Recuring syptoms of Chlamydia or something else?

[GoBucks1966]

45yr old male. Have been with younger female (20's), no protection for intercourse or oral( I know, not smart) and was diagnosed with Chlamydia on Nov. 9th. Looking back, I probably had minor symptoms at least a month prior but didn't think anyting of them. Minor urethrtis/pain in penis. No discharge for at least a month. After a couple nites in a row of sexual contact, I immediately notice much more pain AND discharge. Typical burning during urination but also a fairly constant pain as well. Discharage was clear/cloudy could see bits of  white/milky puss in discharge.
Monday Nov. 12 I took 1500g of Zithro. 4/5 days later things were pretty clear.  I did have protected sex earlier than the 7 days recommended. I think on day 5. Week an half after taking Zithro, I did begin to feel a bit of burning in tip of penis. Only discharge I have had(twice),  I was fairly aroused, After urinating I had very clear discharge, more than usual, but looked like pre-semen. Today is day 15 after zithro. No discharge, but on occasion I feel a slight burning. When I urinate,  feel a very slight burn at the start. But then goes away. I also have a drip sensation, but when I check, nothing there at all. Yes, I am completely stressed, with high anxiety.
Questions:
1. Is this normal? Seems longer healing then the norm from what I have read.
2. Any chance chlamydia is still present and slowely coming back?
3. Could I possibly have gonorrhea as well? I know someone(20%) can get both. No, I wasn't tested for that. stupid on my part. I saw no discharge previously  that was any color but clear with a lil white/milky puss. No yellor or green at all.
4. Could it be NGU? Would the zithro cleared this up?
5. My urine seems stronger/more yellow. But I probably need more water in take as well.
6. I know anxiety is not helping.  But I certainly seem to feel a light burn/tingle at times. In morning, no pain is there. As day goes, it seems to burn feelings seems to come and go.

[Edward W Hook, MD]

The rapid tests are highly accurate fo gonorrhea.  On very, very rare occasions they miss an infection but I would urge you not to worry about this.  EWH

[GoBucks1966]

Just a quick update. Went to STD clinic who ran all test. Have to wait a week on final results. But quick results for Gono came back negative. Gono was the one I was worried about. The quick test did show some very minor irritation. The Dr. did give me another 1000g of Zithro. Which I did take.
I do feel much better, less anxiety. Do not really feel or see any symptoms at all.
Are these quick tests they run fairly accurate? The Dr. said rarely does a negative quick test come back positive with final results.

Thanks again for all the info!

[Edward W Hook, MD]

1.  Possible- anything is possible.  Likely- no.
2.  Possibly.
3. I wonder about hyper vigilence here.
4.  14 days.
EWH

[GoBucks1966]

Last questions. My concern is gonorrhea. Which I plan to be tested.
1. But based on my information, especially with no discharge and symptoms better, is that still possible? You mentioned that symptoms just don't come and go, they are usually consistant.
2. Would the Zithro mask gonorrhea symptoms for a while?
3. The mild urethritis is mostly when I first begin to urinate. But goes away quickly. Then I have relief after. But it seems, at least I think, that my urethra is a bit tender.  But again, that seems to come and go. Thats why I wonder if its just in my head or just taking a while for my urethra to heal?
4. How soon after Zithro treatment should I wait to be retested?

Thanks again Dr. !!

[Edward W Hook, MD]

and no, chlamydial infection is not associated with prostatitis. EWH

[Edward W Hook, MD]

Thanks for the clarification on your partner.  

1.  Not sure re-treatment is needed unless you can show there is really something worng here.  I would probably use the alternative recommended therapy- doxycycline 100 mg orally twice daily for 7 days if re-treatment was needed.

2.  Not sure what you mean by "mild urethritis".  If you mean burning on urination, that is non-specific and may or may not be related to infection.  Your would need a test to show inflammation (i.e. increased numbers of white blood cells) to prove inflammation was present.

3.  I'm guessing this is all residual wariness regarding concerns over whether things are resolved or not.  EWH

[GoBucks1966]

BTW, any chance that Chlamydia can lead/cause to prostatitis?

[GoBucks1966]

Thanks for the reply Dr. My partner was in fact treated as well.
I don't see how I could have been re-infected to be honest. I did have sex on day 5 after treatment, but it was protected/condom with person who was treated. She had been treated 10 days prior to the sex we had.
1. When you say retreated, do you mean another dose of Zithro or would you recommend going to doxycycline ?
2. The past two days, I have seen no discharge whatsoever. As I mentioned, the only recent discharge I have had I was also sexually aroused, but did not ejaculate or have any kind of manipulation or sex. The discharge happened immediately after I urinated.
Only sign I have now, is possibly a very mild urethritus
3. As I said, my symptoms did disappear. The weekend they did, I was pretty relaxed, stress free. It does seem the more stress/anxiety, the more symptoms I seem to find. :( And as I said, I wake in the morning and feel fine. Comes and goes during day it seems.

Thanks again.

[Edward W Hook, MD]

Continued answer


4. Could it be NGU? Would the zithro cleared this up?
There is much overlap between NGU and chlamydial infection. the azithromycin you took should have cured NGU if present as well.  Failures of NGU treatment also do occur from time to time following azithromycin treatment.

5. My urine seems stronger/more yellow. But I probably need more water in take as well.
Perhaps. There is no association of change in urine color with any STD.

6. I know anxiety is not helping.  But I certainly seem to feel a light burn/tingle at times. In morning, no pain is there. As day goes, it seems to burn feelings seems to come and go.
The symptoms of STDs, whther gonorrhea, chlamydia or NGU do not come and go but tend to persist.  Symptoms which "go away" when distracted or require focus to detect are often a manifestation of anxiety rather than infection.

I hope these answers are helpful.  Looking forward to hear of whether this might be re-infection from an untreated partner.  EWH

[Edward W Hook, MD]

Welcome to the Forum.  I will try to help In doing so, can you tell me- after you acquired chlamydia, have you had sex with another partner and, if so, was that partner treated for chlamydia as well?  If not, you may have cured your chlamydia and then been re-infected.

Working through your specific questions:
1. Is this normal? Seems longer healing then the norm from what I have read.
It can take several days for the irritation due to chlamydial infection to resolve, particularly if the infection has been present for a while as you suggest.

2. Any chance chlamydia is still present and slowely coming back?
See above.  I wondered if you might have been re-infected. If not, there are rare chlamydial treatment failures with all treatments.  Re-peat testing may be worthwhile.

3. Could I possibly have gonorrhea as well? I know someone(20%) can get both. No, I wasn't tested for that. stupid on my part. I saw no discharge previously  that was any color but clear with a lil white/milky puss. No yellor or green at all.
Gonorrhea and chlamydial infection can certainly co-exist and this may be what is going on here.  You should be tested for both pathogens- this can be done with the same specimen.

Answer continued on next panel.  EWH