Oral exposure question

[John3219]

Dear Doctor,

I am a 37yr old male, I had protected anal ( I was the "bottom") and unportected oral encounter with a male friend of mine. 2 days later I noticed a pretty pronounced sticky greyish or cloudy drip from my penis. At my local clinic I was just given suprax 400mg X7 days, no test. A month later the drip was there some morings, sometimes I had to milk the penis to spot it, plus an odd smell to the penis, irritation on and off in urethra and tip..sometimes nothing for a week. 2 weeks later I was tested for Gono and chlam by NAAT urine test while still on Suprax. Tests were negative. about a month later drip was the same so I recieved a swab and urine test (negative) and given Zithro 2g oral liquid suspension dose, 800mg Suprax one dose and 200mg doxy for 7 days.

1) Would being on 400mg Suprax daily interfere or give wrong NAAT result? Clinic said no, but I am hearing different views on this.

2) I voided 1 hour prior to the swab test at the urging of the doctor for another NAAT test. Would the voiding interfere with the swab test result as being too early? I was a very deep and long swab test.

3) Would the Suprax, Zithro 2g and a week of doxy clear up any orally aquired bacterial STD's? If so which ones and was I treated accordingly?

4) Could the meds kill Gonhorrhea and Syphilis at 2 months post enounter if this is waht I have?

I m just confused why my symptoms are on and off continuing.

[Edward W Hook, MD]

This is not a debate.  Antibiotics can suppress the growth of bacteria, reducing the perfomrance of tests.  

Your symptoms are not particualrly suggestive of prostatitis.  If you wish to evaluate that possiblity, see a urologist.

I already told you about the antibiotics you took.  Please re-read my comments.  EWH

[John3219]

Thank you for the anwsers. To clarify some things:

The swab was supposed to test for any bacterial STD, the sheet I got had the type of test and a list of bacterial infections that were supposed to be checked off if found. This was a state lab and specific STD check sheet. I was told I was negative for any typical bacterial STD's.
Couple of follow up questions:

I was wondering how can antibiotics mask an infection during NAAT testing? I assumed it would just show either less bacteria or nothing.

Could prostatitis cause abnormal drip as well? Since this all started after protected insertive anal intercourse, might it have irritated or inflamed the prostate?

Also is it reasonabe to assume that with the wack Suprax, Z pac and doxy medication that any typical  bacterial STD is gone?

Thank you again.

[Edward W Hook, MD]

Welcome to the Forum.  I will try to help.  The discharge you describe dose not sound normal and warrants testing off of antibiotics to help sort things out.  The treatments you have received are in excess of the treatments typically used to treat most STDs however if you were taking the cefixime (Suprax) in particular during the time you were tested, could have masked the presence of an infection which was partially resistant to cefixime.  

1) Would being on 400mg Suprax daily interfere or give wrong NAAT result? Clinic said no, but I am hearing different views on this.
See above.  I would answer this question as probably not but for a definitive test you should have been tested off of antibiotics.

2) I voided 1 hour prior to the swab test at the urging of the doctor for another NAAT test. Would the voiding interfere with the swab test result as being too early? I was a very deep and long swab test.
No, voiding would not interfere.  When the doctor did your swab test, do you know of he/she tested for the presence of abnormal white blood cells as well as gonorrhea and chlamydia?  NGU (non-gonococcal urethritis) may have negative tests for STDs but signs of inflammation.  So can prostatitis.

3) Would the Suprax, Zithro 2g and a week of doxy clear up any orally aquired bacterial STD's? If so which ones and was I treated accordingly?
In the vast majority of cases.  There are a very few cases of gonorrhea which are resistant to cefixime but the azithromycin should have taken care of such infections if that had been the case.

4) Could the meds kill Gonhorrhea and Syphilis at 2 months post enounter if this is waht I have?
Yes.

My sense is that your case is a bit unusual.  I think you may need a bit of trial and error in sorting this out, as well as additional testing.  In doing so, I urge you to work with a single health care provider, not go from one to another so that decisions can be made in the context of earlier testing and treatment results.  

I hope these comments are helpful.  EWH