Gonorrhea or Urethritis

[Romans669]

Hi Dr. Handsfield,

I hope this finds you well. A few months ago I posted in this forum with a question about herpes. After receiving a bloodtest, it was revealed that I am positive only for Herpes Simplex 1. Unfortunately, a previous test apparently produced a false negative for gonorrhea/chlamydia, as I required treatment and took it -- in addition to medication for trichonomas vaginitis (sp?) and non-gonococcal urethritis -- a few months ago. Since the symptoms vanished completely, I assumed that the medication had worked.

I abstained from sexual activity until recently, when I had intercourse with a new, monogamous partner. One day or two after intercourse, I began to again show symptoms of an infection; I felt some dull pain and general discomfort in my testicles, and experienced difficulty and sometimes a burning sensation with urination. I immediately went to Planned Parenthood, where the NP prescribed a shot and more Doxy, believing that it must be gonorrhea -- either from before or a new infection. However, I have checked with my partner and I know for certain that she could not be the carrier. I will soon find out whether I have gonorrhea in a few days' time.

My question: Is it possible that the gonorrhea went into remission due to ineffective treatment the first time? Would it resurface because of recent sexual activity, even after three to four months? Or is it possible that this is another form of urethritis, or a bacterial infection, an after-effect of my original infection? At first I thought it might be epididymitis or orchitis; again, would either of these conditions surface immediately following sexual activity?

I would appreciate any help and advice. Thank you!

[Edward W Hook, MD]

This is not orchitis/epididymitis.  Why are you not discussing this with your doctor.  

Unlikely.  UTIs are unusual in young men.  You may be an exception but if you are, your doctor should be able to tell you easily.  EWH

[Romans669]

Or could this be a UTI?

[Romans669]

Hi again Dr. Hook,

Yes, that's what I mean -- sorry for the confusion, though this now leaves me more deeply confused. Could epipidymitis/orchitis occur after a period of months, and appear somewhat symtomatically like gonorrhea/chlamydia?

Thanks so much again!

[Edward W Hook, MD]

I am not sure what you mean by remission.,  If you mean relapse/treatment failure, this does occur but rarely and certainly not after a period of months.  EWH

[Romans669]

Dr. Hook,

Thanks again for your help. So I am confused - is remission never a possibility with these bacterial infections? Would medication for the original STD have been in anyway ineffective?

[Edward W Hook, MD]

No, please foreget about remission.. there is just not a lot to support it.  Non-chlamydial NGu can be casued by bacteria other that chlamydia (or gonorrhea) but imporves withtherapy.  It is standard practice to treat ALL recent sex partners of persons with non-chlamydial NGU.  

Further, as I said, this may not be an STD.  your symptoms onset was ratehr early for that.  EWH

[Romans669]

Hi Dr. Hook,

Thanks for answering my question.

The only reason I am confident is that my partner 1) has abstained from sexual activity for two years and 2) recently tested negative for any STD or infection. I would have her test again, of course.

In absence of another sexually transmitted infection, how could this otherwise surface? Could the medication I took earlier have been ineffective in anyway? Would something like gonorrhea/chlamydia go into remission for a number of months, only to return after sexual activity? What about urethritis as caused by a non-sexual bacterial infection -- can that happen as a result of intercourse? What other forms of non-chlamydial NGU are there?

Thanks so much again - I appreciate your help and advice.

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me this time.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Your symptoms sound like urethritis once again although the onset was a bit soon for most STDs. There are no STDs which have their onset within 24 hours of exposure and typically it takes 2 or even 3 days for symptoms to occur.  .  At this time it is more likely that you have a new infection than that this is a recurrence of your earlier case of NGU.  Please remember that there are 3 main forms of urethritis, gonorrhea, chlamydial infection and non-chlamydial NGU.  Urethritis is diagnosed by looking for inflammation (white blood cells) in either a smear taken from the penis with a swab or in a urine specimen collected at the beginning of urination.  either the swab specimen or the urine specimen I just mentioned could also be tested for gonorrhea and chlamydia allowing further differentiation as to which type of urination is present.

Also, you do not mention how you know that your partner could not be infected.  Unless she was a virgin and you were the only person to have sex with her ever, she should be tested for gonorrhea and chlamydia and she should be treated due to her contact with you. To do otherwise jeopardizes her health.

Take care.  EWH