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Chlamydia - burning persists in the morning after treatment?
Hello,
I started having painful urination and a horrible itching sensation after having unprotected sex with a woman. I went to the doc for a urinalysis which came back positive for chlamydia. I was prescribed a dosage of Azimothrycin which cleared up all the symptoms, however approx. 10 days later I continued to feel a slight burning sensation in the tip of the penis when I urinate, but only in the morning. This sensation, although nowhere near as bad as what I experienced when I was diagnosed, continued to persist after treatment.
Approx. 10 days after I took the Azithromycin, I went back to the doc to get this checked out. I have not had any sex since my first diagnosis, and a second urinalysis came back negative for infection, ghonnorea and chlamydia. The slight burning in the tip when I pee in the morning is still there. The doc recommends a referral to a urologist, but unfortunately I had to leave town for an extended business trip and would not be able to take care of that until I get back.
Is this morning burning normal and something that I had just not noticed until I got chlamydia? Is it possible my second urinalysis for Chlamydia was a false negative? Is my mind just playing tricks on me now since I am overly paranoid?
I started having painful urination and a horrible itching sensation after having unprotected sex with a woman. I went to the doc for a urinalysis which came back positive for chlamydia. I was prescribed a dosage of Azimothrycin which cleared up all the symptoms, however approx. 10 days later I continued to feel a slight burning sensation in the tip of the penis when I urinate, but only in the morning. This sensation, although nowhere near as bad as what I experienced when I was diagnosed, continued to persist after treatment.
Approx. 10 days after I took the Azithromycin, I went back to the doc to get this checked out. I have not had any sex since my first diagnosis, and a second urinalysis came back negative for infection, ghonnorea and chlamydia. The slight burning in the tip when I pee in the morning is still there. The doc recommends a referral to a urologist, but unfortunately I had to leave town for an extended business trip and would not be able to take care of that until I get back.
Is this morning burning normal and something that I had just not noticed until I got chlamydia? Is it possible my second urinalysis for Chlamydia was a false negative? Is my mind just playing tricks on me now since I am overly paranoid?
MEDICAL PROFESSIONAL
Welcome to the forum.
Persistent mild symptoms are not all that unusual at 10 days. I recommend you give it another week or so. If it gets worse, if you also develop any discharge, or the discomfort persists, then additional treatment for persistent urethritis probably would make sense. Usually that would be doxycycline for 7 days plus a single dose of metronidazole or tinidazole. Also, continue to hold off on having sex until this is sorted out. But do give it a bit of time; most likely the discomfort will fade away.
Persistent urethritis doesn't usually mean failure of chlamydia treatment, but that other undiagnosed infection(s) also were present. In the meantime, don't worry too much. This isn't a serious problem; nonchlamydial urethritis has no known complications or long term health problems.
Come back with a follow-up comment in a few days and let me know how thugs are going.
Regards-- HHH, MD
Persistent mild symptoms are not all that unusual at 10 days. I recommend you give it another week or so. If it gets worse, if you also develop any discharge, or the discomfort persists, then additional treatment for persistent urethritis probably would make sense. Usually that would be doxycycline for 7 days plus a single dose of metronidazole or tinidazole. Also, continue to hold off on having sex until this is sorted out. But do give it a bit of time; most likely the discomfort will fade away.
Persistent urethritis doesn't usually mean failure of chlamydia treatment, but that other undiagnosed infection(s) also were present. In the meantime, don't worry too much. This isn't a serious problem; nonchlamydial urethritis has no known complications or long term health problems.
Come back with a follow-up comment in a few days and let me know how thugs are going.
Regards-- HHH, MD
A related discussion, Persistent pain during and after urination after STD's medication was started.
MEDICAL PROFESSIONAL
On rereading the earlier discussion, I'm more puzzled. Chlamydia failing the recommended 1 gram dose of azithromycin is one thing, but 2 grams is something else. That dose has never been carefully studied against chlamydia, but I would think it would be virtually 100% effective. This makes me lean more toward the false positive test. Still, to be safe you definitely should take doxycycline or similar drug (minocycline, tetracycline, etc).
I suppose another possibility is a bad batch of azithromycin (the second time), but I have never heard of that happening.
Let me know how things go after you have been treated with doxy. By the way, tetracyclines are less likely than azithromycin to fail. Assuming your symptoms clear up, hold off on repeat testing until at least a month after your last dose of doxy.
I suppose another possibility is a bad batch of azithromycin (the second time), but I have never heard of that happening.
Let me know how things go after you have been treated with doxy. By the way, tetracyclines are less likely than azithromycin to fail. Assuming your symptoms clear up, hold off on repeat testing until at least a month after your last dose of doxy.
MEDICAL PROFESSIONAL
I'm not sure I understand the sequence. "Urinalysis" doesn't usually mean a chlamydia test. Are you sure your urine was actually tested for chlamydia 6/29 and 7/12? The wording seems to suggest that the first follow-up test (6/29) was negative and the next (7/12) was positive. Is that right? If so, your "Is it unheard of" question is on the right track: azithromycin is around 95% reliable in curing chlamydia, and sometimes that shows up with a negative test followed by a new positive one.
However, there is another possibility. It is recommended that follow-up chlamydia testing never be done sooner than a month after treatment. The test measures chlamydial DNA, not the organism itself. The organism can be killed but DNA can persist at detectable levels for a few weeks. And such tests may be intermittently positive, just as yours were.
On balance, since your symptoms have persisted, I suspect you are just one of the unlucky few in whom azithromycin doesn't cure chlamydia. For sure you didn't reinfect yourself from your underwear; that's impossible. You'll never know the exact reason, but to be safe you should be re-treated with doxycycline (or other tetracycline-class antibiotic). Discuss it with your doctor or clinic.
However, there is another possibility. It is recommended that follow-up chlamydia testing never be done sooner than a month after treatment. The test measures chlamydial DNA, not the organism itself. The organism can be killed but DNA can persist at detectable levels for a few weeks. And such tests may be intermittently positive, just as yours were.
On balance, since your symptoms have persisted, I suspect you are just one of the unlucky few in whom azithromycin doesn't cure chlamydia. For sure you didn't reinfect yourself from your underwear; that's impossible. You'll never know the exact reason, but to be safe you should be re-treated with doxycycline (or other tetracycline-class antibiotic). Discuss it with your doctor or clinic.
Dr. Hansfield,
A final follow up: the results of the latest urinalysis came back positive for Chlamydia trachomatis.
6/19 - initial urinalysis, positive for Chlamydia. Prescribed 1g of Azithromycin
6/29 - symptoms generally better but still persist. Second urinalysis all negative
7/12 - symptoms still persist, third urinalysis taken
7/19 - results returned positive for Chlamydia
How is this possible? I have not had any sex or sexual contact since my initial positive result. Only masturbation by myself. Is it unheard of for chlamydia to "hide out" and return? Or perhaps the first dose of antibiotics was just not enough and the second urinalysis was a false negative by some fluke? Did I drink too much water before the second urinalysis? Am I getting reinfected by my underwear or something?
Thanks in advance for your insight. I know these are a lot of questions, but I'm just trying to get to the root of the problem here.
A final follow up: the results of the latest urinalysis came back positive for Chlamydia trachomatis.
6/19 - initial urinalysis, positive for Chlamydia. Prescribed 1g of Azithromycin
6/29 - symptoms generally better but still persist. Second urinalysis all negative
7/12 - symptoms still persist, third urinalysis taken
7/19 - results returned positive for Chlamydia
How is this possible? I have not had any sex or sexual contact since my initial positive result. Only masturbation by myself. Is it unheard of for chlamydia to "hide out" and return? Or perhaps the first dose of antibiotics was just not enough and the second urinalysis was a false negative by some fluke? Did I drink too much water before the second urinalysis? Am I getting reinfected by my underwear or something?
Thanks in advance for your insight. I know these are a lot of questions, but I'm just trying to get to the root of the problem here.
MEDICAL PROFESSIONAL
Welcome back.
I also question the wisdom of gentamicin in this situation. It is not active against any of the known causes of urethritis; it would work against gonorrhea, but that isn't a realistic possibility.
As for toxicity, you are correct that gentamicin isn't the safest of antibiotics. But side effects are virtually unheard-of after single dose or only 1-2 days treatment. All the bad problems (kidney damage, inner ear problems like vertigo or hearing loss) occur after several days or several weeks of treatment, and at high doses. You needn't worry about it.
If your urethral discomfort continues, the recommended approach would be 1) to determine whether actual urethritis can be documented (abnormal discharge, increased white blood cells in the urethra) and, if documented, to treat with doxycycline plus metronidazole (Flagyl is the most common trade name).
In any case, don't worry about long-term or serious health effects. None are known from persistent or recurrent non-chlamydial urethritis. It is an issue of comfort only. So don't freak out while you wait to see how things go.
I also question the wisdom of gentamicin in this situation. It is not active against any of the known causes of urethritis; it would work against gonorrhea, but that isn't a realistic possibility.
As for toxicity, you are correct that gentamicin isn't the safest of antibiotics. But side effects are virtually unheard-of after single dose or only 1-2 days treatment. All the bad problems (kidney damage, inner ear problems like vertigo or hearing loss) occur after several days or several weeks of treatment, and at high doses. You needn't worry about it.
If your urethral discomfort continues, the recommended approach would be 1) to determine whether actual urethritis can be documented (abnormal discharge, increased white blood cells in the urethra) and, if documented, to treat with doxycycline plus metronidazole (Flagyl is the most common trade name).
In any case, don't worry about long-term or serious health effects. None are known from persistent or recurrent non-chlamydial urethritis. It is an issue of comfort only. So don't freak out while you wait to see how things go.
Dr,
Thanks for your comment. I just wanted to follow up on this one. My symptoms continued to persist 24 days after taking the Azithromycin. Unfortunately I am overseas on business, so I went to an international clinic that they have here in town. The doctor here took a urinalysis, gave me two shots of 80mg Gentamycin, another does of 2g Zithromax and sent me on my way. He said it should clear up whatever I have and to call back in a few days to check the result of the urinalysis.
Obviously this seems backwards to me, but I'm more concerned now about the shots of Gentamycin I received. I looked it up to see what it was and it appears to have some serious side effects. Is this something I should be concerned about? If this warrants a separate thread, I will gladly open one.
Thanks in advance.
Thanks for your comment. I just wanted to follow up on this one. My symptoms continued to persist 24 days after taking the Azithromycin. Unfortunately I am overseas on business, so I went to an international clinic that they have here in town. The doctor here took a urinalysis, gave me two shots of 80mg Gentamycin, another does of 2g Zithromax and sent me on my way. He said it should clear up whatever I have and to call back in a few days to check the result of the urinalysis.
Obviously this seems backwards to me, but I'm more concerned now about the shots of Gentamycin I received. I looked it up to see what it was and it appears to have some serious side effects. Is this something I should be concerned about? If this warrants a separate thread, I will gladly open one.
Thanks in advance.
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