Herpes or another std?

[bt12345]

First of thank you doctor for your time and response this board has really helped me out with other people's posts and your answers.
23 days ago I had unprotected sex with a girl that I didn't know very well.  About 2 days after the encounter or even less I developed a rash on my scrotum that was bright red and burned/itched and was moist.   I initially thought herpes and freaked out.  I didn't develop any bumps or blisters and still haven't yet on any part of my penis/scrotum. About a week later I went to a walk in care doctor.  He examined me and my rash and tested for chlaymida, gonorrhea, took my urine sample checked for bacteria.   He gave me enconazale nitrate cream for my rash and gave me a prescription of 4 azithromycin.  He also gave me a shot in my butt to be safe but cannot remember what that was.  Everything came back negative.  So I thought I had a bad fungal infection or herpes that hasn't shown up yet.  After using the cream for 2 weeks my rash got alot better but did not completely gone away.
Now about 4 days ago I started to see pre ejaculate come out if my penis after I pee or  when i am really excited.  It is clear transparent and somewhat sticky that drips out of my penis after urinate.  I doesn't hurt to pee at all.  One more thing I quit masterbaiting for 2 and half weeks after the incident and I use to masterbait prolly daily before that.  Lastly when I pee my urine is bubbly in the toliet I don't know if that has anything to do with this or not.  
My questions are:
what does this sound like to you? Does it sound at all like herpes or another std?
If I was tested for chlymida, gonorrhhea, and had a urine analysis that came back negative was it too early to test at 7 days after the encounter?
Last question if it was a NGU wouldn't the shot and the azithromycin clear it up?

[Edward W Hook, MD]

Yes, the recommended treatment for chalmydia and NGU is 1 gram of azithromycin (4 pills) all taken at one time.  You can be confident of your test results.  EWH

[bt12345]

Thank you Dr.  for your quick reply.  This is very helpful for me and reinsuring.  My rash has been going for about 3 weeks now it has been getting better but still there and a little redness.  One more thing I was only given one prescription of azithromycin for one dosage of 4 pills at once. Is that normal amount or is it a week cycle that has to be used to clear any infection of another NGU cus I did test negative for it chlaymidia and gonorrhhea.  
Thanks again for your time and thoughtful answers!

[Edward W Hook, MD]

Welcome to the Forum. As I read your post, my thoughts went to a possible fungal infection and indeed that sounds like what you had.  It does not sound like herpes, both in terms of the description of the rash, the location of the rash, or the timing (two days is a bit early for herpes to appear).  

The walk-in doctor who treated you treated you for gonorrhea (the shot was probably ceftriaxone), chlamydia/NGU (with azithromycin), and a fungal infection (with the cream.  The antibiotics you took may have delayed your response to therapy for the fungal infection and you may need more therapy for that if your rash has not cleared up.  The tests you have proven that you did not have STD from the encounter you describe (the timing of your test is fine) and you certainly do not need further treatment of testing related to the exposure you have described.  

I suspect what you are seeing are normal genital secretions which have always been present in the sorts of situations you describe but were not noticed/looked for prior to your heightened concerns related to this exposure.  

My advice, I would not worry further about STD.  If your scrotal rash has not cleared up, you may wish to get a bit more therapy for that.

I hope my comment is helpful. EWH