Meds Question

[thebears]

I am a small person and one of my (two) boyfriends is large so sex with him is often slightly painful. During our last sex (after my period) I had some bleeding and a foul odor.  Since then (a week), I have more bleeding (but not a lot) and a mucousy discharge (no itching).

I immediately tested for Gonorreah/Clamidia (blood and urine) and before getting the results but being (stupidly) sure it was clamydia (the dangers web research), I took 1 gram powerd Zithromax which one of my old roommates left when she moved.  That was stupid of course....and now I just got my results back and its not any of the three they tested for.  That means before anything I have to go get more testing.  From web research (ug) I presume I have BV or Trichomonas or something I don't know.  I have an appointment Monday.

So....I am a little freaked out and need advice.  First, did I hurt myself by taking the Zithromax?  From what I have read, if I have BV or Trichomonas, one web site says to avoid "Antibiotics with activity against lactobacilli."  Is Zithromax one of these antibiotics and if so, what does that mean?  Alternatively, could it help me?  The remedies for BV and mono seem completely different.

TheBears in California

[H. Hunter Handsfield, M.D.]

Almost everything you say reflects a lot of knowledge about the STDs you mention; you obviously found some reliable websites.  Good show.  And yes, it wasn't the smartest move to treat yourself with azithromycin without knowing you had something that would respond to it.  But it wasn't totally unreasonable; depending on what was seen on examination, many health care providers might have presecribed even if you hadn't treated yourself.  And most likely it did no harm.  The bigger problem would have been if you had taken it before the tests were done.

As you suggest, the prominent odor suggest bacterial vaginosis or trichomoniasis.  In either case, azithromycin is not likely to be harmful.  Other things can cause the same symptoms, though--for example, a foreign body (e.g., a forgotten tampon, a lost condom, a contraceptive sponge).  If not done, you should discuss all this with the provider to did the gonorrhea and chlamydia testing; s/he might have already examined your vaginal fluid and might already have suspicions about BV, trich, or other causes.  If not, you are exactly right--you need to be reexamined.  But in the meantime, don't worry about harm from the treatment you have had.

I'm not sure where mono comes up (in your last sentence).  There is nothing in your story to suggest mononucleosis-- but maybe that's a typo.  (Did you mean to repeat trichomonas?)  Statistically, BV is the best bet in your situation.  As you might have already learned, BV doesn't appear to be an STD in the usual sense--i.e., it is unlikely you caught it from either of your partners.

I hope this helps.  Good luck---  HHH, MD

[thebears]

just for clarification....before this most recent encounter with Mr. Longjohn (#2) it had been about two weeks since I was with my other boyfriend (#1).  the time period between him and partner #2 (about two weeks) and the overall symptoms was what it made me think it was clymidia.  

anyway, i just called #1 and told him what was going on and he says he has no real symptoms except possibly some irritation at the end of his penis, but he wasn't really sure if it was anything other than use irritation.  

while partner #2 is monogomous with me (and has no symptoms but is coming with me to get tested), #1 is a (seemingly) marginally bi-sexual white male with (reported) infrequent male partners, always with a condom he says, although he did say one broke on him about 1-2 weeks before our encounter 2 weeks ago.  

on top of Monday's appointment, i guess that means I need to now really get tested again in a couple months for HIV, and have advised him to do the same.
****, this is my fault.  i was a moron.  i hate this.

[thebears]

thank you so much for your prompt reply!  this is a great service.  (and yes, by mono, I meant trichomonas--brain hand disconnect)

Ok, aside from the additional information I provided above (I think after your post) which I'm not sure if it would affect your answer, I have a few (I think final) questions:

One website says the best thing for BV is:
metronidazole, 2000 mg orally as a single dose (4, 500mg tablets) (84% cure); clindamycin 2% vaginal cream, 1 applicator (5gm) intravaginal each day for 7 days (86% cure); metronidazole vaginal cream 0.75% (Metrogel®) 1 applicator intravaginal each day for 3 days (75% cure); exogenous lactobacillus recolonization by vaginal tablets or suppositories containing lactobacillus---or oral tablets with lactobacilli that recolonize the gastrointestinal tract.

Does that line mean maybe with the Zithromax I have taken and some over-the-counter acidopholous, I can start on a cure today and might be cured by that alone?  I will always take natural remedies first if they are really viable and even if it isn't a full cure but just something that will help, is any acidopholis ok or should I look for something special.  (I am generally aware of it and its promotion of positive bacteria.....I've just never used it.)

FWIW, the CDC site says:  "Although BV will sometimes clear up without treatment, all women with symptoms of BV should be treated to avoid such complications as PID. Male partners generally do not need to be treated. However, BV may spread between female sex partners."

Finally (on BV) -- One comment you made about BV I wanted to check on -- every site I have read but one says that there is a least a sex link, even though its a bit of an unknown.  Can you elaborate?

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For Trichom -- once again, it seems like my boyfriends may not be the cause as I've read "It has been reported to be acquired by masturbation using the fingers (4) and contracting the organism from baths, moist toilet seats and towels cannot be ruled out (5)."

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Finally, just to be clear, if its BV or Trichom, it sounds like my partners will not need any treatment and since they are asymptomatic (other than POSSIBLE irritatation at the end of partner 1's inner urethra).....should they just wait for my results and unless its something else, not worry?

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Sigh....I feel better a little, thanks.  I wish I could get something definitive before monday.

[H. Hunter Handsfield, M.D.]

Re the partner with penile irritation:  He needs to be examined.  So does your other partner, regardless of symptoms.  You could have acquired an STD from either partner; or either one could have been infected by you, if you have a transmissible infection.

Anybody with any STD (or suspected) ought to have an HIV test.  And anybody with multiple partners should have an HIV test from time to time, like once a year. The odds are in your favor, but better safe than sorry.

There is broad consensus that the preferred treatment for BV is metronidazole (Flagyl is a trade name, but generic versions are equally good) for 5 days.  Single dose treatments are poor.  The other antibiotics are less effective, or at least no better.  Creams and other intravaginal treatments aren't as good.

Putting acidophilus or other supposed lactobacillus preparations in the vagina have no effect.  It's a nice theory, but the commercial LB products are not the kind that live normally in the vagina; do not remain there when placed in the vagina; and are proved to have no benefit in treating or preventing BV.

The CDC statement about BV is correct.  Sexual transmission by direct exchange of vaginal secretions clearly occurs in lesbians, via genital apposition, fingers, sex toys, etc. In heterosexual women, BV is statistically associated with STD risk (new partner, increased no. of partners, etc).  But no bacteria or virus has been shown to be transmitted to or from male partners, and treating male partners makes no difference in cure or recurrence of BV in women.  BV has been called a SAD ("sexually associated disease") but not an STD.  Its origins and causes remain mysterious.

There has always been speculation about indirect transmission of trich via fingers etc, but it's probably all BS.  Just about all cases are sexually transmitted in the true sense, i.e. by unprotected penile-vaginal intercourse.

As I said above, both your partners need to be examined.  If all you have is BV, they probably won't need treatment.  There are still other possibilities for your symptoms that I didn't think to mention above, such as Mycoplasma genitalium or other organisms that are responsible for nongonococcal urethritis (NGU) in men.

HHH, MD  

[H. Hunter Handsfield, M.D.]

No new questions except as new threads via the Post a Question link.  I would have deleted this comment if I could figure out how to use the new software to do that.  Sorry.