Very Confused

[tacomaTRD]

Very Confused--
Symptoms were burning during urination, increased frequency of urinating, itching sensation at opening of penis and a dripping sensation of penis.  No noticeable "discharge" or "drainage" and especially not any distinct color.  Diagnosed positive for chlamydia.  Perscribed doxycycline over a ten day course.  I took 100mg twice daily for the ten days and noticed symptoms decreased a bit but the dripping sensation remained and both the burning and frequency had lessened but not disappeared completely.  I refilled the doxy for another ten days and.  About 6 or 7 days into the second round of doxycycline received shot called "rosefen".  Finished off second round of doxy, has been nearly two weeks since.  
Still experiencing mild burn during urination and bit of a dripping sensation, along with the frequency remaining but decreasing drastically.  Few weeks ago started noticing a very weird itching sensation around my anus.  New girlfriend and I have been extremely careful and have always had protected sex.  However, on two occassions I have been extra worried about passing it to her. One night we made very light and brief contact with our bare genitals and on a second occurrence I noticed that some of my semen had seeped out of the condom while I was still inside her.  Both of these instances occurred about a week to week and a half after the second round of doxy.  

My questions are as follows:  

Question 1- how long does it usually take to knock this STD out of your system completely?

Question 2-how likely is it to transmit to someone else if you have protected sex during treatment?  

Question 3-is the itching around my anus related to chlamydia, doxy, both or neither?

Question 4-should I seek alternative treatments (Zithromax?)

Question 5-does rosefen effetively cure chlamydia?

Question 6-could I have been diagnosed incorrectly?

Question 7-is there a possibility that the doxy did not cure my chlamydia?

[tacomaTRD]

Thanks for your help.  I greatly appreciate this information.

[H. Hunter Handsfield, M.D.]

The answers come from seeing a health care provider, not from online advice.  You are cleared of your chlamydia.  All the other possibilities have no known serious health outcomes and matter much.  See a provider if you remain concerned about your symptoms, but I have nothing more to offer.

[tacomaTRD]

Thank you so much for the advice.  I"m sure you can imagine my concern as this is something that I've never experienced before and always shuddered to think about when younger.  This forum is very helpful and I appreciate all the information provided.

Just so I'm on the same page...Is it safe to say that the doxycycline cleared my chlamydia and what could've possibly been NGU and the Rocephin erase any possibility of anything related to ghonorrea?  I would be reassured that I am completely cured of these stds if combined zithromax with the doxy to ensure NGU is cured as I 've read that this is sometimes recommended as an alternative and/or supplement to doxycycline.  I'd also like to take tindamax for the possibility of trichomonas.  I know you mentioned that I shouldn't have the zithromax perscribed and you aren't the dr that diagnosed me (so I understand that this is only advise and not a diagnosis) but would you recommend it in the case of getting rid of possible NGU or do you think the doxy is sufficient for chlamydia and NGU?  I'm sorry to be so persistent but I'd really like to be certain.  What do you think?

[H. Hunter Handsfield, M.D.]

You don't need to worry any more about chlamydia.  I cannot advise about treatment of the anal itching because I don't know the cause; yeast infection is just a guess at one possibility. NGU is treated the same as chlamydia, e.g. doxycycline or azithromycin (Zithromax).  Trichomonas is treated with either metronidazole (Flagyl and other brands) or tinidazole (Tindamax), which is the one I favor for treating men.

I'm sure Wichita has a health department that provides STD services.  You can either go to that clinic for further evaluation or phone them to get advice about local private docs.

[tacomaTRD]

I exceeded message capacity with last post.
Thank you for your advice!!  Had unprotected sex with 3 different women once each and exactly one week apart each time.  started having symptoms next day following sex with third and final girl.  was very drunk with second girl and also most certain she was on her period because sex was very bloody.  Positive chlamydia diagnosis was based on swab culture which also tested but came back neg for ghonnorea.  Ran urine test for bladder infection and blood test for HIV and Hepatits.  Dr. said all results came back neg accept chlamydia.  not sure if UA detected blood cell count and dr. did not mention anything about trich or NGU.  Second UA still showed no infection two weeks after initial visit.  Sounds safe to say that I'm cured of the chlamydia I tested pos for but are trich and NGU transmissable and are they serious as I've never heard of them before?  Also, what antibiotics are generally perscribed for NGU and trich?  The dripping sensation I referred to is more like a consant urge to urinate and feeling like tip of penis was always wet.  I didn't ever notice discharge guess wasn't sure what to look for.  How do I get rid of itching in anus if it is a yeast infection?  Dr. I saw for this was first time visit and mentioned doesn't usually deal with STDs.  More like an internal medicine dr.  I'd like to see someone that specializes in stds but don't know where to look.  I live in Wichita, Kansas.  If you have any suggestions I would appreciate it.  Furthermore, I really appreciate you taking the time and consideration to offer advice and knowledge.  Please let me know what you think.  Thanks in advance.

p.s. no longer frequent need to urinate and burning is very minimal, drip sensation is also gone.  just itching anus

[H. Hunter Handsfield, M.D.]

If your username means you live in or near Tacoma, the health department there no longer provides STD care.  But you can phone the HD and learn of private providers who are experienced with STD.  Or visit the Seattle-King County STD clinic at Harborview, one of the best in the world.  (As its former medical director, of course I'm not biased.)  Wherever you go, your new gf should be examined at the same time.  Some infections, especially trichomonas, are much easier to diagnose in women than men.

[H. Hunter Handsfield, M.D.]

I'm not clear on some aspects of your story.  What is a "dripping sensation" without a visible discharge of fluid from the penis?  It doesn't sound like an STD symptom.  Second, when you say chlamydia was "diagnosed", do you mean a positive lab test, or just a provider's best guess based on your symptoms?  Were you also tested for gonorrhea?  Was a test done to look for white blood cells in your urine or the urethra?  You also say nothing about your sexual exposure(s) in the time before your symptoms began.

I press on these issues because from the symptoms alone, chlamydia or other STD doesn't seem very likely, but more like genitally focussed anxiety or something not related at all to sex.  Still, there are other possibilities, such as nongonococcal urethritis (NGU) due to bacteria resistant to doxycycline (e.g., the newly discovered bug called Mycoplasma genitalium, or the old one called trichomonas.)  Itchy anus is not an STD symptom, especially in heterosexual men.  (But it can result from a yeast infection, which can follow multiple antibiotics like you have had.)

Ceftriaxone (trade name Rocephin) is the drug of choice against gonorrhea but doesn't treat chlamydia.  But doxy is 100% reliable against chlamydia.

As far as your new gf is concerned, after the antibiotics you have had, you can be sure you have no continuing chlamydia or gonorrhea.  The main possible exception is trichomonas, which could cause your symptoms and requires different antibiotics.  There is no useful test for trich in men, however; so many providers would just prescribe treatment in men with persistent symptoms like yours, just to be safe.

To the specific questions:

1)  If you had chlamydia or gonorrhea, the treatments you have had would have cleared up the symptoms within a few days.

2) Once treated, transmission to a new partner cannot occur.  But conceivably you have incompletely treated NGU or trichomonas.

3) See above.

4) Return to your provider, or if not certain about his or her STD expertise, find another one.  Your local STD or GUM clinic would be a good choice.  Don't tell your provider you want treatment with Zithromax in particular; tell him or her about your symptoms and the possibilities I mentioned and let the provider use his or her judgment.

5-7) See above.

Good luck--  HHH, MD