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Avatar universal

persisting symptoms post std treatment

Hi Doctor,
I am a heterosexual man living in a south east asia. 41 days ago had unprotected oral(receiving) and protected vaginal sex with csw unkown hiv status(cannot recall if the condom broke/tear), i do remember her vagina had an odor.11 days later while defecating noticed white discharge on my penis and noticed a clear discharge throughout the day. Next day went to a GUM clinic and was diagnosed with Gonorrhea and NSU. Was prescribed the following:
1. Ceftriaxone 2 shots
2. Cipro 2x/7days
3. Azithromycin 2g
4. Doxycycline 2x/7days
5. Discharge persist after the first 3 days and added metronidazole 2x/7 days.(which i believed did the trick)
Returned after a week,did gram stain/urine test showed i was clean(epethelial cells on gram stain) but still given cefuroxime IM.Several days saw a urologist complaining of pain in my left lower abdomen area and slight ache on left testicles,he said it was probably muscular and did a DRE and said i was ok. Presently, visited the clinic and asked if i could have a urethral swab due to the occasional stinging in my urethra and occasional aching pain in left testicle and discharge(especially when aroused, 10-20 mins after orgasm and at at times after defecation).
Questions:
1. What're the chances infection has'nt cleared since i still feel stinging sensation and ache 2 weeks post meds?
2. Since this, became concerned of other STD's especially HIV?have done 1 1/2 week post exposure (-) HIV Elisa test .353. VDRL/RPR test 13 and 39 days post exposure results (-),is this conclusive?
3. Is there a chance I have infected my partner?no oral or vaginal sex, just kissing prior and after taking medications.
4.I have read on your post 6-8 weeks HIV testing is conclusive,do you think i could have a test at 42 days?they prefer 6 months,I am unsure what generation of hiv test they use here or would it matter?
5. They saw possible genital warts, very small and not hyperpigmented, should i have it remove even if it is just suspected?
7 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your question.

Your initial symptoms were typical for nongonococcal urethritis (NGU, which is the same as nonspecific urethritis, or NSU), both the nature of the discharge and the timing. Are you sure about the diagnosis of gonorrhea as well?  It's pretty much impossible to diagnose both gonorrhea and NGU simultaneously; if gonorrhea is found, then by definition the problem isn't NGU. My guess is the GUM clinic treated you for both but really only diagnosed NGU (unless a later gonorrhea test returned positive).

In any case, you were impressively treated with a mix of antibiotics that was obviously designed to cover every possibility, i.e. NGU, chlamydia, gonorrhea, and eventually trichomonas.  It often takes several days for symptoms of NGU to start to improve, and persistent symptoms at 3 days is not unusual.  My guess is you didn't actually have trichomonas and the problem would have improved without the metronidazole -- which was prescribed in an unusually large and prolonged regimen.  (Usually it's a single dose of 2 grams.)

When symptoms of NGU persist after such intensive treatment, it generally does not mean any infection is actually continuing.  And it appears to be harmless.  Men with persistent/recurrent NGU seem not to develop any complications of any sort, and their partners don't either.  In your case, it isn't clear to me that any important problem is continuing.  Discharge with defecation isn't necessarily abnormal (see the link below), although you might have a case of non-infectious prostatitis.  This also is generally harmless.

http://www.medhelp.org/posts/STDs/Discharge-and-Bowell-Movement-and-Concern/show/859854

To your specific questions:

1) As noted above, I doubt you have any continuing infection of any importance.

2,4) Those test results are 100% reliable, showing you didn't catch HIV and I see no need for further testing.  But you'll have to decide whether to follow this advice or that of your GUM clinic.

3) If you didn't have sex with your regular parnter before you completed your various antibiotics, you can safely assume you didn't infect her with anything.

5) I can't comment on a questionable diagnosis of genital warts.  If you really have warts, you can expect they will soon become more obvious.  And if you have warts, you didn't catch them during the sexual exposure 6 weeks ago.  It takes a minimum of 2-3 months after catching HPV, and usually 6+ months, for warts to become apparent.

Bottom line:  I don't think your current symptoms are worrisome.  But if they continue or you remain concerned, consider seeing a urologist to check out your prostate gland.

Best wishes--  HHH, MD
Avatar universal
Thank you for your quick and as usual very informative. On your question about my gonorrhea diagnosis, actually, 3 days post exposure i got worried and self medicated with Zithromax 2g and Cefixime 400mg (i know, i know, i am wrong). To my dismay 9 days later after having a hard time defecating (my poop was really hard) that is when i saw a white discharge. Upon checking the next day with the doctor, he lectured me because of self medication and told me I had that diagnosis, he then asked me the color of my discharge, I then told him it was initially white, then clear afterwards. He gave me a shot of ceftriaxone, doxy and cipro and told me that the discharge would disappear 24 hours after. I returned 3 days later stressful that there was still discharge. He again shot me with ceftriaxone and added metronidazole. Reading your forums, i know that metronidazole targets trich but they keep saying i may have a different strand of gonorrhea. I find it hard to believe, and anyways waited and made sure before i asked in this forum after the symptoms would subside. Anyways, if you would answer another set of questions, i would greatly appreciate it.
Questions:
1. With these new developments, would it increase the likelihood that it was trich? or maybe it was a non sexual ngu? i have been thinking about this the whole time since if it was trich then i must've got it from a broken/torn condom to which scared me more that i may have aquired other std's since you stated trich could not be aquired through oral sex
2. My apologies on posting hiv questions on the std forum, but i believe since the initial symptoms was of std, I posted it here. So you are implying i could relax and not think of contracting hiv or syphilis anymore? even if i tested just 1 1/2 week post exposure for hiv? I have been sleepless, anxious, worried for the last six weeks and been checking myself consistently for ars, the only thing i have now is oral thrush (probably due to the numerous antibiotics and my excessive smoking due to the stress), the suspected general wart and the aching in my testicles and occasional stinging urethra.
3. While you have answered that i can safely assume i did not infect anything to my partner, those kissing episodes with my partner were before the symptoms of ngu arrived. I never kissed the csw in the lips, only in her breast and skin, is it possible i have contracted an std with that? or could the infectious part be contained in the area of signs/symptoms(penis). Do you think i could resume unprotected sex with her again?

I hope you would give another opportunity to answer these questions so i could move on and get on with my life. I thank you doctor for your expertise and these public forums have brought a lot of people relief and the importance of a monogamous relationship. I have learned my lesson.
239123 tn?1267647614
MEDICAL PROFESSIONAL
None of this changes my opinion or advice.  Nothing serious is wrong.  I agree with your doctor about self-treatment with antibiotics, especially since over-treatment may well be responsible for some of your continuing symptoms and anxiety.

"With these new developments, would it increase the likelihood that it was trich?"  No way.  Trich was never likely anyway (it usually causes no symptoms in men) and could persist after such high doses of metronidazole.

Non-sexually acquired NGU is rare, if it occurs at all.

It's no problem to ask about HIV on this forum, along with other STDs, but I already answered your question about HIV testing.  I haven't changed my mind in the past 2 hours.

Syphilis is impossible given the treatment you received.  Do not have any more syphilis tests.

", the only thing i have now is oral thrush (probably due to the numerous antibiotics and my excessive smoking due to the stress)...."  Good bet, but nothing to worry about.

"I have been sleepless, anxious, worried for the last six weeks and been checking myself consistently for ars..." plus ..."aching in my testicles and occasional stinging urethra" are classical symptoms of genitally focused anxiety, which I believe is the main problem here.

No STDs ever are transmitted by kissing, nor from mouth to skin (e.g. nipples or elsewhere).

Thanks for the thanks about the forum, but that will have to end this thread. I hope these answers indeed allow you to "move on and get on with [your] life."  If not, professional counseling would be a logical next step.
Avatar universal
Thank you for the reply. Indeed, I did have anxiety over these but who wouldn't especially after having protected vaginal but unprotected oral sex than having contracted an std? Anyways, I just wanted a good reply from an experienced doctor in this field. I will leave this behind me...Again thanks.  
Avatar universal
I guess my last post was deleted. Thank you anyways doctor
239123 tn?1267647614
MEDICAL PROFESSIONAL
"Thanks for the thanks about the forum, but that will have to end this thread. I hope these answers indeed allow you to "move on and get on with [your] life."  If not, professional counseling would be a logical next step."
239123 tn?1267647614
MEDICAL PROFESSIONAL
If you continue to ask anxiety-driven questions that have already been answered, the entire thread will be deleted.
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