Post Docking Burning in urethra

[heronotvictim]

I am a late 30s male who has sex with men, currently travelling in Asia. Two and a half weeks ago (after fighting jet lag and a cold) I hand a sexual encounter that involved docking (touching penis tip to penis tip). Later that week I felt a burning in my urethra and some pain around my anus (the butt pain I had earlier from the long flight, but it turned into a rash).I went to the doctor and after a mid-stream urine test and a swab, the doctor told me that I had clamydia and thought that this might have been dormant in my body for a while and just surfaced when my immunity was low. He prescribed Azithromycin (single dose) 1000mg. The pain went away but after 3-4 days the burning resurfaced and I visited an STD clinic at the two week mark after the encounter. They took a swab and told me I didn't have an STD but probably a urinary tract infection.They prescribed methronidazole (2 tablets twice a day for a week). I also had my anus looked at by a butt doctor and they diagnosed  a thrombosed hemroid (from sitting too long on the plane) and a rash (from spicy food). They proscribed a topical cream that appears to be helping.  Its now the fourth day on the methronidazole and the burning has resurfaced after clearing up for the first few days. Not sure what to do.I If after finishing the 7 day course of methronidazole and I still have this burning, what advise would you have? Any advise would be greatly appreciated.

[heronotvictim]

Thanks for all the info. Great advise. Sounds like a visit to the STD clinic again to find out what is going on is in order. Thanks again!

[Edward W Hook, MD]

In fact, the studies show that the 1.0 gram dose of azithromycin is more effective for chlamydia than taking the 500 mg dose followed by 250 dose pills.   You really don't know what is going on, nor do I.  My approach is always to try to learn what is going on.  STDs are an international speciality.  I'd suggest that you find an STD clinic whereever you are.   In the interim, I would continue to complete your metroniazole but would not take other antibiotics.  Far better to make an informed decision than to guess (again).  EWH

[heronotvictim]

Thank-you very much for your answer. Its great to have this forum.  I forgot to ask if my large frame 275 lb. might have made the one time 1000mg Azithromycin less effective than for the average person (i.e. should I have had a larger dose)? I've read that 500mg followed by 250mg Azithromycin for a certain number of days has a better treatment success. If I failed the first 1000mg-one dose should I consider taking a higher dose or the 500mg followed by 250mg per day. Or should I request of the STD clinic to take (doxycycline) plus metronidazole? Now that I have started metronidazole should I just stop on the 4th day, and wait for the new doxycycline plus metronidazole regime? That is, will taking another 3 days of it without the doxycycline make me build up a resistance to it or should I stay the course and see if another 3 days helps. I'm concerned about the testing I'm receiving (and confusing results) and it perhaps has alot to do with communicating with non-native English speakers( us not understanding each other). I do want to find relief from my symptoms, but will waiting a couple of weeks to return to Western doctors and a planned parenthood STD clinic cause problems with my bladder/kidney or should I go to the south east asian STD clinic here, where communication is difficult. Thanks again for your insight and the opprtunity to consult with you. It is truly appreciated.

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  To my knowledge (which is better than most), there are no data on the risk of STD associated with docking as you describe.  That said, if you were tested with a reliable test and had a positive result, you had chlamydia.  Azithromycin is thought to be highly effective for treatment of chlamydial infection although one recent report has suggested that the treatment failure rate may be increasing slightly (despite this, the vast majority of chlamydial infections will still be successfully treated with azithromycin).  In our clinic, given your recurrent symptoms, you would have been treated with the alternate medication recommended for chlamydial infection (doxycycline) plus metronidazole, not just metronidazole alone because of the (unproven) possibility that you might have failed your recent treatment.  

Several additional thoughts arise however.  First, your testing sounds unusual.   Testing for chlamydial infection is typically performed on urine collected at the beginning of urination, not at mid-stream.  Second, a penile swab would not be useful for detecting a UTI but would detect STDs, gonorrhea, chlamydia and NGU in particular.  

Second, men under the age of 40 VERY rarely get urinary tract infection.  The possible exception to this is men engaging in unprotected, active rectal intercourse  Your recurrent symptoms suggest to me that whatever was causing your initial penile symptoms is still there.

Third, following penis-penis contact, if there was no rectal contact there is no risk of rectal STD.  Thus I suspect your rectal symptoms are totally unrelated to your possible chlamydial infection and are likely due to something else- hemorrhoids being a possibility, yeast infection being another.  The anal rash you report makes yeast a somewhat more likely possibility.    

I hope these comments help. To be honest, the evaluations and information you have reported, if not mis-understood by you, suggest that the folks who evaluated you were not sure of what was going on.  I suggest that you seek further evaluation by an STD specialist- perhaps a public health STD clinic. EWH