PLEASE HELP!

[laman08]

I am 40 year old homosexual male,I am sexually involved  with a partner in a non penetrating and Oral type sex every other month or so for about three years.About a year ago, I had burning sensation when urinating followed by a milky discharge from my penis.After consulting with my doctor, he tested me for STD (incl Gonorrhea, Chlamydia, Syphilis and HIV both antibody and NAAT HIV virus DNA test) and while waiting for the results he prescribed Doxycycline, and an injection for speculating possible Gonorrhea and/or Chlamydia.A week later all the tests results came back negative and the symptoms went away, but only for a short period of time.Since then the same symptoms have been reoccurring every few months.They have reoccurred 7 times in a year for now.Every time it happens I go back for consultation and go through the same routine.Everytime I am given Doxycycline, and Gonorrhea shot everytime followed by same tests.Each and every single STDs/HIV test results have came back negative. about 4 weeks ago, the discharge happened again I went to a new doctor diagnosed me with NGU, He also tested for all the STDs/HIV, again a week later they all came back negative.He also did a physical prostate exam and noticed inflammation (I have to mention that I've also had periodic pain in the prostate area for about 4 years now. It happens mostly at night when I am sleep and I am awaken by the pain.It is a sharp pressure pain and stays for about 10 minutes and goes away by itself). In addition to Doxycycline for NGU, he also prescribed Ciprofloxacin 500 mg twice a day for two weeks. I have finished both prescriptions about two weeks ago. About 3 days ago I started having burning sensation again and today I see the some discharge.  Also, I am not sure if this is related to my condistion but 4 days ago I developed pink eye (Conjunctivitis) which I am being treated by Tobradex. I am frustrated to say the least and desperate for a correct diagnosis.  Please help me with your opinion.

[Edward W Hook, MD]

What you describe sounds like one of two things, prostatitis or the syndrome we call recurrent NGU.  Other STDs have been ruled out.

First, with regard to prostatitis, this syndrome sometimes requires a prolonged course of antibiotics, up to 4 weeks.  Your pattern of what sounds like a partial response suggests that prolonged therapy might help.  

Recurrent NGU is more difficult.  In some folks with this syndrome, treatment with an alternate antibiotic, azithromycin, administered with metronidazole is recommended by the CDC. The are some organisms that can cause NGU and are more responsive to this combination than to doxycycline.   This seems a bit less likely given the duration this has gone on.

In a small proportion of persons with recurrent NGU, the symptoms continue to recur for reasons that are unclear.  After repeated therapy however, if there is no cure with antibiotics, the most common approach is to simply wait for it to respond over time.  The good news in this situation is that when this occurs, the infection is not infectious for sex partners, as troublesome as the symptoms are.

Finally, when NGU occurs in the company of conjunctivitis, it raises the possibility of a VERY, VERY rare syndrome called reactive arthritis syndrome which is characterized by NGU, conjunctivitis, and joint pains (the don't need to occur at the same time).  This syndrome, as I've mentioned is very rare and if a possibility, should be evaluated by an arthritis expert (a rheumatologist) or at the least, an internist.  

Hope this is helpful.  EWH

[Edward W Hook, MD]

I'm pleased this has helped you.  Regarding your concerns about the possibility of recurrence, please remember that knowledge is power and knowing what you have would be a far better perspective from which to address recurrences than to have to worry about what exactly is going on.  I hope all goes well with you.  EWH

[laman08]

I wanted to thank you for your expert opinion you were right on target.  After seeing an eye specialist and Retina specialist, It turned out that my eye problem was Uveitis and I am taking steroids drops, and after almost 12 days, I am feeling better.  I was given a test HLA_B27 and currently waiting for the results, with urethritis and Prostatitis problems the doctor is pretty sure that I must have Reiter's Syndrome.  Meantime he suggested to see a good urologist, and I have an appointment to see tomorrow.  I am happy that I have diagnosis but again concerned if these symptoms may reoccur

Thanks again.