reiters syndrome after 7 months of exposure, progressing

[arj123]

had oral sex with an escort 15 months back,  but developed gum bleeding afterwards, was treated completely with oral antibiotics (tetracycline). had sex with same person 17 months back,but this time i had urethritis and gum bleeding, again had tetracyclines, but with an initial improvement, it took a protracted and non remitting course with persistent urethritis. it went on with new symptoms like testicular pain, pain during ejaculation, burning during urination, dry cough sometimes. tests showed hiv negetive, pyuria (16 puscells pe rhpf, ),culture negetive, normal blood count. normal chest x ray, diagnosed with non gonococcal urethritis,was tried with ofloxacine, azithromycine , doxycycline  (2wk), one after another. but with out any help. after that I stopped asking for any antibiotic s further. for next 4 months it was low grade urethritis and occasional testicular pain. 3 months back i had right knee joint pain, that was mild but it is going on since then and even mildly increased. last month i had right eye redness,i was diagnosed to have reiters syndrome and was started on doxycycline 100 mg bd. red eye subsided again to be full blown red eyes on both sides last week. both eyes were swollen, painful with yellowish discharge. with some eyedrops it is reduced in severity now, but still right eye is swollen with blurring of vision sometime.

can you please help me if any other antibiotic or combination antibiotic can help me get through this condition. I am still on doxycycline for last 6 week, right now urethritis, sometimes testicular pain, left knee pain, conjunctivitis on left side , all are there.

[arj123]

Thank you very much, sorry for the late reply..

I have been to the eye specialist, gastroenterologist, skin specialist and also a rheumatologist. 3 of them mentioned it as reactive arthritis. I changed the rheumatologist for a 2nd opinion after 2 months of doxy . I was told by the 2nd doc that doxycycline wont help, I am HLA B27 negative and it will subside within 1 yr automatically. No need for special antibiotics. So I am off of it with mild but persistent symptoms. Day by day I am just hoping everything will subside. But whenever I am having  vigorous physical activity, the symptoms get worsened. I just hope this will go automatically.

I was depressed that they say there is no treatment for this and only they tackle the symptoms. As the symptoms are not much to their viewpoint as this moment, no need to take medicine.

thank you a lot again for your support. will post if i get recovered or any change in course.
I

[HowardH]

First, if you don't mind an editorial comment: the term Reiter's syndrome is not used anymore; the correct term is reactive arthritis. In recent years it came to light that Hans Reiter, a German physician, was a Nazi war criminal who conducted horrific human experimentation in concentration camp inmates. He escaped conviction in the Nuremberg trials on a technicality. His name should not be used in a manner that implies honor, as in a disease name.

To your questions:  The urethritis that accompanies reactive arthritis usually is not usually due to infection, but urethral inflammation that is part of the aberrant immune system problem that also causes arthritis, conjunctivitis, and the typical skin rash experienced by some patients. As you found, it often doesn't respond to antibiotics, and my guess is that doxycycline also won't make much difference in any of your symptoms. Doxy is given not so much to control symptoms as to clear up any persistent infection that trigger for ReA is.

Although chlamydia is the most common trigger of ReA, it isn't the only one. Several infections of mucous membranes (genital, gastrointestinal, maybe oral) can trigger it. And chlamydia is rarely acquired by oral sex. Your ReA may have nothing at all to do with the commercial sex exposures you have described.

Presumably you are in the care of a rheumatologist. She or he is by far the best source of answers to your questions about long term management of ReA and all its symptoms. OTOH, if s/he still calls by the old name, I wonder if s/he is an older doc who hasn't got the word -- and maybe isn't up to speed on current management? If you have any doubt about it, getting a second opinion might be a good idea.

Good luck with it.

[arj123]

sorry ,it will be 7 months back, not 17 in second line of the post