Second opinion

[detravel]

Hello Doctors.  Thank you for this extremely valuable resource.

I am a 30 yr old male. About 1 month ago I had unprotected sex with a woman.  A one-time stupid mistake not to be repeated.

I noticed symptoms 28-30 hours after the encounter. Thick discharge, abdominal discomfort, frequent urination. Was given swab test 5 days after encounter, and a single large dose of (I think) Cipro. Symptoms disappeared almost immediately.  Swab test came back negative for chlamydia and gonorrhea. Blood test also returned negative.

On day 8, I experienced a return of symptoms.  Very warm sensation behind and (seemingly) in the testicles. Also a thin discharge and frequent urination. Testicles remained warm (and very low hanging) but not as warm as on day 8. Urologist prescribed Cipro (250mg 2x/day 10 days). Did not alleviate the symptoms. Actually, I seem to have had an allergic reaction to the Cipro (difficulty breathing most nights and a fainting episode on one night). Discontinued the Cipro; after completing 9 days of treatment.

Recently had another swab test, no results for 2 weeks.

Symptoms have subsided a bit over time, very slowly. Still feel a bit warm; frequent urination; after urination have a continued release of urine for unusually long period (very difficult not to have dripping after re-buckling the pants). I also now have some asthma-bronchitis-like symptoms (it has been a rough month).

Any explanation for the negative swab test?

If an infection has moved into the prostate, but eradicated elsewhere, would a swab test detect this?

Should the Cipro have worked on everything?

Could the AB's (and stress) have lowered my immune response, so that I caught a bronchial infection? Seems unrelated (oral gonorrhea doesn't have this symptom?).

Would allergy to Cipro inhibit it's effectiveness?

Can my body remove the infection, without antibiotics?

Which AB is typical treatment for a chlamydia prostate infection?

And any other insight you might have.  Thank you!

[Edward W Hook, MD]

NGU is defined by detection of increased numbers of white blood cells in a swab specimen taken from the penis or the inital portion of a urine specimen, collected as a person begins to urinate.  In either case, the specimen is most relaible is you have not urianted for at least an hour before the specimen is collected.  EWH

[detravel]

Thank you again for your reply.  

I don't doubt that my psychological state may have contributed.  Some of the symptoms, however, (mainly the thick discharge and now the urine release) were/are certainly uncharacteristic of my history and quite visible. Nonetheless, I won't rule out the possibility. I would like to be sure.

Are NGU's tested for in the same way as chlamydia/gonorrhea?  Also a swab test?  I believe that only chlamydia/gonorrhea were tested.

Thanks.

[Edward W Hook, MD]

NGU is  an STD.  You inidcated negative tests, I presumed this included NGU. If you were not tested for NGU, you should be but even then the onset of symptoms would be uncharacteristic.  

Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation.    EWH

[detravel]

Thank you for your quick reply.  

If not an STD, do you have another suspicion?  Is NGU considered an STD? Or, rather, do you include this as being unlikely?

The Cipro was effective on the initial symptoms, could this indicate an alternative bacterial infection?

Thanks again.

[Edward W Hook, MD]

Welcome to the STD Forum.  My suspicion is that the unifying theme which would tie together your apparent lack of a complete response to therapy and your negative tests is that the original symptoms were not due to an STD.  Let me explain my reasoning:

1.  The chances of infection are low.  You do not describe your partner but most women, even most commercial sex workers do not have STDs and most STDs are not transmitted following a single exposure.
2.  The onset of symptoms was too quick to be due to STD.  STDs rarely have the onset of symptoms less than 48 hours after exposure and virtually never within the first 36.
3.  Amongst your initial symptoms, abdominal pain is not a typical sign of STD for men.
4.  Your tests were negative.
5.  Ciprofloxacin is effective therapy for many but not all strains of gonorrhea but is not recommended for other, more common forms of urethral infection such as NGU or chlamydia.
6.  Respiratory tract symptoms are not due to STDs.  Yours may be due to a summer cold or bronchitis.  If the symptoms are troubling you, you should check with your doctor.  This would be an unusual form of allergic reaction to ciprofloxacin and if it had been due to the cipro, stopping it should have helped.

Thus, in answer to your specific questions:
1.  The negative swab test suggests you did not have an STD.
2.  STDs almost never cause prostate infections.
3.  See comments above about cipro.  If this had been prostatitis, ciprofloxacin would have been an appropriate therapy.
4.  This is not oral gonorrhea.  As I said above, you could have caught something else coincidental to the exposure you mentioned.  
5.  See comments above about ciprofloxacin allergy.  This is a diagnosis that should be made by a health care provider.
6.  Yes, infections do sometimes cure themselves.
7.  Ciprofloxacin is the among the recommended therapies for prostate infection

Hope this helps.  My suspicion is that this is not an STD.  EWH