Discharge after taking antibiotics

[Globetrotter123]

Dear Doctor,

Let me begin by providing you with some relevant history.  When I was 19 years old I contracted chlamydia.  It was treated with antibiotics.  Several years later I contracted chlamydia and gonorrhea.  Antibiotics were once again used to treat the diseases.  A couple of years have passed and again I find myself with STD symptoms.  Unfortunately I am currently in Asia and I have had difficulty getting tested and treated properly.  During mid December 2012 I noticed discharge from my penis.  I visited a pharmacy on December 18 and was prescribed 200 mg of Tarivid Ofloxacin pills to be taken twice a day for ten days.  I was told that this would take care of the infection, be it chlamydia, gonorrhea or both.  Two weeks after I commenced treatment the symptoms had not disappeared so I visited a local clinic on January 2, 2013.  After I explained the circumstance to the doctor, he injected 1 gram of Cefotaxime into my arm and pracribed me 100 grams of Cefixime pills to be taken twice a day for 5 days. He was certain this would cure me.  It has now been over 20 days since I visited the clinic and I still have symptoms.  The discharge has become thicker and the tip of my penis hurts a bit when I urinate (it began hurting a couple of weeks ago).  Unfortunately I am at a small island without a lab where my discharge can be tested and  I have lost faith in the local doctors with whom, due to the language barrier, I have a hard time communicating with.  What antibiotic/dose can I buy and be sure it will cure me?  What risk do I run if my condition is left untreated until April, when I'm scheduled to return home.   I masturbated and had protected sex while taking the antibiotics.  Is that significant?  Thank you for your time and help.

[Edward W Hook, MD]

Discharge present in the morning on awakening is often normal gneital secretions.

Further, having taken the medications you have describe, it is unlikely that your discharge represents an STD or that delay in treatment would lead to complicaitons.  EWH

[Globetrotter123]

Thank you for the response.  The treatments I have received have not affected the symptoms I am experiencing.  The symptoms are discharge from penis (particularly early in the morning after it builds up while I sleep) and a bit of pain while I urinate.  

In addition to the 2000 mg Metronidazole oral dose, would the re-treatment be another 250 mg Ceftriaxone injection plus how many days of 100 mg Doxycycline pills twice a day?

What risks do I run if the condition is treated properly only after I return home 2 months from now?

Thank you for your time and help.  

[Edward W Hook, MD]

Welcome to the Forum.  Your situation is unusual and it sounds like the cdoctors you have seen have done as well or better than most in their approach to your problem. The therapies you have received, while not quite the "optimal recommended therapy" would have cured most typical causes of urethritis related to STDs.  The recommended therapy for your situation would be to take a single 250 mg injection of ceftriaxone and then a single 1000 mg dose of azithromycin at the same time.  Your therapy while not quite this, would have covered most of the sorts of infections that are sexually transmissible.  If it had failed, the re-treatment with ceftriaxone plus doxycycline 100 mg twice daily, plus a single 2000 mg treatment with metronidazole is the recommended therapy for refractory urethritis.

Given how unusual your situation is, I find myself wondering if something other than an STD could be going on. did any of the therapies you have taken make any difference in your symptoms?

Once I hear a bit more detail form you , I suspect I will have further comments.  EWH