Penile Discharge?

[justplainconfused]

Hi Doctor,

I'm not sure if im posting in the right place or not so please forgive if not ;-)  I thought I posted in one of the free forums but cant seem to find the post so now I'm here....

Here is my situation.

I slept with a girl maybe a month ago.. maybe a little longer.  About a week and a half a go she called me and said she came up with chlamydia and trich.  Since I had been having some abdominal pains prior to this and my left testicle was bothering me I decided to go see a my doc.  He did blood work, urine ( to check for uti ), and a swab.  As it turns out the swab was expired so the lab did not run the test....  So I after the doc told me this he had me go to the lab and do a urine test to check for chlamydia.  The only thing I know from the previous tests ( the ones that actually were done ) was that I'm not HIV positive and I dont have a UTI.

This was a condom protected event but i did perform orally on her.  Now from what I've read here on other posts oral transmission risk is extremely low.  Is it correct that Chlamydia and Trich do not transmit in this way or have I misunderstood what I've read?

I dont have any weird bumps on my penis, no itching, and I dont have any difficulty in urination ( no burn, sting, etc ).  At first I was experiencing bladder awareness but I think that was just momentary "panic" as it seems to have gone away.  

I have had 3 seperate mornings where I've woken up and the urethra opening seems to be a tiny bit crusty and sealed shut if you would.   Other than that no noticeable discharge or odors.  Im just wondering, is that a normal thing that wouldnt otherwise be noticed if I wasnt hyper sensitive to "symptoms" right now?

So here's a summary of my questions

1)  Does Trich transmit orally?  ( I did not check dates on the posts but I believe one of the doctors did say no at one point... just want to get my facts correct here and that this is the most up to date info )

2)  Same question for Chlamydia?

3)  How does one get these STD's?  Does it have to enter your urethra for it to effect you?  ( So a condom would be highly effective in avoiding these? )  Is that the only way these transmit?

4)  How good is a urine test for chlamydia / ghonn?  Is it as effective as a swab in determining if you have these?  ( I cant believe ALL of their swabs were expired!)

5)  What's this weird penis 'crust' about?  Again, it's just barely there.... I would think an STD would produce something more if it was discharge of that nature?  Is that a correct assumption?  Is this something I should see a doctor about for some othere NON STD related problem or normal?

And my last one is just a curiosity one as the various answers I've read on this still leave me unclear.  If a woman has HPV and has the cells removed, can she still pass the virus or is she "safe" from passing it along.  Again I'm just curious and cant seem to get my brain to register heads or tails on that one.

[Edward W Hook, MD]

Staright to your questions:

1.  No penetration, no transmission.  I find myself wondering why you even ask since your tests are negative.
2.  Azithromycin is recommended therapy for both NGU and for chalmydia and would kill most but not all gonorrhea. Once again, with negative tests, even asking seems a bit silly - your tests are negative.
3.  You are most likely sore becasue of your own self-examination, not infection.
4.  No
5.  Why don't you believe the tests (or for that matter me)?  If it takes un-needed therapy for trich to help your misplaced anxiety, then take it but please don't ask for information and then ignore it.  EWH

[justplainconfused]

First off, thank you for your detailed response.   You have been very helpful in calming some of my fears while I waited the extened wait for test results.

I did receive my lab results back which were neg for chlamydia, Gon, and Syph.  The first urine test checked for the presence of Trich and came back neg but I know that's hard to determine when it comes to men.

A few more questions and I think I'm done with this situation, if you dont mind.  

1)  There was some genital to genital contact prior to me putting the condom on.  Some sites say that this can allow Trich to transmit, and from others sites I gather that there must be actual penetration for enough of the Trich to infect you.  Which is correct and would this change my likelyhood of having it?  ( No penetration, just rubbing )

2)  On NGU.... Would the 1g of Azit the doc gave me take care of that if it were a contributor to my "symptoms".  I didnt take the Azithromiacin (spelling?) until after the 2nd urine sample was provided so I know my neg Chlamid and Gon results are accurate.  

3)  Does or Can NGU cause testicular pain?  I have sensitivity in my left testicle still.  It's just sore near the tube that attaches to it.  I have resisted the urge to touch it and "feel for problems" so that I'm not creating symptoms of a problem that may not exist anywhere but in my head.  It's still sore after 3 days though... although it is less noticable than before.

4)  Does Trich cause Epiditymitis ( again spelling? )  If so, is it with any noticable frequency or rare?  Does this cause extreme swelling and pain if you have it?  ( My discomfort is relatively mild and If there is any swelling, it's minimal at most ).

5)  Final Question - Given that my partner had Chlamid and Trich and I tested neg for Chlamid, is it likely that the condom protected me from both?  Or, should I just ask my doc to give me the antibiotic for Trich and call it a day?

Again, thank you for your responses.

[Edward W Hook, MD]

In the specific situation you are in, the data and recommendations are a bit in conflict.  Let's go through things step by step.  For starters, if your partner has exposed you to an STD, the standard recommendation from the CDC is that you too should be treated for the same infection.  Thus, according to this recommendation you should be treated for trich and chlamydia (p.s.  your partner has done the right thing by letting you know.  Sadly many people would not tell their partners out of embarrassment).

This recommendation however conflicts with the fact that your genital sex was protected, making the chances that you have either STD essentially zero if the condom was used throughout and properly.  Condoms do work.  As for your oral expsoure, you are correct, that oral sex does not lead to transmission of infection by either chlamydia or trich with any appreciable frequency.  Using this line of reasoning, you should not need treatment.

Finally, you report some "stickiness" to the urethra.   This could be a manifestation of a discharge and, at the very least warrants an evaluation by a trained health care professional, preferably at least 1-2 hours since your last urination in order to evaluate for the presence of a small amount of discharge and/or the presence of white blood cells upon microscopic evaluation of a specimen from your penis (or the first portion of a voided urine specimen).  

Putting all of these fact together, and knowing that you were both exposed and have symptoms which COULD be an STD, my advice would be to get checked and then treated for the exposure.  It is the path of least resistance and, in this instance, there is little downside to treatment.

As for your specific questions:

1.  Nope
2.  Almost never. A few cases are reported but it is so rare that neither we, nor the CDC recommend testing for it in the mouth, even for exposed persons.
3.  The infections infect mucosal surfaces. In your case this would be the urethra.  oral infection would not be expected to occur.
4.  They are excellent.  They rarely miss infections and detect, on average well over 99% of infections when they are there.
5.  See above. Hard to say but NGU can show up this way.

Regarding HPV, if a person has had the infection "removed" meaning treated or surgically removed, the risk of infection is very, very low.  Sometimes residual HPV is left behind and can be transmitted.  EWH