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Contagious Yet?
Drs., Thank you in advance for your help. This past Saturday night I had an alcohol fueled, mistake filled sexual encounter in which I had unprotected oral and vaginal sex with a call girl. The next day (about 13 hours later), I had unprotected vaginal intercourse with my girlfriend, in which I ejaculated inside her. My girlfriend and I had unprotected intercourse again the next day, but I did not ejaculate. Today (approx 2 1/2 days after risky encounter), I notice a small amount (one drop?) of clear/milky discharge just before urinating. I do not have any other symptoms as yet. I went to the clinic, and they took a urine sample for testing, and also gave me a shot of some antibiotic and prescribed a gram of oral zithromax. The healthcare provider said that if my labs come back positive, I have to tell my girlfriend, which of course I know and will do if that is the case. In the meantime, I have the following questions. Is their an incubation period during which time I could have been exposed but not yet contagious? From my web research, it looks like the only STD that could have shown symptoms so early is gonorrhea. Given that there was a very small amount of discharge that one time, it didn't smell, and it hasn't happened again, what are the chances it was not gonorrhea? Or to ask another way, if I had gonorrhea and was showing symptoms, would they likely be much more pronounced than what I've described. Many thanks.
MEDICAL PROFESSIONAL
Yes, I agree; in the presence of symptoms, even with such a short incubation period, if chlamydia were the cause the chlamydia test would be positive.
Thank you very much, Doctor. One last follow up question, I promise. If the discharge was a result/symptom of chlamydia infection, would chlamydia test still show negative at this early point even if it's already causing symptoms? In other words, if chlamydia test comes back negative, then is it safe to conclude that discharge was not a result or a symptom of chlamydia?
MEDICAL PROFESSIONAL
It's difficult for me to speculate on whether or not the basic diagnosis -- that you have (or had) urethritis of some sort -- is wrong or right. Such mild symptoms could mean nothing was really wrong at all. What did the doctor say? Was your discharge examined microscopically? Was there other evidence of inflammation, e.g. white blood cells microscopically or by a urinalysis dipstick test for leukocyte esterase? All these are normal and usual tests in evaluating men with suspected urethritis. I hope these were done. If not, I'm afraid you and your partner are going to be stuck (and I don't mean with antibiotic). Since you've been treated, there will be no way to go back and do any testing that would tell for certain. And I don't think you're going to want to take the risk of your partner developing potentially serious complications, or being diagnosed at a later time, to learn only then that she hadn't been informed of a possible exposure.
There are options for oral therapy for gonorrhea if your gf just can't handle the idea of an injection. She could be given cefxime 400 mg by mouth instead of the ceftriaxone shot, plus azithromycin as you had. Cefixime isn't ideal, not quite as reliable as ceftriaxone -- but still would be effective almost 99% of the time.
There are options for oral therapy for gonorrhea if your gf just can't handle the idea of an injection. She could be given cefxime 400 mg by mouth instead of the ceftriaxone shot, plus azithromycin as you had. Cefixime isn't ideal, not quite as reliable as ceftriaxone -- but still would be effective almost 99% of the time.
Doctor Handsfield, thank you for your reply. You are correct, not the answers I was hoping for. Two follow up questions. The discharge seemed so small, really looked like a small drop of semen, and hasn't repeated again. Still no other symptoms. Is there any possibility its not an infection? Also, my girlfriend HATES shots, so this is going to compound what will already be a huge insult and injury situation. Is there any oral alternative to the shot I was given?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
It sounds like you have urethritis -- urethral infection -- either gonorrhea, chlamydia, or nongonococcal urethritis (NGU). You are correct that the short time from exposure to symptoms -- apparently just 2-3 days? -- suggests gonorrhea. The mildness of your symptoms doesn't mean much one way or the other; you sought care promptly and it can take a couple of days for gonorrhea to become painful. You were prescribed exactly the right treatment to cover all three possibilities.
All three of these STDs -- for sure gonorrhea and chlamydia, and probably NGU -- are transmissible to partners almost immediately after catching them. You definitely exposed your girlfriend. Your doctor is only partly right about the need to inform her: you need to do it even if all your lab tests are negative. If you have gonorrhea, it probably will show up. But you were tested too soon for chlamydia; you could be infected but the test not yet positive. And treatment of partners is also necessary for NGU, which doesn't show up on any lab tests anyway.
So your girlfriend does need to be tested and treated. Her treatment should not await your test results or hers; regardless of either of your results, she'll need the same drugs you received.
I'm sure this isn't what you were hoping to hear, but I hope the information is helpful. Best wishes--
HHH, MD
It sounds like you have urethritis -- urethral infection -- either gonorrhea, chlamydia, or nongonococcal urethritis (NGU). You are correct that the short time from exposure to symptoms -- apparently just 2-3 days? -- suggests gonorrhea. The mildness of your symptoms doesn't mean much one way or the other; you sought care promptly and it can take a couple of days for gonorrhea to become painful. You were prescribed exactly the right treatment to cover all three possibilities.
All three of these STDs -- for sure gonorrhea and chlamydia, and probably NGU -- are transmissible to partners almost immediately after catching them. You definitely exposed your girlfriend. Your doctor is only partly right about the need to inform her: you need to do it even if all your lab tests are negative. If you have gonorrhea, it probably will show up. But you were tested too soon for chlamydia; you could be infected but the test not yet positive. And treatment of partners is also necessary for NGU, which doesn't show up on any lab tests anyway.
So your girlfriend does need to be tested and treated. Her treatment should not await your test results or hers; regardless of either of your results, she'll need the same drugs you received.
I'm sure this isn't what you were hoping to hear, but I hope the information is helpful. Best wishes--
HHH, MD
You are reading content posted in the STDs Forum
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