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Gonorrhea doesn't want to clean up...
I live in Thailand at the moment and contracted Gonorrhea at the 1st of December 2009 from a Thai sex worker who gave me a ******* without condom. Since then I had a burning sensation on the tip of my penis (no discharge). I didn't worry too much about it because I had the same symptoms already two times before last year and I just received some antibiotics from the doctors and it got better (they didnt find anything).
I visited Germany over Christmas and went to a STD doctor to get checked and they analyzed a sperm sample and found Gonorrhea and recommended that I should get a 1000mg Ceftriaxone injection.
I read online (I know I shouldn't do this) that 400mg Cefixime would clear up my infection too and took it. The burning stopped for a day but then came back. So I went to the hospital explained them my situation and received a 500mg shot of Rocephin and the doctor gave me a course of Ciprofloaxin. After one day and bad adverse effects (nightmares, insomnia, weird sensations in my arms, dizzyness) I decided to stop taking Ciprofloaxin.
I told the doctor about this and he said the shot should be enough to clean this up. The burning got a bit better again but came back after 2 days. So I went to another hospital and got my 1000mg shot of Rocephin and they checked my urine for Gonorrhea but the test came back negative. The doctor didn't tell me to wait an hour between giving the sample and my previous urination though. So I'm not sure if the negative result is conclusive or not ( I had about 40 minutes between my sample and the previous urination).
This was last Tuesday and I take Azithromycin 500mg in the morning and evening since then. It seems the burning gets a bit better now.
Other than the burning I have no symptoms of disseminated gonorrhea. What's the next step if the burning remains? Is there cephalosporin antibiotic resistant gonorrhea? Can a blood culture show which antibiotic works? What else could this be, should I do?
I visited Germany over Christmas and went to a STD doctor to get checked and they analyzed a sperm sample and found Gonorrhea and recommended that I should get a 1000mg Ceftriaxone injection.
I read online (I know I shouldn't do this) that 400mg Cefixime would clear up my infection too and took it. The burning stopped for a day but then came back. So I went to the hospital explained them my situation and received a 500mg shot of Rocephin and the doctor gave me a course of Ciprofloaxin. After one day and bad adverse effects (nightmares, insomnia, weird sensations in my arms, dizzyness) I decided to stop taking Ciprofloaxin.
I told the doctor about this and he said the shot should be enough to clean this up. The burning got a bit better again but came back after 2 days. So I went to another hospital and got my 1000mg shot of Rocephin and they checked my urine for Gonorrhea but the test came back negative. The doctor didn't tell me to wait an hour between giving the sample and my previous urination though. So I'm not sure if the negative result is conclusive or not ( I had about 40 minutes between my sample and the previous urination).
This was last Tuesday and I take Azithromycin 500mg in the morning and evening since then. It seems the burning gets a bit better now.
Other than the burning I have no symptoms of disseminated gonorrhea. What's the next step if the burning remains? Is there cephalosporin antibiotic resistant gonorrhea? Can a blood culture show which antibiotic works? What else could this be, should I do?
Thanks a lot for your comments. They helped me a lot, and made me realize some mistakes I probably made. Whatever I have got better today again so I'm optimistic to get good again in the coming days.
I should have used a condom in the first place, confirmed the gonorrhea result the German doctor gave me in Bangkok right away (before getting the Rocephin and Cefixime), taken Azithromycin or whatever else works for NGU and I would probably be fine by now.
I should have used a condom in the first place, confirmed the gonorrhea result the German doctor gave me in Bangkok right away (before getting the Rocephin and Cefixime), taken Azithromycin or whatever else works for NGU and I would probably be fine by now.
MEDICAL PROFESSIONAL
That the antibiotics aren't working is good evidence against an infection as the cause of your symptoms. Clearly you no longer have gonorrhea (and maybe never did -- see my comments above), and probably you have nothing serious at all, nothing that will harm your health in the future. It seems an overreaction to fly to Europe for this reason; I doubt even the top clinics and experts anywhere in the world would find anything different or have different advice than you are finding in Thailand.
That's my last comment. This thread is over.
That's my last comment. This thread is over.
And yes I do all this under a doctors supervision. The last question is just that I have something to suggest to the doctor. I'm aware that there are good Thai doctors to treat me. I just feel I didn't find the right one yet. I just always received rocephin and cipro and after some talks azithromycin which seems to help now.
I live in Bangkok and was visiting doctors there. I will take both now and see how it goes. One last question if the problem persists what kind of tests would be the next in line given the burning remains and I'm tested negative to gonorrhea and chlamydia when I return to Bangkok. I want to avoid flying to Germany to get treated.
Ok sure I understand. I have been seeing doctors of course but they gave me always Cipro. The doctor in Germany specializes in Stds so I think he knows what he does. The problem is just that I'm in Thailand and couldn't find a doctor that seems to know how to treat this. I will stick to cefixime and see how I go and in the worst case fly to Germany for further treatment I guess.
MEDICAL PROFESSIONAL
Sorry for the confusion; I thought you had returned to Germany.
No harm would likely come from taking both cefixime and azithromycin, but I doubt you need the cefixime -- and you may not need azithromycin either. But that's as much as I can say. I suggest again that you see a physician or clinic in person. Fortunately, excellent STD services are available in Thailand.
No harm would likely come from taking both cefixime and azithromycin, but I doubt you need the cefixime -- and you may not need azithromycin either. But that's as much as I can say. I suggest again that you see a physician or clinic in person. Fortunately, excellent STD services are available in Thailand.
Just been to the hospital here in northern Thailand (I'm on vacation this week) and they can only do gonorrhea tests from the discharge (no NCAA test). So I can't get tested. Is it possible to take Cefixime and Azithromicyn at the same time? Right now it does get better I just don't know why and don't want to screw the progress by taking the wrong medicine.
MEDICAL PROFESSIONAL
I'm confused. Are you going on line to find testing services? Or are you seeing a qualified physician or clinic in person? If on line without professional advice, and they test semen ("sperm"), this is very weird and I would not trust it -- and you probably are paying a lot of money, perhaps for tests you don't need. If you are being evaluated by a personal health care provider, you're going to need to address further questions there. Perhaps different standards exist in Germany, so I cannot comment further.
Symptoms that resolve within a few hours of treatment indicate a placebo effect. No antibiotic can work that quickly. This reinforces my suspicion that at this point, you have no continuing infection -- regardless of whether or not you had gonorrhea to start.
I will not advise any particular treatment. A forum like this cannot provider personal treatment or prescribing advice.
In summary, you're going to need to rely on your own physician or clinic. I'm sorry this forum cannot help you further.
Symptoms that resolve within a few hours of treatment indicate a placebo effect. No antibiotic can work that quickly. This reinforces my suspicion that at this point, you have no continuing infection -- regardless of whether or not you had gonorrhea to start.
I will not advise any particular treatment. A forum like this cannot provider personal treatment or prescribing advice.
In summary, you're going to need to rely on your own physician or clinic. I'm sorry this forum cannot help you further.
I'm not sure about Chlamydia testing but will get tested on this today as well. I guess azithromycin should have cleared it up by now. I never expected to have it because I had only oral sex.
Thank you for your quick reply. I had a similar test done with a sperm sample 6 month ago. They usually test on many different Stds but I can not say what tests were performed. I guess a sperm culture because I had to wait 12 days for test results.
What surprises me is that I had these symptomes already twice last year and it would have laways been from short episodes of oral sex. My main problem is that I feel lost here and wherever I go I get the standard pack of pills usually with Cipro and get sent home.
I switched to cefixime yesterday again because I thought I already had enough Azithromycin. That's probably stupid given what you wrote that this might be GNU. Right now the burning is better than ever but I can't say if its because of azithromycin or cefixime.
Yesterday morning the burning was bad again then I took Cefixime and it almost dissappeared in the afternoon and evening. Does cefixime work so quick? I plan to do a urine test today again. Would the result be valid even though I'm on antibiotics?
I would love to stop taking all these pills. Somewhere I think I read that multi resistant gonorrhea stains can't be detected with urine tests. Is that the case? How would you suggest should I proceed?
What surprises me is that I had these symptomes already twice last year and it would have laways been from short episodes of oral sex. My main problem is that I feel lost here and wherever I go I get the standard pack of pills usually with Cipro and get sent home.
I switched to cefixime yesterday again because I thought I already had enough Azithromycin. That's probably stupid given what you wrote that this might be GNU. Right now the burning is better than ever but I can't say if its because of azithromycin or cefixime.
Yesterday morning the burning was bad again then I took Cefixime and it almost dissappeared in the afternoon and evening. Does cefixime work so quick? I plan to do a urine test today again. Would the result be valid even though I'm on antibiotics?
I would love to stop taking all these pills. Somewhere I think I read that multi resistant gonorrhea stains can't be detected with urine tests. Is that the case? How would you suggest should I proceed?
MEDICAL PROFESSIONAL
Welcome to the STD forum.
There are some atypical features here that make me wonder whether you really had gonorrhea. It is uncommon to have gonorrhea only with penile burning; discharge of pus from the penis usually is present. Also, did your doctors really have you masturbate to produce semen for gonorrhea testing? Why? That is not the normal way to diagnose gonorrhea or any other STD, and to my knowledge the tests have not been validated for use on semen. They have been studied only for genital swab specimens and urine. So I have to wonder a bit about the reliability of the positive test result. Can you provide more information about it, i.e. the exact test that was done, and whether testing was also done on a urethral swab or urine?
But let's assume you did indeed have gonorrhea. If so, you were cured with the ceftriaxone. You were given 4 times the normal dose, but that might have made sense, given the possibility that the previous treatment in Thailand had apparently failed to cure you. (The cefixime made no difference. It is less potent against gonorrhea than ceftriaxone.) In any case, it cured you. The current gonorrhea lab tests are highly reliable; even though the test is technically supposed to be done at least an hour after urinating, it actually makes little if any difference.
Therefore, almost certainly something other than gonorrhea explains the symptoms that continued after ceftriaxone. Improvement with azithromycin suggests possible chlamydia or nongonococcal urethritis (NGU). Chlamydia is rare after oral sex, so NGU is more likely. The cephalosporin antibiotics (ceftriaxone, cefixime, and others) and ciprofloxacin have no activity against chlamydia and NGU, but azithromycin is one of the drugs of choice -- so this is a plausible explanation. (Usually chlamydia testing is done automatically along with gonorrhea. Were you tested for it?
Gonorrhea strains resistant to the cephalosporin antibiotics (ceftriaxone, cefixime, etc) have begun to emerge in Japan and Korea. Such strains might have spread to Thailand, although that has not been reported.
There is no basis for concern about disseminated gonorrhea, which is rare, and causes fever, acute arthritis, and a certain kind of skin rash. You don't have it. A blood culture would be a meaningless test.
Most likely the worst is over. At this point, you should sit tight and see if your symptoms resolve completely after azithromycin. If not, return for further evaluation. But at this point, I see no serious concern that you still have persisting gonorrhea.
I'm interested in hearing more about the diagnosis of gonorrhea, whether chlamydia testing was done, and so on. Let me know.
Best wishes-- HHH, MD
There are some atypical features here that make me wonder whether you really had gonorrhea. It is uncommon to have gonorrhea only with penile burning; discharge of pus from the penis usually is present. Also, did your doctors really have you masturbate to produce semen for gonorrhea testing? Why? That is not the normal way to diagnose gonorrhea or any other STD, and to my knowledge the tests have not been validated for use on semen. They have been studied only for genital swab specimens and urine. So I have to wonder a bit about the reliability of the positive test result. Can you provide more information about it, i.e. the exact test that was done, and whether testing was also done on a urethral swab or urine?
But let's assume you did indeed have gonorrhea. If so, you were cured with the ceftriaxone. You were given 4 times the normal dose, but that might have made sense, given the possibility that the previous treatment in Thailand had apparently failed to cure you. (The cefixime made no difference. It is less potent against gonorrhea than ceftriaxone.) In any case, it cured you. The current gonorrhea lab tests are highly reliable; even though the test is technically supposed to be done at least an hour after urinating, it actually makes little if any difference.
Therefore, almost certainly something other than gonorrhea explains the symptoms that continued after ceftriaxone. Improvement with azithromycin suggests possible chlamydia or nongonococcal urethritis (NGU). Chlamydia is rare after oral sex, so NGU is more likely. The cephalosporin antibiotics (ceftriaxone, cefixime, and others) and ciprofloxacin have no activity against chlamydia and NGU, but azithromycin is one of the drugs of choice -- so this is a plausible explanation. (Usually chlamydia testing is done automatically along with gonorrhea. Were you tested for it?
Gonorrhea strains resistant to the cephalosporin antibiotics (ceftriaxone, cefixime, etc) have begun to emerge in Japan and Korea. Such strains might have spread to Thailand, although that has not been reported.
There is no basis for concern about disseminated gonorrhea, which is rare, and causes fever, acute arthritis, and a certain kind of skin rash. You don't have it. A blood culture would be a meaningless test.
Most likely the worst is over. At this point, you should sit tight and see if your symptoms resolve completely after azithromycin. If not, return for further evaluation. But at this point, I see no serious concern that you still have persisting gonorrhea.
I'm interested in hearing more about the diagnosis of gonorrhea, whether chlamydia testing was done, and so on. Let me know.
Best wishes-- HHH, MD
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