Persistent symptoms 45 days post exposure

[StealthVirusCCID]

~6 weeks ago I had unprotected oral + protected vaginal from Brazilian CSW.  3-4 days later mild urethral itchiness/irritation, pain upon urination @ tip & within glans, after ejaculation, upon first void.

2 weeks post exp. urine test Ghonorrhea/Chlamydia, -tive, however I urinated ~45 minutes before giving sample.  Other tests -.  Low fever (99.1), chills, muscle tremors, some drenching night sweats.

~ 3 weeks post symptom onset took 1 gr Ceftin, went to see doc next day.  Pcp did urinalysis, (-) Rx. Bactrim-DS.  I masturbated hours after dose, glans and external meatus stayed red color after painful ejaculation.  Glans/uretheral rash since faded in color but cracking skin & discoloration still visible until today.

4 weeks post exposure (the next day) Pcp diagnosed prostatitis after DRE, which was immediately painful.  Tests: std ab, post DRE-urine culture, ghono/chlamydia urine, oral quick HIV: all -.  Started Cipro 500 mg 2x/day.

35 days post exp.  (~1 week on Cipro) develop icterus. Rash, low grade fever, warm feeling skin/forehead, loss of appetite, loss of sex drive, occasional bouts of extreme fatigue, and odd tingling sensations at the urethral tip when peeing.    

~40 day post exp. PCP advised continue abx, 2 gram dose of Flagyl - seemed to help somewhat but ~4 days ago. Currently 2 weeks into regimen and persistent symptoms as above.  Rash resembles Zoon’s Balanitis, but I am circumsized.
        
~45 days post exposure. 1. Any tests I should take or repeat?  2. Specialist for 2nd opinion, if so what type?  3. Additional tests, like blood or semen culture, or special ones for unusual organisms (ureaplasma/mycobac)?  4. Any insight on possible causes of glans rash?   5. I read Cipro will not treat STD and wonder if any benefits thus far can be due to proposed anti inflammatory action of antibiotics or my body developing antibodies naturally?

I do not know how long I should expect this to go on, but I greatly appreciate this forum and your advice.

[Edward W Hook, MD]

Welcome to our Forum.  I reviewed your other posts on other Med Help community sites as well.  To summarize, you started having symptoms of mild urethral irritation and burning on urination several days after condom protected sex and receipt of unprotected oral sex from a CSW.  In addition, with repeated self examination you have occasionally noted a slight amount of clear urethral discharge, had had a low grade fever, and  some sweats. You have had negative tests for gonorrhea and chlamydia as well as negative urine cultures. You have also been treated with Flagyl (metronidazole), Ceftin, Bactrim and now are taking ciprofloxacin.  

My assessment.  Your exposure was low risk and you have had negative tests for the most common STDs as well as a variety of antibiotics, none of which are recommended therapy for the most common STD infections if you had been infected.  The most common infection to occur following an exposure of the sort you describe in NGU, for which recommended therapy is either a single 1.0 gram dose of azithromycin or 7 days of doxycycline,100 mg PO twice daily.  Personally however I doubt that you need this therapy or that any of this represents an STD.  Whatever is going on, your self-acknowledged anxiety over the possible relationship to your CSW exposure is probably making it worse.

Your doctor appears to have diagnosed prostatitis and the ciprofloxacin you are taking is good therapy for this problem.  Typically prostatitis will require up to 4 weeks of therapy and may need to be treated  more than once.

I did note that you mentioned icterus - did you really turn yellow>  Are you still?  Did yo ask your doctor about this? The reason I ask is that hepatitis (food bourne most often) could be causing this and some of your other symptoms as well.,  Perhaps you should discuss hepatitis screening with your doctor if you have not already.,

In answer to your specific questions:

1. Any tests I should take or repeat?
See above. Not for STDs,  Perhaps for hepatitis, depending on your doctor's evaluation.

2. Specialist for 2nd opinion, if so what type?
It is not clear what sort of doctor you have already seen.  An internist should be able to address your questions nd concerns.

3. Additional tests, like blood or semen culture, or special ones for unusual organisms (ureaplasma/mycobac)?
No, other than as mentioned above.

4. Any insight on possible causes of glans rash?  
Ash the doctor.  Perhaps a fungus.

5. I read Cipro will not treat STD and wonder if any benefits thus far can be due to proposed anti inflammatory action of antibiotics or my body developing antibodies naturally?
You are correct about cipro and STDs but I doubt that you have an STD. Perhaps prostatitis.

I hope these comments are helpful.  I suspect the timing of your current illness, in relationship to your interaction with the CSW is coincidence.  EWH

[StealthVirusCCID]

Hi Dr. Hook,

Thanks for your thorough review and recommendations.  I do have a ~2mm ring of icterus around the outer portion of my sclera bilaterally.  My primary examined and noted it when I got the Flagyl.  Additional tests taken at that time were hepatic panel, liver enzymes, etc. but I am waiting on the results.

I recall an episode where my girlfriend baked then forgot salmon in the oven.~3-4+ hours passed by the time I came home & put it away.  I ended up eating most of it over the next few days after she told me she would not cook further until it was gone.  That was before my symptoms started but I am uncertain on timing and if this could be considered a food borne cause.  

The last time I had unprotected intercourse was ~ 7 days post CSW encounter, after which time my girlfriend started having symptoms such as lower back/flank pain, flushed skin/low grade fever, chills, occasional bouts of fatigue, nausea.  I notice when I touch her forehead and neck that she still feels warm persistently 3 weeks later whereas this symptom is slowly becoming more intermittent for myself.  She denies feeling sick and refuses to go see a dr. but that is her personality and I am praying I will not have to have a serious conversation with her pending upcoming results.  

I understand that you are advising against further testing besides hepatitis & that the timing maybe a coincidence and so I am hopeful for the best.  Once again I greatly appreciate your time and expertise in this forum.