Gono and Chlamydia Questions

[GonoMan]

I had sex w/ an escort 6 days ago, on withdrawal I noticed the condom was broken and realized why the last 5-10 seconds felt different.  I asked the escort about her STD status, she assured me she was clean and got regular screenings.  She was in her mid 40's.  Starting that evening, I began taking Avelox from a prev infection.  I took 4 does over 4 nights.  On day 5 I woke up with an erection and began masturbating.  I noticed a milky yellowish discharge at the tip of my penis prior to ejaculation.  I finished masturbating (ejaculate was yellowish white) and went to work.  I noticed discharge from my penis.  There was a yellowish underwear stain but unsure if that is from semen or if gonocal discharge.  I immediately took a 400mg Suprax from a prev infection and I went to my doctor for a CT/ NG screening.  Test results pending.  I've been wrapping toilet paper around my penis to verify discharge and notice some accumulation in the toilet paper when I check, however, it appears more cream colored when dried on the toilet paper. No other symptoms except increased urge to urinate.  I live in CA, and my doctor does not know I self medicated.  I remained in contact w/ the escort pleading w/ her to tell me if she was not 100% sure about her status because I didn't want to harm my partner.  She told me multiple times she was 100% sure I did not have to worry.  

Questions
1.Should I be worried about NG or CT?
2.Do you feel the milky discharge at the tip of my penis during masturbation and the 1 yellow stain are strong evidence to support NG?
3.Urine sample provided approximately 2.5 hrs after I took the Suprax.  Will my test results be accurate?  
4.Is the 4 doses of avelox and dose of Suprax sufficient treatment for NG, CT, & NGU?
5.  Assuming my test results are negative, when do you think it would be appropriate to resume unprotected sex with my partner.   7 days is recommended, but she does not know about this and has been wondering why we are not having sex.

[Edward W Hook, MD]

I hope you found my comments helpful. EWH

[shaken2core]

Thank you Sir for responding and the service you provide.  Take care Dr Hook, I hope I won't be posting here anymore.  

[Edward W Hook, MD]

You said it- final answers:

1. Is there a concern at this point that there may be something going on that was not tested for or was not erradicated by the antibiotics?  
No, no STD.

2. If so, do you still recommend a gram stain and urinalysis or is other testing preferrable?  
You've treated yourself for everything.  Nothing more to do.  

3.  If you don't think this is being caused by any virus or bacteria, what else could it be?  I've read a lot about anxiety induced symptoms but I feel strongly that this is not due to anxiety or guilt.  
I have no idea.  

4.  If I were your patient, would you advise me to return to unprotected sexual activity with my partner?
Yes

EWH

[GonoMan]

Doc, since I received another set of test results I wanted to do another follow up for you and others who are following this thread or may stumble upon it in the future.  Hopefully it will help calm the fears of others who might find themselves in the same situation.  

My second set of test results from the STD clinic were negative for Gono and Chlamydia, so it's probably safe to say I do not have either of those.  I've self medicated my self for NGU, Gono, Chlamydia, and Trich.  Sorry, after my first post I couldn't resist and treated myself with a 2g dose of Metronidazole.  So essentially I've had antibiotic treatment which may or may not have been enough to erradicate the above culprits.  So it seems the only thing that may be an issue is NGU, however my spontaneous discharge has stopped.  I've been checking and there are no stains in my underwear and when I go to the bathroom I place a single sheet of toilet paper over the tip of my penis and it's completely dry.  I know, I may sound like a nut case, but this stuff does crazy stuff to your mind.  

The only things that I'm left with at this point is the intermitent sharp pains in the urethra, like it's trying to discharge something.  This happens throughout the morning, day and night.  There is also the very present and obvious urge to urinate.  If I stand at the toilet and try to relax, nothing comes out, and if anything does, it's a very small amount.  Once I pull up my pants, I'll have the bad urge to go again in about 5 min.  

My question is, if you're willing to spend a few more minutes on me to share your thoughts.

1. Is there a concern at this point that there may be something going on that was not tested for or was not erradicated by the antibiotics?  

2. If so, do you still recommend a gram stain and urinalysis or is other testing preferrable?  

3.  If you don't think this is being caused by any virus or bacteria, what else could it be?  I've read a lot about anxiety induced symptoms but I feel strongly that this is not due to anxiety or guilt.  

4.  If I were your patient, would you advise me to return to unprotected sexual activity with my partner?

I know this thread has probably gone on long enough so I'll say it for you....."this will end this thread"

Thanks for all your help and answers thus far.

[Edward W Hook, MD]

thanks for the follow-up.

Syphilis is most unlikely. Your symptoms are not at all suggestive.

Regarding NGU, I am sorry they did not examine you.  On the other hand, they may have looked at your urine for white blood cells which are the sign of NGU that we look for - you could call and ask.  Either way, if this set of tests are negative, I think you can presume you are OK and resume sexual activity even though you may not know whether or not you were ever infected and cured by the meds you took or were not infected at all.  EWH

[GonoMan]

That is not encouraging but I guess I can't expect much if you have not examined me personally and run tests.  

Just an update and answers to your questions:

My doctor did not examine me, I requested a screening and he ordered it, all I did was provide a sample.  My results have come back and they show negative for NG and CT.  

I would say that I have spontaneous discharge, although now it appears to be clear.  I've noticed the toilet paper I wrap around my penis had discharge in it when I would go to the bathroom and check, and as I said before, It was drying to a cream color.  Today the discharge has been clear, doesn't have any color when dried, and is more liquid on consistency and does not accumulate on in the toilet paper, it soaks in.  I take this as a sign of things getting better?  I do gat a feeling in my urethra as if it's trying to eject discharge, but again, the discharge present is not as bad as yesterday.

I did go to a public STD clinic today and they did not examine me.  I was very surprised since they were a very large facility that touts AIDS and STD screening and prevention.  I was seen by a counselor that had me submit a urine sample for testing and that was all.  

If I could ask a few more questions:

Should Syphillis be a concern at this point?  

Given my test results are negative, and discharge appears to be going away, do you feel there is still the possibility of NGU and if so, what do you think would be the best way to test for it?  If there is a possibility of NGU, with the antibiotics I've taken, would the NGU causing bacteria still be contagious or do you feel this could be inflammation that will fade in time?  

Thanks for your help, I will follow up with my doctor if I continue to have issues, but I would greatly appreciate any additional input or answers to my questions.  

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help however your self-medication has complicated things and could potentially have deleterious effects on your test results making it difficult to interpret.  Overall, the chance of infection from any single encounter is low- most commercial sex workers do not have STDs and most exposures to STD infected partners typically do not result in infection.  On the other hand, in California where you live, the frequency of gonorrhea which are resistant to either quinolone type antibiotics (like Avelox) or to cefixime (Suprax) are a bit higher than in other parts of the U.S. and may comprise as much as 1 out of 20 gonorrhea infections.  Several other comments and then I will answer your questions:

The presence of a discharge during masturbation is difficult to interpret and is likely of little significance.  On the other hand, spontaneous discharge  is of concern.  When you saw your doctor did he/she see the discharge?  

If you were having the discharge at the time you were tested, your test results were probably accurate.

With regard to your specific questions:

1.Should I be worried about NG or CT?
I'm doubtful that you have either gonorrhea or chlamydia infection but it is difficult to tell.  

2.Do you feel the milky discharge at the tip of my penis during masturbation and the 1 yellow stain are strong evidence to support NG?
Probably not.

3.Urine sample provided approximately 2.5 hrs after I took the Suprax.  Will my test results be accurate?
Yes.
  
4.Is the 4 doses of avelox and dose of Suprax sufficient treatment for NG, CT, & NGU?
see above, possibly but not for sure.

5.  Assuming my test results are negative, when do you think it would be appropriate to resume unprotected sex with my partner.   7 days is recommended, but she does not know about this and has been wondering why we are not having sex.
If your tests are negative and you are not noticing a spontaneous discharge, things are probably safe and you can move forward. On the other hand, if you are continuing to have a discharge (spontaneously!!), then you should be evaluated, probably at a public health STD Clinic, were they can do a gram stain and re-test.

In the meantime, please do not mess things up further by taking additional antibiotics and do not repeatedly self-examine you as repeated self exams can be sufficiently traumatic as to cause discharge themselves.  EWH