Did I get the right STD treatment?

[mudcreek]

Hi, I am a male, early 30's. While in Japan I visited a "******** bar" (a place where prostitutes service you orally at a booth) several times over a period of 3 days. I received unprotected oral sex from a total of 5 women. Nothing more. About 5 days after the first experience, I woke up with some discomfort. I had a small amount (maybe the size of a grain of rice) of white discharge in the morning, and some irritation with urination. This has continued for about a week, with the amount of discharge sometimes disappearing, and the irritation increasing (even though it hurts a lot less when I hydrate well).

I finally was able to visit a clinic today. The doctor could barely speak English and I cannot speak Japanese. I explained the problem. He asked me to pee in a cup. A few minutes later he said "there was some problem visible with the urine" but didn't explain further. Since I'm traveling, I couldn't submit to a long list of tests he wanted to run.

He ended up giving me a very painful shot in the backside (the shot didn't hurt, but my leg is still stiff and sore hours later) and told me to come back for 4 more over the next 4 days. I couldn't make out what the shot was. He also gave me levofloxacin 100 mg (3 per day for 10 days) and uro-vaxom 100 mg (1 per day for 10 days).

I am wondering what the shot could be. As far as I know, the only shot you would get for an STD would be penicillin, and that is just one shot. I am also wondering about the levoflaxacin, as it seems to be an alternative treatment to azithromycin; and the dose seems low (from what I'm readig 500 mg per day for 7 days is the usual dose). Finally, I have no idea what the uro-vaxom is for. NGU?

Thanks a lot for your help. As you can imagine I'm full of worry and discomfort, and being far from home and a doctor I can put my faith in is making things worse.

[Edward W Hook, MD]

As I understand it, rephrasing your question, you are asking if it is possible the you contaminated your tub of lubricant with an STD which then you could re-infect yourself with when you continue to use the lubricant. The answer is no. While I am unfamiliar with "Boy Butler", the microbes which cause STDs do not survive outside fo the body for long periods and thus the possible contaimiination of your lubircant should not concern you.  

Take care.  EWH

[mudcreek]

Thanks doc. I didn't go back for the other shots. Seems things are clearing up. The discomfort has largely gone away (with just a little tingling after the first urination of the day). No white discharge. If I squeeze a little I can sometimes get a very tiny amount of clear discharge, but I'm guessing that's normal or after effect.

If I may ask one more question I would truly appreciate it. I use a based lubricant for masturbation called "boy butter" sold in the US. It comes in a small tub. I have been using this same tub until I started noticing the discharge. Is there any danger of reinfecting by using this again? Obviously I won't be going to any more sex workers during my trip, so it would be nice to be able to help myself so to speak!

Thanks a lot Dr. Hook for the time and service you are providing here.

[Edward W Hook, MD]

There is an antibiotic called Amikacin which has some activity against gonorrhea.  It may have been used if the doctor was concerned that you had gonorrhea and that the gonorrhea you had was resistant to ceftriaxone, a phoenomen which has been rarely reported from Japan.  

My advice is to get re-evaluated by a health care provider you can speak with.  EWH

[mudcreek]

I called the clinic to ask them the name of the injection, but the best I could get was that it sounds like "amicasin" something like that. Wish I knew. Thanks.

[Edward W Hook, MD]

Sorry, I cannot answer that since I cannot be sure what medication you received.  Typically however a single shot of antibiotics is typically effective for gonorrhea.  EWH

[mudcreek]

Thanks doc. I usually follow doctors orders, but If I do not go back for the additional 4 shots, do you think it will be a problem? I simply cannot imagine getting four more of these very painful shots on top of the medicine I'm taking. I am, after all, supposed to be on vacation!

[Edward W Hook, MD]

Welcome back to our Forum.  The problem you describe sounds very much like non-gonococcal urethritis, a relatively common problem following receipt of oral sex or, alternatively, gonorrhea (although this is less likely, both on a statistical basis and from the description of your symptoms).

While there is no substitute for an examination and it is even better if communications between the patient and the doctor are clear, I suspect you have been treated appropriately.  The painful injection you received was likely a cephalosporin antibiotic such as ceftriaxone.  This, not penicillin, is now the preferred therapy for gonorrhea.  As for the other drugs, chlamydia is very rare following receipt of oral sex and the drugs you have received would likely be fine for non-chlamydial NGU. Uro-vaxom is not an antibiotic but is given to stimulate the immune response to urinary infection, if that is what is going on, it should not hurt you (it is used in Europe, not the U.S.).  Whether it will help of not in unknown.  

I think you have been well treated and anticipate the your symptoms will improve over the next few days.  If they do not, you shold be re-evaluated but, form what you describe, I suspect you will be fine. EWH