tested negative but questions....

[nottiny]

I was very stupid a little over a month ago.  On Day 1, I had unprotected oral sex with a transexual (in the USA).  I received for about 5 minutes, did not orgasm.  I gave for about 3 minutes, did not orgasm.  Then received a hand job and I came.  On Day 7 I had unprotected oral (gave and received) from a woman, and protected intercourse (for about 5 minutes).  The oral was long (15 - 20 minutes) and sometimes rough.  On day 8, masturbated and used a perfumed body lotion for lubrication.

On Day 13: some discomfort while urinating.  I masturbated out of curiosity and there was some burning in penis as I came.  On Day 14: small stain on my underwear.  On Day 15: yellowish creamy dishcharge from my penis in the morning.  I had frequent desire to urinate, some discomfort but no real burning.  I got tested (urine sample and blood sample) for Gonorrhea, Chlamydia, HIV, Syphillis, Herpes.  On Days 16-19, no more disharge in the morning, but stain (yellow/dark yellow, stain on underwear throughout the day).  On Day 19, I received anti-biotics from the Dr.  He gave me 1 gram orally of Azithromycin.  

By Day 21, no more stain on underwear.

On Day 22, I got the test results back:  all negative. Day 27: masturbate out of curiosity; no pain; lots of fluid in ejaculation.

On day 26, small amount clear discharge on underwear sometime during day.  It was after a long bowel movement.

On day 36, I notice a clear discharge in my underwear (so it was dry when I found it).  Long bowel movement several hours before.

It's now Day 41.  No discharge that I can tell, no stain, but I do have to make some effort to empty the penis completely after urination almost every time.  I recall this would happen every now and then before my acts of stupidity above.  I have not had any discharge in the morning.
Do I need to worry that it was a false negative? Should I get tested again? Could my actions have cause prostatitis? Any advice? (I am 42 yrs old)

thanks

[nottiny]

A final thanks, Doctor.

Keep up the excellent work.

Humbly,
me.

[Edward W Hook, MD]

If there were no white blood cells, yes, you are clear.

I think trich is very unlikely.  I have never heard of someone getting trich from oral sex

[nottiny]

Thank you, again, Doctor.

Coincidentally, on day 29 of the originally time line, I had to give a urine sample for drug testing.  One of the required screens is checking for white blood cells.  None showed up.  This was 10 days after the Azithromycin.  So, it looks like I'm clear?

Lastly, trichomoniasis.  Given the events that began this, should this be a concern? The panel of std tests I was given did not test for this (or at least did not indicate).

And, thank you for the comments on prostatitis.  I hope I can close this chapter and have learned my lesson.  I hope others reading this saga can learn from it, too.

Peace.

[Edward W Hook, MD]

As I mentioned earlier, the recommended treatment for NGU is azithromycin.  If you have a recurrence you should be treated with the same medicine.  An alternative is to take doxycline, twice daily for 7 days.

If you have sex with your girlfreind since the expsoure which was followed by development of NGU, your girlfriend should be treated.   If you have recurrent NGU following treatment it is not clear that your GF needs treatment again but it would probably be the safest course of action.

In general follow-up is not recommended for NGU as the treatment is highly effective.  If you have recurrent NGU (based on the lab tests for white blood cells I mentioned, not sypmtoms) the appropriate follow-up would be a repeat test for white blood cells a week after treatment.  

This is not prostatitis.  I am sure you can find someone who will call your problem that if you look hard enough and perhaps even treat you for it but that is not what you describe.  If you have questions about prostatitis, please see a urologist. EWH

[nottiny]

Doctor,

Thank you for your thoughts on this.  It is of great help.

Follow up questions on the NGU... if it indeed was NGU and turns out that I need re-treatment:
1) would Azithromycin again be the recommendation, at the same dosage? If not, what would be a typical follow on treatment?
2) I do have a monogamous girl friend who does not know about my foolish behavior. Would it be better for me to only have protected sex with her until I am 100% sure the NGU has cleared?  In other words, if I currently have NGU that was not taken care of by the first course of antibiotics, could I pass on something to her?
3) What is my signal that the NGU has cleared?

And, I looked up symptoms of prostatis.  I found them on
http://men.webmd.com/prostate-enlargement-bph/prostatitis-symptoms
Is there  a tell-tale symptom of prostatitis?

Thank you again for your time and patience.  This is great site and a great service.

[Edward W Hook, MD]

Since, as I understand it, your vaginal exposures were protected your risks are only oral in nature.  following receipt of oral sex, the most common forms of urethritis are either gonorrhea or non-chlamydial nongonococcal urethritis (NGU).  Since your gonorrhea test was negative before you took antibiotics, I presume you hand nongonococcal NGU.  Azithromycin is the recommended treatment and cures over 95% of NGU.  The resolution of your symptoms suggests that you were cured and there is little reason for concern.  If the clear discharge is regular, it may be in your interest to get a urine or swab test for whitle blood cells.  If either of these is positive, you may need re-treatment.

I would not be concerned about the occasional sensation of incomplete emptying.  BTW, there is no recommendation for follow-up testing after treatment for NGU - treatment faliures are too rare to make it worthwhile.

AS for prostatitis.   We now appreciate that most prostatitis is not related to STD.  Your symptoms do not sound like prostatis either.  I would not worry abou this.  Hope this helps.  EWH