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Problematic NGU - Next step?
Hi Dr. Handsfield - I am a 23y/o male in Miami. Last Sat and Sun Night, I had two sexual encounters w/ two different men. (Rare btw) Sat. was receptive oral only. Sunday was receptive oral and protected penetrative anal. Both oral were unprotected. Early Monday morning I had a slight clear discharge. I had had non-chlamydial ngu once before a few years back - was given rocephin and doxy for a week that cleared it.
I lost my health insurance, and had to wait until Tues. to go to a clinic. I called my sinus doc Mon. and asked for a refill on a z-pak. I took 500mg Monday night (11pm). Tuesday afternoon, I saw a N.P. at the clinic. She did a gram stain that came back Neg for Gonorrhea. She told me to continue on the Z-Pak, if symptoms didn't improve to start 100mg of Doxy 2x daily for 7 days that she prescribed. She told me the 500mg of Azith wouldn't have affected the gram stain. I asked for the rocephin but she insisted on the Doxy. Wed symptoms were worse so I started the doxy as well. Thurs even worse with now a slight yellow color so I called her. I came in that day, another gram stain was done, also negative and she told me just to continue with Doxy. She said she had someone else who had called back with symptoms that didn't improve. Fri I went to another clinic, saw a doc. He said it sounded like gonorrhea, he gave me Rocephin (not sure of dosage) and told me to continue Doxy. Saturday discharge much less, and clear. Today (Sun.) Still very clear, but more discharge than yesterday. What should I do? The guy from the 2nd night said that he noticed he was getting a cold on Monday (he had a sore throat when he woke up Mon morn.)
Should I go back to the Doc tomorrow? Could this be a resistant strain of gonorrhea? Could the Gonorrhea(if it is) be cleared and the discharge be from urethral irritation only? Is there an NGU bacteria that is resistant to all these antibiotics? Can gonorrhea symptoms show up in hours? The Doc said yes. Looking forward to your advice!
I lost my health insurance, and had to wait until Tues. to go to a clinic. I called my sinus doc Mon. and asked for a refill on a z-pak. I took 500mg Monday night (11pm). Tuesday afternoon, I saw a N.P. at the clinic. She did a gram stain that came back Neg for Gonorrhea. She told me to continue on the Z-Pak, if symptoms didn't improve to start 100mg of Doxy 2x daily for 7 days that she prescribed. She told me the 500mg of Azith wouldn't have affected the gram stain. I asked for the rocephin but she insisted on the Doxy. Wed symptoms were worse so I started the doxy as well. Thurs even worse with now a slight yellow color so I called her. I came in that day, another gram stain was done, also negative and she told me just to continue with Doxy. She said she had someone else who had called back with symptoms that didn't improve. Fri I went to another clinic, saw a doc. He said it sounded like gonorrhea, he gave me Rocephin (not sure of dosage) and told me to continue Doxy. Saturday discharge much less, and clear. Today (Sun.) Still very clear, but more discharge than yesterday. What should I do? The guy from the 2nd night said that he noticed he was getting a cold on Monday (he had a sore throat when he woke up Mon morn.)
Should I go back to the Doc tomorrow? Could this be a resistant strain of gonorrhea? Could the Gonorrhea(if it is) be cleared and the discharge be from urethral irritation only? Is there an NGU bacteria that is resistant to all these antibiotics? Can gonorrhea symptoms show up in hours? The Doc said yes. Looking forward to your advice!
MEDICAL PROFESSIONAL
It sounds as though you are beginning to respond to these antibiotics. It is now clear that the problem you are having is not an STD. It may well be somehow related to your prostate. I would suggest continuuing to work with your doctor. If the discharge continues to improve, you are in good shape. If not, he will ne3ed to guide your next steps. EWH
Hi Doc,
To give an update, I waited the extra week and my symptoms didn't clear up. My doctor gave me Ofloxacin 300mg to be taken 2x daily for the next 6 weeks for prostatitis. I've been on them since last Friday and the discharge is no longer clear. This morning it was a thick white/slightly yellow discharge. Still no pain anywhere. Can this other discharge be caused by prostatitis? If so, how long do I need to wait before I see results from the antibiotic? Any other suggestions?
Thank you.
To give an update, I waited the extra week and my symptoms didn't clear up. My doctor gave me Ofloxacin 300mg to be taken 2x daily for the next 6 weeks for prostatitis. I've been on them since last Friday and the discharge is no longer clear. This morning it was a thick white/slightly yellow discharge. Still no pain anywhere. Can this other discharge be caused by prostatitis? If so, how long do I need to wait before I see results from the antibiotic? Any other suggestions?
Thank you.
MEDICAL PROFESSIONAL
Sorry, within 7 days. EWH
With in a what? it's blank.
MEDICAL PROFESSIONAL
I would expect it to have completely resolved within a from now. EWH
After how long, if it doesn't pass on it's own, should I head back to the Doctor's?
Thanks again for all of your help! That will be my last question.
Thanks again for all of your help! That will be my last question.
MEDICAL PROFESSIONAL
Our policy here on MedHelp is not to try to get between our clients and their doctors, this rarely works out for the best. There is no harm in taking the additional antibiotics.
There are trichomonas species which are in the intestinal tract but to my knowledge they have not been described to cause STD, even with rectial exposure.
The azithromycin prior to your gram stain could have made it negative.
I'm still betting that this will pass on its own. EWH
There are trichomonas species which are in the intestinal tract but to my knowledge they have not been described to cause STD, even with rectial exposure.
The azithromycin prior to your gram stain could have made it negative.
I'm still betting that this will pass on its own. EWH
Forgot to add, my partner from Sunday night had told me the next day that he was developing a head cold, (stuffy nose, etc.) and Monday morning he had a sore throat as well.
I believe you are right with him having a type of virus in the oral cavity, thus waiting the rest of this out for any inflammation, etc. to heal.
I believe you are right with him having a type of virus in the oral cavity, thus waiting the rest of this out for any inflammation, etc. to heal.
Thank you for your comments. Just to make sure, I did not address the posting to him in the hopes that I would not get you to answer. I trust your advice and experience as much as I trust his. I had posted once before and he had answered my questions, so it strictly did it without paying much attention.
I actually went to the doctor this morning before you had answered my questions. Now I have a few simple follow up questions, if you don't mind. He gave me a prescription of 1g of Cipro to be taken at once orally, just in case there was a persistent gonorrheal infection, as well as 2g of Flagyl to be taken all at once as well. I know this is for Trichomoniasis, and I mentioned to him that as far as I knew this was mainly a vaginal infection and mostly asymptomatic in men. He said that there are types that can be found in the anal cavity in men. Is this true?
Should I take both medicines that I was prescribed? He also mentioned that if I didn't see improvement after this, that I would have to begin treatment for Prostatitis.
Also, I had had NGU once before, and it had actually occurred the next morning as well. I had not had any sexual partners for awhile before that, so I am almost positive that it was from that occurrence. Is non-Chlamydial NGU more prominent in some people that others?
Lastly, I know it is irrelevant to the treatment, but for the sake of my partners at that time, as well as my own curiosity, would the 500mg of Azithromycin I had taken the night before had made my Gonorrhea Gram Stain come out negative, if it actually was gonorrhea?
Thank you again for your advice.
I actually went to the doctor this morning before you had answered my questions. Now I have a few simple follow up questions, if you don't mind. He gave me a prescription of 1g of Cipro to be taken at once orally, just in case there was a persistent gonorrheal infection, as well as 2g of Flagyl to be taken all at once as well. I know this is for Trichomoniasis, and I mentioned to him that as far as I knew this was mainly a vaginal infection and mostly asymptomatic in men. He said that there are types that can be found in the anal cavity in men. Is this true?
Should I take both medicines that I was prescribed? He also mentioned that if I didn't see improvement after this, that I would have to begin treatment for Prostatitis.
Also, I had had NGU once before, and it had actually occurred the next morning as well. I had not had any sexual partners for awhile before that, so I am almost positive that it was from that occurrence. Is non-Chlamydial NGU more prominent in some people that others?
Lastly, I know it is irrelevant to the treatment, but for the sake of my partners at that time, as well as my own curiosity, would the 500mg of Azithromycin I had taken the night before had made my Gonorrhea Gram Stain come out negative, if it actually was gonorrhea?
Thank you again for your advice.
MEDICAL PROFESSIONAL
Dr. Handsfield and I share the forum. You got me. FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.
To develop urethritis symptoms due to either gonorrhea or NGU within a day of exposure is most unlikely. On the other hand, you may have acquired NGU from your partner Saturday. Even then would be a bit early. Either way, most NGU arising from oral sex is due to either non-STD mouth organisms or non-STD oral/respiratory tract viruses introduced into the urethra during sex.
Whether you had gonorrhea or NGU at this point is a none issue. Between the ceftriaxone (Rocephin), doxycycline and the azithromycin you would have been treated for almost all typical causes of both problems. No ceftriaxone resistant gonorrhea has been reported in the U.S. Your urethritis is most likely due to the oral exposure and a substantial proportion of NGU related to receipt of oral sex is not due to typical STD-organisms. That your discharge went from purulent to clear is a good sign and my advice would be to wait this out. If it is due to a non-STD, oral (sore throat type) virus, no amount of additional antibiotics will help- time has to pass for it to improve. I would not recommend treatment with additional antibiotics at this time.
Hope this helps. EWH
p.s. In patients with persistent NGU due to vaginal sex we would follow the treatment you have had with metronidazole treatment but this is to cover trichomonas which is not found in the oral cavity. You do not need metronidazole treatment. EWH
To develop urethritis symptoms due to either gonorrhea or NGU within a day of exposure is most unlikely. On the other hand, you may have acquired NGU from your partner Saturday. Even then would be a bit early. Either way, most NGU arising from oral sex is due to either non-STD mouth organisms or non-STD oral/respiratory tract viruses introduced into the urethra during sex.
Whether you had gonorrhea or NGU at this point is a none issue. Between the ceftriaxone (Rocephin), doxycycline and the azithromycin you would have been treated for almost all typical causes of both problems. No ceftriaxone resistant gonorrhea has been reported in the U.S. Your urethritis is most likely due to the oral exposure and a substantial proportion of NGU related to receipt of oral sex is not due to typical STD-organisms. That your discharge went from purulent to clear is a good sign and my advice would be to wait this out. If it is due to a non-STD, oral (sore throat type) virus, no amount of additional antibiotics will help- time has to pass for it to improve. I would not recommend treatment with additional antibiotics at this time.
Hope this helps. EWH
p.s. In patients with persistent NGU due to vaginal sex we would follow the treatment you have had with metronidazole treatment but this is to cover trichomonas which is not found in the oral cavity. You do not need metronidazole treatment. EWH
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
