(man) tested negative for chlamydia but still have discharge!!!

[inthatboat]

Hi, this story is a bit conveluted so please bear with me.
I had unprotected sex with a girl a few weeks ago. She is the only person I have slept with in many months.
Exactly one week after, I had thick white discharge from my penis in the morning. We both immediately went to the doctor, but since I don't have insurance only she could get tested (even though she had no symptoms).
We had to wait one week for her results, but in the meantime the doctor gave us both Azithromycin. The medicine never cleared up my discharge, however.
This morning she got the results back, which were NEGATIVE for Chlamydia, Gonorrhea, etc.
So why do I still have discharge? Is it a UTI? Or can she be carrying something else that she gave to me that the doctor failed to test for?
There is no Planned Parenthood around here, so please don't suggest it. And I can't afford testing without insurance. Someone recommended me Minocycline, to cover all STDs, but of course I can't get it without a script.

[auntiejessi]

Is there a low cost or free std clinic near you?  Call your local health dept and ask if they have one or know of one.

Minocycline won't cure any std, and each std needs a different antibiotic, so I might stop getting medical advice from that friend.  ;)

You might have something called urethritis, which you can get from many different bacteria, and not all of them are sexually transmitted.  

What you'd need to do is pee in a cup.  Make sure they only get the first part of your urine stream, and don't pee for at least an hour before going.

If there isn't an std or free clinic, then ask the health dept where they recommend people go when they have no health insurance.  If they say the ER, then ask the ER about uncompensated care.

AJ

[stillHurting]

Here's something which I wrote up that I like to paste in threads like this.  NGU is non-gonococcal urethritis, all it means is urethritis not due to Gonorrhea.

Unfortunately almost any doctor in the US is not going to test for these as a normal procedure and quite possibly won't even know what they are.  So you're going to have to be very pro active about your own treatment.


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Testing for causes of NGU beyond Chlamydia.

There are three main casuses of non-chlamydial non-gonococcal urethritis.  These are Ureaplasma, Mycoplasma, and Trichomonas.  They are not tested for with the typical battery of STD tests in the US, though they are in some other countries.

Tests are available through LabCorp, they are often not covered by insurance.

Mycoplasma/Ureaplasma, Real-Time PCR
http://www.****Number138778CPT87801

Trichomonas vaginalis, Nucleic Acid Amplification (NAA):
http://www.****Number188052CPT87798

These organisms are frequently transfered at the same time as the better known STDs like gonorrhea and chlamydia.  Gonorrhea has a high cure rate of about 98% (except for resistant strains, where cipro might fail but cefiximine will nearly always work) and chlamydia 96-98%. However mycoplasma/ureaplasma recur about 20-60% of the time.  So recurrent urethritis is nearly never due to gonorrhea or chlamydia, unless the patient was reinfected.

Mycoplasma are harder to eradicate for a few reasons.  Many strains are resistant to antibiotics, especially tetracycline resistance.  This means doxycycline, a commonly prescribed drug, will often fail in treatment.  Resistance rates of 50% have been reported for ureaplasma and doxycycline.  M hominis is resistant to erythromycin, azithromycin, and clarithromycin.  Levofloxacin, another common drug, also has been shown to have a high failure rate for M genitalium.  This is why knowing which infection you have is very valuable in determining the correct treatment.

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In your case I'd think Trich is pretty unlikely because it usually causes symptoms in women, but not always.  But that's probably the last of the 3 things I'd test for.

As above, Minocycline is pretty weak for treating STDs.  Given the non response to Azithromycin, the next thing I'd try is a stronger fluoroquinolone type antibiotic such as Avelox or Levaquin, but then again I actually read studies which talk about effectiveness with different antibiotics when most doctors have a tendency to just go with what they know.  Sad but true.  Once again since Azithromycin didn't work, M hominis is a good possibility.  I'd rather test than treat, but it seems that nearly nobody ever actually gets tested with the more advanced tests above.

As this is kinda my area of specialty on this board, feel free to ask me any questions you might have.  Good luck.