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Avatar universal

posoive chlamydia results, symptoms remain

Hell Dr. I am a 25 yo male who recently had sex with three woman over the span of two weeks. the first 2 were protected except for the first 30 seconds then i put a condom on. The 3rd was not protected. One was on March 8. the last two were on the weekend of March 15-17. That same weekend i noticed a small bump on the underside of my penis shaft near the base. I squeezed it and a little bit of white puss came out. The bump did not go away so I got a full panel test done on wednesday march 26, 10 days after my last sexual encounter. I tested negative for everything except chlamydia. I also had a HIV RNAl. I got a dose of azithromycin which i took on saturday march 29, 4 days ago. At the time i was experiencing mild pain wile urinating and some lower abdominal pain as well. Today i went into get the bump checked out by a doctor and he said that it was an infected gland and to leave it alone. i asked him if it could be herpes and he did not agree. he also did not want to do a swab because there was no open sore and i assume he did not want to squeeze the bump. i will also add this bump dose not cause me pain unless i squeeze it. And it dose have a hair follicle hole at the base which leads me to believe that it is a infected gland. the dr. also checked me for chlamydia again and i have not got the results back yet. However today i am experiencing some persistent intense testicular pain as well as some mild discomfort while urinating this morning and im not sure why. my questions are as follows.

-could it be possible that i still have chlamydia and it is taking this long for the symptoms to go away?

-dose the bump sound like herpes or perhaps another std to you even with my negative test results.

-how accurate are RNA tests, would you recommend i get tested for HIV again or are these tests conclusive?

-would you recommend i do any type of follow up testing ( assuming my chlamydia results come back negative from today)
9 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for your question.

Your chlamydial infection was entirely asymptomatic.  It had nothing to do with the penile lesion you describe.  Based on your description and your doctor's evaluation, I agree exactly with him:  the infected gland, sebaceous cyst, or whatever it was definitely wasn't an STD and not something you acquired sexually. To your specific questions:

1,4) Azithromycin isn't perfect, and it's always a good idea to be retested a few weeks later to be sure chlamydia is gone, or that reinfection hasn't occurred (although that's of course impossible if no further sexual exposures).  Have another chlamydia urine test in a few weeks.

2) This bump absolutely is not due to herpes, chlamydia, or any other STD.

3) RNA testing is not the main way to check for HIV.  The test is accurate, but much too expensive.  And anyway it's not officially approved to diagnose new HIV infections.  However it's an accurate test, so the result is reassuring.  And the chance of HIV from exposures like yours is very, very low. For complete reassurance have an additional antibody test 4 weeks after the last exposure, but don't worry about it in the meantime.  It will confirm you don't have HIV.

I hope this has helped.  Best wishes and stay safe--   HHH, MD
Avatar universal
Thank you for the speedy reply, i just have one follow up question.
the pain in my testicles is pretty persistent and throbbing. it did start around the time i got tested, although it has been off and un until today. i assume it is related to the chlamydia infection.if this is the case, is it normal to have to still have symptoms 4 days after being treated?

side note: i was also tested with an hiv antibody test that was negative as well. However, i will take your advice and do a 4 week follow up for my negative conformation.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Chlamydia doesn't cause testicular throbbing of this sort.  This also is a classical symptom of genitally focused anxiety and the "chronic pelvic pain syndrome", and I don't expect it to imrpove as a result of antibiotics.

For more information, google CPPS (spell it out) and start your reading with the excellent Wikipedia article and information from the Stanford Univ dept of urology.  You'll find a carbon copy of your symptoms -- and the pain mechanism is the same in genitally focused anxiety (pelvic muscle tension).
Avatar universal
Thank you for the info on the CPPS and genital focused anxiety. Although this is somewhat of a stretch for me to believe it's a physiological issue, I am also not a dr. So I will take this into account. My only question was is it possible to be experiencing symptoms I.e painful urination 4-5 days after treatment if it was succesfull? The only reason I ask is because I could not seem to find this info anywhere else.
239123 tn?1267647614
MEDICAL PROFESSIONAL
When treatment for urethritis is successful, dysuria -- painful urination -- usually resolves within 2-3 days. Dysuria without pain usually is not due to STD.

Perhaps the notion of "psychological origin" will seem more acceptable if you consider the physiologic cause of the pain, which is increased muscle tension or spasm. This is basically the same as for tension headache, except that pelvic rather then head and neck muscles are involved.  Are you disturbed by the notion that anxiety or stress can cause headache? Back pain?  Unexplained abdominal pain or nausea?  Why should the genital area be any less susceptible to such pain?
Avatar universal
Ok, I understand. Now that you explain it that way it makes more sense. Thank you for all your help. This will be the end of my thread.
Avatar universal
Sorry i know i said that the last message was the end of my thread, however i got my test results back today and i was still positive for chlamydia. im a little shocked considering the success rate is so high on initial treatment. Is it possible it actually did work but i didnt wait long enough before i got tested again (4 days) or could there be something else going on? ether way i was perscribed doxy for the next week so we will see if that works i guess. Any info you can give me will be appreciated.

Best.
239123 tn?1267647614
MEDICAL PROFESSIONAL
First, let's be sure you had the right kind of chlamydia test.  From the start, I assumed your chlamydia test was on urine or a urethral swab.  If it was a blood test, the results are useless and you probably never had chlamydia to start.  And once positive, a chlamydia blood test remains positive for life.

But even assuming you had the right kind of test (urine or urethral swab), your repeat test at 4 days was way too soon.  With successful treatment, it takes up to 3 weeks for chlamydia tests to become negative.  Until and unless you have a new sexual exposure, you do not need any further chlamydia tests.  It is impossible for chlamydia to persist after both azithrmycin and doxycycline, so there is no point in being tested again.

Continue to work with your doctor about any continuing symptoms that concern you.
Avatar universal
Thank you for the response. Both the tests were a urine test. Thanks for answering those questions. thats all i wanted to know. I will consult my dr. for any thing else i may need.

Best
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