Gonorrhea Help

[henchman]

I had unprotected sex with a women 2. weeks ago and a few days ago I started noticing a discharge from my penis, at first it was a thick white discharge and then one day it was actually green.  A little tingle experienced when urinating but no pain in my testicles or any other symptoms.

I went to the STD clinic and they took swab sample from my penis but at the time the discharge was barely visible, I also have a urine sample but it wasn't my first urination of the day.  They looked under the microscope at the lab to see if they could detect gonorrhea but it came back inconclusive as they could only see pus cells.  Nevertheless, I was given 1g Azithromycin which I took on 5th Sept.  The gonorrhea is going to take up to 3 weeks and so I was filled with too much anxiety to wait for the results, so I went to see a GP and told him my symptoms and he prescribed 400mg Cefixime (Suprax). I took the tablets in one dose but 2 days after I originally took the Azithromycin i.e. 7th Sept.  It's now 4 days since I took Azithromycin and 2 days since I've taken the Cefixime.

My questions are:

1. Should my symptoms have disappeared yet or how long will it take?
2. Is this combination of treatment still effective considering the recommended treatment is now ceftriaxone IM?  The GP suggested this treatment regime and the STD clinic said they only give the IM ceftriaxone treatment + azithromycin.
3. When my test results from the STD clinic come back in 2/3 weeks time, I'm suspecting they will be positive, but what should I then do, go back for another test and wait another 3 weeks?  I really don't want to wait that long and looking for alternative recommendations,
4. My girlfriend also received treatment as I had sex with her after having unprotected sex with someone else the day after and she gave me oral sex.  Will the treatment be effective for her?
5. The discharge has lessened and is more of a clear liquid than a pus/thick discharge, does this mean things are improving?

[Edward W Hook, MD]

The time is coming for this thread to end.   I need to be able to address otehr client's concerns. this will be the last answer, particularly as references your partner's health care as you should not insert yourself bewtween her communications wsith health professionals.

While studies may suggest that PID can be treated with azithromycin alone, that is not the regimen favored by the CDC or by me.

Estimates of how often chlamydial infection leads to PID are imprecise but most would accept a figure of 15-20%  

There is no reason to delay efforts to become pregnant because of a recent chlamydial infection.

This will end this thread.EWH

[henchman]

Many thanks.

[henchman]

That is very helpful thanks.

I read a study that suggested that treating acute PID with Azithromycin should also be considered as an effective and less complicated treatment.  Tests showed a success rate of 97% using Azithromycin alone (500mg for 1 day and then 250mg for 7 days).  Would you agree with this approach vs a more evasive treatment plan which involves multiple anti-biotic treatment?

Also, do you know how long it would take for Chlamydia to lead to PID and how likely it is?  I also read somewhere about 50-60% of women that contract Chlamydia develop PID, does that sound correct because it sounds awfully high?

Lastly, my girlfriend and I would like to get pregnant soon, do you advise against trying so soon after having Chlamydia or is there a decreased risk of getting pregnant after having Chlamydia?

[Edward W Hook, MD]

Despite your positive test, you are likely to have been cured by the therapy you received..  Treatment failures with azithromycin are rare but do occur.  Tests for chlamydia can remain positive for up to three weeks after successful therapy so your positive test for chlamydia may reflect either a treatment failure (less likely) or residual dead organisims (more likely). This being the case however, the most conservative approach to your positive test would be for both you and your partner to repeat treatment with either doxycycline, 100 mg orally twice daily or azithromycin 1.0 grams once again.  

chlamydia can cause a green discharge.  

PID is a cocnern and can be address by a repeat exam by your GF's GYN.

Hope this helps. EWH

[henchman]

Dear Doctor

I finally got my results back and I was negative for Gonorrhea and positive for Chlamydia.

I assume that the Azithromycin 1g would have cured me with relatively high success rate.

Given that I had green discharge from my penis (usually associated with Gonorrhea), should I be suspicious that I was negative or is it common to have green discharge from Chlamydia?  My initial test was urine sample and swab.

Lastly, my girlfriend was also treated at the same time with Azithromycin but she recently started developing slight discomfort in her lower abdomen and also a slightly different discharge with some odour but no other signs.  Should we be concerned that she has developed PID assuming she was also had Chlamydia (contracted by having sexual intercourse with me)?

[henchman]

Thanks Doctor Hook, that puts my mind at ease.

[Edward W Hook, MD]

I would not be concerned. My suspicion is that you are so concerned and fixated on possible symptoms that what you are noting is normal discharge that you've overlooked in the past, as do most men. EWH

[henchman]

Hi Doctor

I just wanted to ask you at what point should I be concerned about my symptoms not disappearing all together?

At the moment, its 5 full days after my treatment with cefixime and I still have a tiny bit of discharge once a day but its very watery and clear with a slight tingle when urinating.  So I'm just wondering if this is anything to be concerned about?

[henchman]

Thanks Doctor

[Edward W Hook, MD]

1.  A retest at least 21 days after your last dose of any antibiotic will provide accurate information about infection.  It takes this long because there can be remnants of dead bacteria which remain an can be detected by modern tests for that long after successful therapy.

2.  While not yet recommended or cleared by the FDA, the home tests are generally accurate.  They are not as well standardized or subjected to the same sort of quality-control oversight as clinic-based testing.

3.  The reports describe increasing resistance but not yet treatment failures with the therapies you’ve ha in heterosexual men and women.  The reports mostly deal with foreign countries (Japan in particular where the same case has been reported several times). In the U.S. concerns are mostly on the West Coast and in men who have sex with men.  Your risk of having failed therapy is less than 1%

4.  We typically recommend that partners wait at least 5-7 days following therapy to resume unprotected sex.  EWH

[henchman]

Dear Doctor

Thank you for your help.

Just a couple of other questions:

1. How long do you recommend I wait before being retested to ensure I will get an accurate reading that all is clear?
2. Do you know if any of the home testing kits are reliable?  I am referring to the ones where you provide a urine sample and post it back.
3. I've done a lot of research online (mainly out of anxiety) and there are several reports that gonorrhoea is fast becoming resistant to cepholosporins and that either a multi approach treatment is recommended or higher doses of the current drugs.  I just want to know how likely it is that I could have a resistant strain of the bacteria?
4. What would you recommend as the waiting period that I should abstain from sex after taking the cefixime and azithromycin? (Bearing in mind that I would still not have received my results until 2 weeks from now).

Many thanks in advance.

[Edward W Hook, MD]

Welcome to the Forum.  The discharge you had certainly does sound typical of gonorrhea although it could have conceivably been NGU as well, thus it is good that you were tested. Either way, the antibiotics you've taken will take care of you. The azithromycin given as part of gonorrhea therapy is for chlamydia which is commonly present simultaneously with gonorrhea.  The cefixime, which will almost certainly cure your gonorrhea, if that is what you had,  and is active by itself an does not have to be taken at the same time as the azithromycin.  

In answer to your specific questions:
1. Should my symptoms have disappeared yet or how long will it take?
They should have improved but sometimes it takes a few days for symptoms to completely resolve.

2. Is this combination of treatment still effective considering the recommended treatment is now ceftriaxone IM?  The GP suggested this treatment regime and the STD clinic said they only give the IM ceftriaxone treatment in the patient following delivery  + azithromycin.
In studies ceftriaxone gives slightly better cure rates than cefixime but for a heterosexual male, the difference is not meaningful.  Many clinics prefer knowing that the antibiotic is actually using an injection. Further, in the future, as gonorrhea treatment may evolve to only involve ceftriaxone but for now the cefixime is fine.

3. When my test results from the STD clinic come back in 2/3 weeks time, I'm suspecting they will be positive, but what should I then do, go back for another test and wait another 3 weeks?  I really don't want to wait that long and looking for alternative recommendations,
The gonorrhea test only takes a day or two.  I'm perplexed that the clinic will take that long to get results.  That said, if you have gonorrhea, I'm confident the meds you took will be curative.  

4. My girlfriend also received treatment as I had sex with her after having unprotected sex with someone else the day after and she gave me oral sex.  Will the treatment be effective for her?
Yes.

5. The discharge has lessened and is more of a clear liquid than a pus/thick discharge, does this mean things are improving?
See above. You are responding to therapy.

Take care.EWH