[Question #12547] Symptoms but confused
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7 months ago
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I am in my early 50s, with past urinary tract problems (urethral stricture, kidneys stones, and occasional dysuria that tends to resolve on its own).
I had unprotected oral and unprotected vaginal sex with two very high-risk women, and received unprotected oral from a third high risk women. The first exposure was Day 1, second exposure was Day 2, third exposure was Day 3, and today is Day 9.
The symptoms started late on Day 4, with discomfort on urination and some spraying in the stream. On Day 6 I had small discharge. The discharge was clear and dried to a black crust. I took a 1 gram dose of unexpired azithromycin on the night of Day 6.
On Day 7, the symptoms continued. the discharge is clear, like urine but with a slight viscosity. On Day 7, I had blood after each urination. That day, my regular doctor prescribed Cipro. I did not discuss my sexual exposures with my regular doctor. I have had three full days of Cipro, no improvement.
On Day 8, after Cipro and azithromycin had done nothing, I took 800 mg of cefixime. I had some left over and so I figured I would try it. The wild card is that the cefixime expired in November 2023 (i.e., 14 months ago).
Today is Day 9, about 36 hours after the cefixime, and the symptoms continue.
I had unprotected oral and unprotected vaginal sex with two very high-risk women, and received unprotected oral from a third high risk women. The first exposure was Day 1, second exposure was Day 2, third exposure was Day 3, and today is Day 9.
The symptoms started late on Day 4, with discomfort on urination and some spraying in the stream. On Day 6 I had small discharge. The discharge was clear and dried to a black crust. I took a 1 gram dose of unexpired azithromycin on the night of Day 6.
On Day 7, the symptoms continued. the discharge is clear, like urine but with a slight viscosity. On Day 7, I had blood after each urination. That day, my regular doctor prescribed Cipro. I did not discuss my sexual exposures with my regular doctor. I have had three full days of Cipro, no improvement.
On Day 8, after Cipro and azithromycin had done nothing, I took 800 mg of cefixime. I had some left over and so I figured I would try it. The wild card is that the cefixime expired in November 2023 (i.e., 14 months ago).
Today is Day 9, about 36 hours after the cefixime, and the symptoms continue.
I want some expert feedback and guidance before going doing anything else.
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H. Hunter Handsfield, MD
7 months ago
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Welcome to the forum. Thank you for your confidence in our services.
It is difficult to know whether your current problem is sexually acquired gonorrhea or nongonococcal urethritis (NGU), versus a non-STD urinaary tract infection or perhaps prostatitis. And unfortunately you and your doctor have done exactly the wrong things in sorting things out. You should not have tried azithromycin (or any other antibiotic) prior to medical evaluation; your doctor should have been informed of your sexual risks; and although ciprofloxacin is often an excellent choice for treatment of non-STD urinary tract infections, it is not recommended and usually not effective against STDs. At the same time, the treatments have reduced the reliability of an accurate testing.
I suspect your symptoms are not related at all to the sexual exposures, i.e. you're dealing with some variation on non-STD UTI or prostatitis. But none of these is a likely cause of blood in the urine, so a higher level urinary tract infection might be involved. Azithromycin would have cured chlamydia, and the cefixime would have been effective if you had gonorrhea. At this point, I would advise stopping all antibiotic treatment and returning to your doctor and discussing your sexual history. Given your past problems with stricture and kidney stones, you should be in the care of a urologist, and perhaps also an infectious diseases or STD specialist. After a few days off all antibiotics, testing should then be done for chlamydia, gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis.
Please discuss these options with your primary care provider and/or urologist (or maybe an ID specialist) then follow their advice for next steps. In the meantime, another approach might be to contact your recent sex partners -- if you in touch with them and able to do so -- and let them know your problems. They probably would then want to be tested for STDs themselves, which conceivably could help direct your further evaluation and treatment.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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7 months ago
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"And unfortunately you and your doctor have done exactly the wrong things in sorting things out." LOL - I knew I was driving a clown car on this but did not realize my doc was riding along!
Thanks - this is clear and makes sense. It sounds like I have some more homework to do -- hope you can keep this open for a while for follow ups.
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H. Hunter Handsfield, MD
7 months ago
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To be respectful of your doc, I would stress that your failure to tell him of your sexual exposure may have led him to assume a non STD UTI, since STDs are quite uncommon beyond age 35-40; and ciprofloxacin often is a reasonable choice for UTI. But even with that, I don't understand not doing a urinalysis and urine culture to determine the cause of a presumed UTI; and at least asking about sexual risks.
Threads are closed after two follow-up comments and replies, so it would be best to gain as much additional information and perhaps test results before your final comments.---
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6 months ago
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Hi Dr. Handsfield,
I intended no disrespect. I shared your answers with my doctor and we used your feedback to help guide our next steps.
My doc did do a urinalysis and culture. Negative for white blood cells and culture, positive for red blood cells.
I discontinued cipro after taking the first dose on Day 9. Symptoms continued. Discharge lessened significantly on Day 12 while the other symptoms remained. I went to test 36 hours after discontinuing cipro. After giving the sample, I went on Bactrim and doxy.
The lab made an error and only tested for trich. I returned to give another sample on Day 14. By then I had been on bactrim and doxy for two days. The lab told me AFTER I had urinated that the m. genitalium test required a swab and instructed me to swab myself on the outside the meatus.
The test was negative for trich, chlamydia and gonorrhea. M. genitalium is pending.
My symptoms continue (other than discharge, as stated above). Starting Day 14, I had significant trouble getting urine out, and bad spraying. The pain became random - significant at times, random at others. The night of Day 15, I developed fatigue and fever (as high as 102.8) that lasted for 2.5 days - and my urine turned to an abnormally dark yellow (like a deep amber beer). I also had pain in the testicles. The fever has cleared, but I am now tender from my lower back down to my feet. And testicles remain tender. Today is the morning of Day 16.
Interested in your views on this from an STI perspective. And I have some specific final questions:
1. Are the chlamydia and gonorrhea tests sufficiently reliable given the initial lab error and bactrim/doxy?
2. Is the m. genitalium test reliable at all given that I was instructed to self-swab on the outer part of the meatus AFTER voiding?
I intended no disrespect. I shared your answers with my doctor and we used your feedback to help guide our next steps.
My doc did do a urinalysis and culture. Negative for white blood cells and culture, positive for red blood cells.
I discontinued cipro after taking the first dose on Day 9. Symptoms continued. Discharge lessened significantly on Day 12 while the other symptoms remained. I went to test 36 hours after discontinuing cipro. After giving the sample, I went on Bactrim and doxy.
The lab made an error and only tested for trich. I returned to give another sample on Day 14. By then I had been on bactrim and doxy for two days. The lab told me AFTER I had urinated that the m. genitalium test required a swab and instructed me to swab myself on the outside the meatus.
The test was negative for trich, chlamydia and gonorrhea. M. genitalium is pending.
My symptoms continue (other than discharge, as stated above). Starting Day 14, I had significant trouble getting urine out, and bad spraying. The pain became random - significant at times, random at others. The night of Day 15, I developed fatigue and fever (as high as 102.8) that lasted for 2.5 days - and my urine turned to an abnormally dark yellow (like a deep amber beer). I also had pain in the testicles. The fever has cleared, but I am now tender from my lower back down to my feet. And testicles remain tender. Today is the morning of Day 16.
Interested in your views on this from an STI perspective. And I have some specific final questions:
1. Are the chlamydia and gonorrhea tests sufficiently reliable given the initial lab error and bactrim/doxy?
2. Is the m. genitalium test reliable at all given that I was instructed to self-swab on the outer part of the meatus AFTER voiding?
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H. Hunter Handsfield, MD
6 months ago
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I'm glad to hear of your negative test results. All things considered, I am very confident your symptoms are prostatitis, an undetected bacterial UTI, or something along these lines. You have no STD and these issues have nothing to do with the sexual exposure that started your concerns.
1. Your negative chlamydia/gonorrhea tests are 100% proof you were not infected at the time the tests were done. There is no way to know whether you had one of these that was eradicated by the initial treatment, but it is exceedingly unlikely.
2. I have never heard of M genitalium testing on an external swab specimen. Urine or a swab inserted well inside the urethra are the normal specimen collection methods. But the chance of M genitalium was near zero to start and I don't think you needed testing for it.
That will have to conclude this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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