Confusion About Oral Sex Transmission, Penile Discharge and More!

[thestevester]

I've been receiving and giving unprotected oral sex from multiple women (all white, middle to upper middle class, know them personally, no drug use, all healthy individuals; two of the several are very promiscuous but "almost never swallow" and always use protection when having penile/vaginal intercourse) over the past several weeks. Two have had strep throat recently. I use a condom during sex. I have a narrow urethra and had surgery on my left testicle for hydrocele/hernia when 12. A sensitive system.

I have been waking up the last few days with a discharge (it's almost always clear and sticky; in the morning it looks a little cloudy and is slightly larger in volume than throughout the day but I think it's because it's clear and I can see the color of my skin through it, making it look cloudy when at my pee slit); no pain or burning in my urethra when I urinate (if there's anything there's a little tenderness). Slight tightness in left testicle which I usually have anyway. I almost always have to squeeze and force out the discharge from the lower regions in my urethra and then when it comes up it's almost non-existent in amount.

I just started a Z-Pack. After three days, the discharge is still there.

I had chlamydia when I was in my early 20's, accurately diagnosed via culture, and I was WRITHING IN PAIN, pissing pus and miserable. I'm assuming if I had The Clap I would be in just as bad or worse condition.

1. Could this be The Clap, given my history and reaction to chlamydia, and, if so, will a z-pack cure it?
2. If chlamydia doesn't live in the mouth, and The Clap is probably not what I have (I don't think it is given how disgusting the discharge is and the symptoms of it), then what, if any, kind of infection could I have?
3. Is a z-pack a good thing to be on given these circumstances?
4. If discharge continues, won't a culture prove inconclusive because I've been on them and then if so, what to do?

THANK YOU!

[Edward W Hook, MD]

Yes, I did miss that. That would cure gonorrhea.  Sorry. EWH

[thestevester]

You told me to take one full dose of 2,000 mg; I did that on Friday. Did you miss that? Not being flippant; just curious. :-)

[Edward W Hook, MD]

Testing is the only way to be sure you are no longer infected and as I've already said, the way you are taking the azithromycin in not the recommended approach to gonorrhea treatment.  Nonethless it is likely to be effective.  

The absence of discharge makes it less likely that you are infected (if you ever were) but is not definitive.  Testing is definitive. EWH

[thestevester]

Dr. Hook,

Just to make sure I'm o.k. (I keep hearing about there being azithromicin-resistant strains of the Clap, even though I never had anything more than a extremely light discharge, no fever, no real tenderness in my testicles, no burning when I urinate and minor tenderness in my urethra), I have taken so far:
Wednesday: 500 mg of azithromicin
Thursday: 250 mg of azithromicin
Friday: 250 mg, then 2,000 mg (2G) of azithromicin
Saturday: 500 mg of azithromicin
Sunday: 500 mg of azithromicin
As of this morning (Sunday), while my urethra is still irritated, there is no longer any discharge. I am going to take 250 mg tomorrow and Tuesday to be sure.

1. Is this enough to kill even an azithromicin-resistant strain of The Clap, which I doubt I had anyway? I'm assuming when the literature online states there are these resistant strains out there, they mean against the 2G dose (which they quote): but resistant to the amount of azithromicin I've taken?

2. If no discharge comes back, I can assume I am clean?

That will for sure be the end for this post. I assume you'll forgive my last promise of "ending it": thank you for being so wonderful, informative and helpful! :-)

[Edward W Hook, MD]

As you wish:

1. I have two more z-packs: Dr. Hansfield, in a forum post on z-packs and gonorrhea, said that azithromycin will kill the clap but the dosage needs to go a few more days than the typically z-pack length of time. Should I take another one after this one to ensure I kill whatever it is I have?
If you choose to take additonal azithromycin, I would take a singe dose of 2.0 grams (2000 mg). This is the recommended dose for gonorrhea and twice the recommended dose for doxycycline.

2. I don't understand how, after having chlaymedia, which is not nearly as severe symptomatically as the clap, you can state that the severity can be low to high IN ME specifically. I've had NGUs before which were of the low severity in symptoms that I currently have and chlaymedia once which was SEVERE. Please readdress how, given these facts, the clap would potentially not be as severe as, chlaymedia in me specifically?
Every person and every infection is different. If you got chlamydia again it might bemore or less severe. thats a fact!!!

3. The day before I got this discharge, I masturbated 4 times to orgasm and it was vigorous and then I also had sex that night. Could I have damaged my urethra and THAT'S what's causing this? If so, will a z-pack help?
Certainly trauma can irritate the urethra and this may be a contributor.  if this is the case antibiotics are not needed, just time to heal.

4. None of these women have throat discomfort and the ones that had strep had it three weeks to a month or so ago. Wouldn't they have a foul smell and/or throat pain from their throat?
No. the mouth has more bacteria in it than any other place on the body.   There are lots of bacteria there and introduction through oral sex is a chance event.  You could get NGU from someone who had just gargles and brsuhed their teeth.  

5. How common is the clap and in what social groups is it typically found?
Gonorrhea can occur in any social group but is more common among members of lower socio-economic status and minorities.  

EWH

[thestevester]

I greatly appreciate your prompt response: I actually wanted answers to my specific questions, which your post answered somewhat. If I may, I'd like to, with this new information you've presented, ask a few more specific questions which I would appreciate you'd answer directly? This will be the last go around for me question-wise:
1. I have two more z-packs: Dr. Hansfield, in a forum post on z-packs and gonorrhea, said that azithromycin will kill the clap but the dosage needs to go a few more days than the typically z-pack length of time. Should I take another one after this one to ensure I kill whatever it is I have?
2. I don't understand how, after having chlaymedia, which is not nearly as severe symptomatically as the clap, you can state that the severity can be low to high IN ME specifically. I've had NGUs before which were of the low severity in symptoms that I currently have and chlaymedia once which was SEVERE. Please readdress how, given these facts, the clap would potentially not be as severe as, chlaymedia in me specifically?
3. The day before I got this discharge, I masturbated 4 times to orgasm and it was vigorous and then I also had sex that night. Could I have damaged my urethra and THAT'S what's causing this? If so, will a z-pack help?
4. None of these women have throat discomfort and the ones that had strep had it three weeks to a month or so ago. Wouldn't they have a foul smell and/or throat pain from their throat?
5. How common is the clap and in what social groups is it typically found?

That's it I swear! THANK YOU DOC!

[Edward W Hook, MD]

Welcome to our Forum. Usually I address questions one-by-one but in this case I think a single, hopefully more comprehensive answer will, be more helpful to you.  It does sound like you have urethritis (penile inflammation) and, given that most of your genital exposures have been protected, most probably from receipt of oral sex.  So, what could be causing it?  The answer is that you might have gonorrhea or NGU (non-gonococcal urethritis) .  While many people equate NGU with chlamydia, the fact is that most NGU is caused by organisms other than chlamydia and almost no NGU associated with oral sex is chlamydial in origin.  

NGU is best diagnosed with a swab specimen taken from the penis at least an hour after last urination. On occasion microscopic evaluation of urine collected just as a person begins to urinate can serve the same purpose but the swab is the preferred  approach.  With either method, one is not looking for bacteria but for white blood cells which are a sign of inflammation.  It is the signs of inflammation, manifest as increased numbers of white blood cells, which are the basis for the diagnosis of NGU.

Further, I would add that both NGU and gonorrhea can cause anything from very mild to severe symptoms so the severity of your symptoms is not much help.

The recommended therapy for NGU is either a single 1.0 gram dose of azithromycin or doxycycline, 100 mg orally, twice daily for 7 days.  The Z-pack is the right drug but may not be the right dose.  My advice would be to go get checked for gonorrhea and NGU.  After that, therapy with doxycycline, given your modest response to azithromycin might be the way to go.

I hope this helps. EWH