such prominent symptoms in men.  Or prostatitis.  Or even herpes, although that also is unlikely.

Performing cunnilingus is low to zero risk for any STD transmission from either partner to the other.  Some low risk of herpes transmission, but that's about it.

Presumably the partner on treatment is the one from whom you might have been infected.  All partners starting back to about a month before your symptoms started should be treated to protect their health and also that of any other sex partners they may have.

Good luck--  HHH, MD

[daggotht]

I forgot...I know that some strains are resistent in certain geographical areas like California.  So for your information, I reside in Canada.  Thank you.

[H. Hunter Handsfield, M.D.]

The gonorrhea resistance problem is for the class of drugs called fluoroquinolones, such as ciprofloxacin (Cipro).  Cefixime (Suprax) is fully effective.

[daggotht]

i do not know the results.

i'm not even sure they made all proper tests.  it was rather confusing and quickly done.  they told me they'd give me a prescription anyway...just to make sure.

socialized medecine, eh?

[daggotht]

ok then...thank you for the information

[daggotht]

Discharges still persistent after 7 days.

According to the pharmacian, I could have unprotected sex now.  

Would you advise against it?

[H. Hunter Handsfield, M.D.]

Disregard the pharmacist.  Return to your health care provider.

[daggotht]

I know there are a number of possibilities...should I worry about this?  Or is it likely to require just another course of antibiotics or simply waiting?

[H. Hunter Handsfield, M.D.]

I cannot speculate further.  You need to rely on personal health care, not the guesswork from online advice.