I am an expat living in Thailand. On the night of the 2nd of December 2006, I met up with an ex-girlfriend also a foreigner. We ended up sleeping together without protection, after having showed our respective Hiv tests which were negative. This was just a one night incident. Four days after the incident, I developed urethral itch, irritation after urination and ejaculation and a very slight clear discharge. I went to see a doctor for a gram stain test and a urinalysis. The results were negative for gonnorhea and chlamydia. The Urinalysis was normal...no elevated wbc or blood in urine. But the Urethral swab test came back with gram positive coccobacilli. I was treated with an injection of Ceftriaxone 500mg, one week of Roxithromycin 150mg twice a day. I also took a single dose of Zithro 2 grams and a single dose of Flagyl 2 grams (just in case). After a couple days off the antibiotics, I still felt slight irritation and discomfort, but not as severe and no discharge I waited one week to be off the antibiotics to go back for a follow up exam. The results were positive for gram positive coccobacilli and a slight increase in wbc count 3-5. The doctor this time administered me with Klacid MR 500mg (Clarithromycin) one tablet a day for a week. He also frightened me and said I should go to see a urologist and that it might be NSU. He also stated that the roxithromycin was inappropriate, this was done by his colleague. He was also worried about prostatitis, which I am sure it is not, as I had a bout of it 10 yrs ago. My questions are;
a. What is the proper treatment for gram positive coccobacilli?
b. How can it be NSU if the pathogen was identified?
c. Does gram positive coccobacilli come as a result of a partner with bacterial vaginitis?
d. What should be my next approach for treatment?
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You apparently had nongonococcal urethritis (NGU). About 30% of NGU cases are caused by chlamydia, but not in your case, given the negative chlamydia test. The other general conclusion is that either you have a provider who doesn't know much about STD, or you misunderstood his diagnosis and advice. The coccobacilli observed in your urethra have nothing to do with anything; they are normal bacteria. The treatments you have had have cleared up any significant infection you may have had, and any continuing symptoms are meaningless. The specific answers to your questions are:
a) No treatment is necessary for those bacteria.
b) I don't understand the question. The causes of most cases of NGU are uncertain, and there are no regularly available tests for any of the known causes other than chlamydia. But all of them respond to the antibiotics you have had.
c) They are normal bacteria, present from time to time (or all the time) in normal men's urethras.
d) You need no further treatment. You have nothing that will ever harm you or a future sex partner. Let it go.
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