Conundrum

[mvkl22a]

I had protected vag sex with a woman of high chance of STD 8 wks ago. 10 days later, I saw a clear penile discharge and I went to the ER. They did a culture for gonorrhea and chlymidia and gave a single dose of cipro and zithromycin and 28 days combivir and viread for HIV exp. After the cipro and zithro, I still felt discharge. The chlym and gonorr tests were neg and I saw an internist. She gave me an HIV PCR test which was neg, noticed a fungal infection with the discharge. A urologist gave me 10 days of doxycycline and metronidazole and did another chlaym, gonorr and NGU test. I also saw an infect diseases doc who did herpes and HIV test. Tests were neg. However, after the doxycyc and metronidaz, I still had the discharge and the fungal infection. Urologist gave another 10 days of metronidaz and a urine dye to see if it's just urine. It's not urine, still clear discharge and I am 5 days through the second dose of metronidaz; I still see the discharge. My concern is not HIV, mentioned that in case the combiv and vir could have caused the discharge or the metronidaz not to work. Concern is discharge and not knowing the cause. While my doctor has not been able to test for trich, he said the metronidaz would have cured it. Describing the clear discharge better, a few drops every 4 hrs or so, and if I have not masturbated for a few days, more comes out in the few days after masturbation. I can feel it slowly collecting through my penis. I am not circumsized. Urologist checked prostate, it's fine; I am only 23. Is it another STD not checked for, like syphilis?

[mvkl22a]

My doctor did a prostate massage a few weeks ago; after which I felt some burning and inflammation, however there seemed to be less discharge. My doctor did a urine test which came back positive for pseudononas aeruginos as a uti. I was given two weeks of cipro which I'm close to finishing. However, I feel more discharge now, it's a little cloudier and while i don't feel as much burning and inflammation, I still feel slight burning. I'd appreciate your diagnosis.
Thanks

[H. Hunter Handsfield, M.D.]

With apology, I really cannot help much.  Had you been a patient in my STD clinic, we would have referred you to a urologist ourselves; the STD world  has no answers to the sort of problems you describe.

The problem clearly started as nonchlamydial nongonococcal urethritis (NGU).  In a minority of such cases, symptoms persist such as you describe despite treatment for all possible causes.  Most likely there is no residual infection at all; some sort of non-infectious inflammatory reaction probably is responsible.  If so, no antibiotic will clear it up.  The same is true if the problem has evolved into chronic prostatitis; most such cases probably also are not due to infection and don't respond to antibiotics.

However, there is no evidence the condition is harmful in any way, i.e. no risk of complications like urethral stricture or infertility, nothing to transmit to a partner or to cause any kind of harm to a future sex partner.  Over time, the symptoms seem to resolve in most men. Although trials of antibiotic therapy are reasonable, there is no point in continuing them repeatedly.

The bottom line is that you need to continue to follow your own providers' advice; it sounds like they are on exactly the same track that I am.  If in doubt, return to the urologist for possible further diagnostic tests or treatment trials.

Good luck--  HHH, MD