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Nsu symptoms despite treatment
Hi doc
I am an HIV positive male (CD4 count 850 , undetectible)Five weeks ago I was treated (following symptoms and a positive test of chlamydia) with a stat dose of azithromycin . The symptoms cleared within a couple of days and I thought nothing more of it. Then, two weeks ago after unprotected oral/anal sex (me active)with a casual male partner(also known to be HIV positive , I developed similar symptoms again (clear penile discharge during the day and a small amount of White discharge upon wakening, I also feel the need to urinate more often). I was given a further stat dose of azithromycin after a diagnosis of NSU from a urine sample.I was also given a full sexual health screen, and all blood/culture tests have come back negative .This stat treatment had no effect on my NSU symptoms and I returned to the GUM clinic a week ago. The doctor gave me a further prescription of azithromycin (2 tablet stat dose followed by 1 tab per day for 4 days) together with a five day course of metronidazole. Despite
all of this, I am still experiencing a small amount of White discharge from my penis upon wakening. Any thoughts as to what could be causing this/ what I should do?
I am an HIV positive male (CD4 count 850 , undetectible)Five weeks ago I was treated (following symptoms and a positive test of chlamydia) with a stat dose of azithromycin . The symptoms cleared within a couple of days and I thought nothing more of it. Then, two weeks ago after unprotected oral/anal sex (me active)with a casual male partner(also known to be HIV positive , I developed similar symptoms again (clear penile discharge during the day and a small amount of White discharge upon wakening, I also feel the need to urinate more often). I was given a further stat dose of azithromycin after a diagnosis of NSU from a urine sample.I was also given a full sexual health screen, and all blood/culture tests have come back negative .This stat treatment had no effect on my NSU symptoms and I returned to the GUM clinic a week ago. The doctor gave me a further prescription of azithromycin (2 tablet stat dose followed by 1 tab per day for 4 days) together with a five day course of metronidazole. Despite
all of this, I am still experiencing a small amount of White discharge from my penis upon wakening. Any thoughts as to what could be causing this/ what I should do?
MEDICAL PROFESSIONAL
I'm pleased my comments were helpful. EWH
Dear Doc , many thanks for your advice . Returned to GUM clinic on monday last and was prescribed doxycycline after test showed WBCs . Symptoms have now gone (although I am obviously completing the course of meds).Your advice was invaluable as I felt very empowered to discuss options with my doc . Thanks again
MEDICAL PROFESSIONAL
Welcome to our Forum. Your doctor treated you is just the way the CDC recommends. He sounds well informed. There are several possible reasons for your continued discharge and I will be happy to outline them and suggest an approach. By way of background, all NSU (or NGU as an alternate term) is not due to chlamydia and in a fair number of cases despite rigorous microbiological evaluation, no obvious cause is discovered. Whether such cases in which we cannot identify a cause represent a health hazard is unclear.
Further NSU is typically defined in part by symptoms- do you have burning on urination which accompanies your persisting discharge? The reason I ask is that it is normal for men to have erections during their sleep and following this there may be a small amount of residual discharge present in the morning- this is normal.
Alternatively, your persisting discharge could represent several other processes. Chlamydial treatment failures are rare following azithromycin treatment but they do occur. Alternatively, as the active partner in rectal intercourse fecal bacteria resistant to azithromycin might have been introduced and be the source of your discharge.
My suggestions are:
1. You need to know if this discharge is normal or not- a test for white blood cells, either from a urethral swab (best approach) or testing urine collected just as you start to urinate, would help to sort this out. If no WBCs, no reason for concern.
2. A repeat chlamydial test is reasonable.
3. If there are increased WBCs present or a chlamydial test is positive, the next step would be to treat, this time using doxycycline 100 mg twice daily for 7 days would be the next appropriate step.
I hope this information is helpful. EWH
Further NSU is typically defined in part by symptoms- do you have burning on urination which accompanies your persisting discharge? The reason I ask is that it is normal for men to have erections during their sleep and following this there may be a small amount of residual discharge present in the morning- this is normal.
Alternatively, your persisting discharge could represent several other processes. Chlamydial treatment failures are rare following azithromycin treatment but they do occur. Alternatively, as the active partner in rectal intercourse fecal bacteria resistant to azithromycin might have been introduced and be the source of your discharge.
My suggestions are:
1. You need to know if this discharge is normal or not- a test for white blood cells, either from a urethral swab (best approach) or testing urine collected just as you start to urinate, would help to sort this out. If no WBCs, no reason for concern.
2. A repeat chlamydial test is reasonable.
3. If there are increased WBCs present or a chlamydial test is positive, the next step would be to treat, this time using doxycycline 100 mg twice daily for 7 days would be the next appropriate step.
I hope this information is helpful. EWH
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