Please advise.

[reassurance1234]

Hi Dr.

I was wondering if you could please advise me on the following:

1. If a man were to have NSU in order to cover all bases what the prescribed method be?

2. Would it be single dose of 1g azithromycin (pardon spelling)

as well as a single dose 400mg cefexine?

I believe that azithromycin would clear up chylmidia.

3. Incase there was gonorrhoea, would a single dose of 400mg of cefexine clear it up?

4. Is cefexine as good as doxycyline for clearing up ghonorrea. The reason why I was thinking cefexine wold be better was because it could be taken as a single dosage.

Also, I was thinking in order for me to start treatment asap, I could take treatment which would kill clymidia and ghonorrea as well, just to cover all bases.

5. I am going to the Dr. about this irritation that I am having, I just want to know where I stand before I go. My partner has been performing oral sex on me and this is a relatively new thing as she stopped doing it for a while. I have read on the internet, that she should be treated as well.

We do have vaginal sex with condoms, but I read that it is better to treat the partner too, just to cover all possibilities. Do you agree?

Thanks a lot.

[H. Hunter Handsfield, M.D.]

The recommendations for PID treatment are different.  But in the absence of symptoms, you can be confident your partner doesn't have PID.

That will have to end this thread.  I'll have no further comments or advice.

[reassurance1234]

I should say that my GF has never displayed any symptoms of PID apart from intermittent pain during intercourse which has been due to a lack of lubrication. I just wanted to know to lay everything at rest.

[reassurance1234]

Dr.

Out of sheer morbid curiosity from my reading as I cannot find the answer, if a women were to have PID, would the antibiotics that we have spoken about above resolve the issue of PID by resolving the bacteria causing PID?

Thanks a lot once again. You have helped me understand a lot.

[reassurance1234]

Thank you and best wishes.

[H. Hunter Handsfield, M.D.]

With or without food; doesn't matter.

[reassurance1234]

Thank you dr.

Out of interest how soon after can one eat after taking the anti biotcs on an empty stomacch? Is an hour ok.

[H. Hunter Handsfield, M.D.]

I'm sure you had instructions from the doctor, or from the pharmacy, on how and when to take the medications.  Normally the pills are taking all at once.

We already discussed what these antibiotics cover.  Together they will be effective against gonorrhea, chlamydia, and non-chlamydial NGU.

I'm disappointed to hear that apparently specific tests for gonorrhea and chlamydia were not done, apparently either in you or your partner.  That's bad medicine.

[reassurance1234]

Thought I'd give you an update. Dr dipped my urine and there was inflammation so he prescribed me one g of azithromycin and 400mg of cefixime. My partner has also been prescribed it.

Will this reliably clear any bacteria, whether due to clamydia or ghonorrea or anything?

Also, should we take all the pills at one? And on an empty stomach or with some food in it? Does that matter?

Just want to make sure we take it in the best way possible.

Thanks.

[reassurance1234]

Thank you Dr Handsfield.

No I am going to speak to my GP tomorrow who is indeed very knowledgable about STD's.

One final question, out of curiosity, do the antibiotics we have spoken about cure the bacteria fully? for example If one were to have clymidia for one year un detected, would the standard dose, still clear it up? I have heard about the antibiotics not working before.

[H. Hunter Handsfield, M.D.]

Regardless of your "going away" plans, I strongly urge you not to treat yourself before being professionally evaluated.  I'm not going to advise about specific doses of a treatment I believe you should not take.

Many apparently authoritative sources list oral sex as a source of chlamydia, and many doctors believe it.  This has been discussed previously on the forum, and I'm not going to repeat the information.  But the fact is that chlamydia rarely infects the throat or mouh.  It can happen, but is far less common than genital or anal infection, and therefore is rarely transmitted by oral to genital sex.

[reassurance1234]

Thank you Dr.

I have been having irritation and burning sensations when I urinate and frequency to urinate. I am going away, so I felt it would just be better to get treated asap to cover all bases.

Regarding the 400mg of cefixime, is that a single dose too? So effectively, treatment for clym. and ghon. can be taken in a single oral dose, and that will cure infection? end of story?

The FH doctors seem to say that clym. frequently is transferred by oral sex, yet you and Dr. Hook say the opposite.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Whatever else, please do not start treatment of any kind before you are professionally examined.  You don't say that is your intent, so I can't tell --- but it would be a very bad idea, which would make it very dificult to eventually tell whether you have gonorrhea, chlamydia, or nonchlamydial NGU (or something else entirely).  Even one or two doses of antibiotic would be likely to cause difficulties.

You are on the right track about the various treatment options, but  I recommend you not go in requesting specific treatments.  If you plan to see an STD expert -- e.g., public STD clinic or its equivalent, such as a GUM or sexual health clinic -- just follow the advice you receive.  If you aren't certain about the doctor's expertise, then some diplomatic suggestions may be helpful.

To your specific questions:  The primary drug for gonorrhea is cefixime (orally) or cetriaxone (by injection); and the treatments for chlamydia or NGU are either azithromycin (single dose) or doxycycline twice daily for a week.  Gonorrhea is usually treated with both -- i.e. cefixime or cetriaxone plus either azithromycin or doxycycline.  NGU is treated with azithro or doxy alone.  Based on symptoms, physical examination, and microscopy of urethral discharge, usually it is possible to tell quite reliable at the initial visit whether a patient has gonorrhea or NGU.  If there is any doubt, however, it is best to treat with both kinds of drug.

Those comments cover questions 1 and 2.

3) Yes, 400 mg is the normal dose of cefixime.  It is highly reliable against gonorrhea.

4) Doxycycline, by itself, is not recommended for gonorrhea; cefixime is much better.

5) Oral sex can transmit gonorrhea or NGU, but rarely chlamydia.  On the other hand, if there has been a lapse on condom use, you could be susceptible to chlamydia as well.  You don't describe your symptoms except to say "irritation".  Are you having discharge of pus or mucus from the penis?  Or only urinary discomfort?

Finally, it is true that partners of men with gonorrhea, NGU, or chlamydia also need to be treated. My suggestion is that you and your partner visit the doctor or clinic together.  Examing both members of a couple often leads to more accurate diagnosis and better treatment, and more prompt treatment, then when they are examined separately.

I'll be interested to hear how this all turns out after you and your partner have been examined and tested.

Regards--  HHH, MD