Urethritis

[Malcolm532]

I am a male and had unprotected oral sex with another male, including kissing.  A day later I had sex with my female partner.  Ten days later, I had a pharyngitis and discomfort at the tip of my penis with no discharge but tingling and discomfort.  In the meatal area there was a clear but not discharging secretions. I self treated with 1 gram of Cipro and 1 gram of Azithromycin, followed by 250mg per day of Azithromycin for 2 days.  However, symptoms of pharyngitis & urethritis continued.  I went to my doctor about a week after having taken the Azithromycin & Cipro.  They checked for strep, gonorrhea and nongonococcal causes of the pharyngitis, however, because I had self medicated with antibiotics, a urethral culture was not done. The strep test was negative & throat labs came back negative. I was prescribed cefixime and doxycycline 100mg twice daily for 7 days. The pharyngitis was actually resolving itself by the next day before I had even started antibiotics, however I proceeded to take the prescribed antibiotics.  Finally, about 10 days after the doxycycline treatment was "completed", the urethritis was gone.  If the cause of the urethritis was nongonococcal then wouldn’t the Azithromycin have worked & symptoms been gone at least by the time I started and/or finished the Doxycycline?  

Now, about 10 days ago after having sex with my female partner, the same symptoms of urethritis are back.  No pharyngitis.  So about 4 days ago I took 1 gram of Azithromycin followed by four days of 250mg per day just in case it was a nongonococcal urethritis.  It has been 3 days since I took the Azithromycin and my symptoms are still there.  My female partner has not mentioned having any symptoms.

(1) does this sound like possibly a viral (adenovirus) urethritis or other?  (2) if it sounds like an adenovirus then could that have been transmitted to my female partner and would she harbor this virus vaginally & bounce it back and forth?,

What do I do?  Thanks.

[Edward W Hook, MD]

Adenovirus urethritis typically resolves over a week or less.  No if your urethritis was due to adeno it would not bounce back and forth. EWH

[Malcolm532]

Thank you for your help.  

What is the duration of symptoms with adenoviral urethritis?  Does it take weeks to resolve or just days?  

Also, can the adenovirus be bounced back and forth with vaginal sex or do both individuals develop immunity to the virus?

[Edward W Hook, MD]

Several comments:

1.  The azithromycin you took was a lower dose than what is recommended for NGU.  The recommended dose is 2.0 grams once.  To be honest, I suspect that the azithromycin you took would cure NGU but it is appropriate to comment that you took less than the recommended dose.   There are no data on what the outcome of a lower dose might be.
2.  The dose of doxycycline you took is the recommended dose and would be curative for most NGU.
3.  Most STD-related pharyngitis is asymptomatic.  Most symptomatic throat infections are due to viruses (including adenovirus).  If your problems are due to virus, there is no need for further treatment but it does not explain your recurrent sypmtoms.  there is really no way to tell if this is due to a virus or not.
4.  Antoher possibility is that you infected your partner and that you were better until you returned and had sex with her, then got re-infected.

The best way to address this is as follows:

1.  First, be sure that you have urethritis.  This can be determined by a swab test from your penis showing the presence of white blood cells.   Alternatively, you could look for white blood cells in the first portion of a voided urine specimen.  Either test will be better if you have not voided for 2 hour before the specimen is obtained.
2.  If you have urethritis, you should be re-treated.  You cannot be sure that you do not have a bacteria. If it is a virus, it will get better on its own, if it is bacteria it needs treatment.
3.  Your GF needs to be treated, either with the appropriate dose of azithromycin or with doxycycline

Hope this helps.  EWH