Persistent NGU

[puzzled1624]

I had a slight clear discharge last month, about 12 days after an unprotected sexual encounter (hetero) in Canada.  I called my long time doctor describing symptoms and he prescribed for me azithromycin 1 gram orally.  I took that but still had symptoms of clear discharge a few days later.
I next went in and was given a urine test for all sorts of infections that i can't even name and that showed negative for everything.  I was also given a swab test for Chlamydia and Gonnorhea specifically.  I tested negative for both but given the large degree of inflammation indicated by the swab test, i was told that i had sexually transmitted non-chlamydia NGU caused by bacteria which apparently is fairly common.  
I was then prescribed doxycycline and ciprofloxacin, both for a 7 days, twice a day and told that i should feel a lot better.
By about the 16th or 17th day after this I noticed the same clear discharge as before but now a bit more copious with a slight white tint.  I came home from work one day and there was definately a good amount of discharge...unlike before.  I also am now experiencing burning during urination (nothing overwhelming, but definately new) and some pain in my testicles.  I also noticed that urinating doesn't flow as easily...almost like the stream is less strong than normal and feels restricted.  This is not in my head, the increased discharge and burning are definately there...
My doctor now just prescribed erythromycin for a week as well as metronizadole.

After taking Azithromycin, Ciprofloxacin and Doxycycline, do you feel that this additional treatment will be of benefit?

[puzzled1624]

Should I spend the time and energy to make an appointment with my PCP again, then, in order to be referred to a urologist? or just live with any continuing symptoms to see if they go away on their own?

Just wondering if it could be more serious than i assume and/or if HSV/HIV has anything to do with it.  

Thanks.

[Edward W Hook, MD]

After this treatment, unless you have been re-exposed, I suspect there is really little more that your docyor can do.  You will have received treatment for all known bacterial casues of NGU.  Interestingly, doxycycline has a small amount of anti-inflammatory activity which is seperate from its antibiotic effect which may enhance is effect.  Having said that however, my guess is that the erythromycin/metronidazole will take care of things.  I sure hope so.  Take care.  EWH

[puzzled1624]

Thank you Doctor Hook.  My final question is as follows:

If after taking the metronizadole and completing the erythromycin treatment and having waited for a few days to make sure i've given ample time for the symptoms to subside, if this recurrent condition continues with discharge, dysuria and pain should i assume the "bacterial" cause of infection is resolved and not worry anymore or should i consider a further follow up with my doctor?

The reason why i ask this is because after the doxy treatment i seem to have improved for a few days before the recurrence of symptoms all of the sudden.  The discharge was actually more purulent in the morning this weekend than clear.  I am now on day 2 of erythromycin.

Both you and Dr. Hansfield are real pros at this so i wanted to ask.

thank you.

[Edward W Hook, MD]

Yes, I agree with your doctor's decision.  The CDC now recommends re-treatment of men with persistent NGU with 1.0 gram of metronidazole (Flagyl) in addition to erythromycin.  The reason for the recommendation is that a substantial proportion of men with NGU also have co-existent infection with trichomonas.  Trichomonas is difficult to diagnose in men but can certainly be a cause of persistent discharge and symptoms.  I suspect this will help.  Good luck. EWH