[Question #1445] White discharge no STD

46 months ago
Unprotected sex one time. Itchy urethra and small white penile discharge after 4 weeks. No significant pain in testicle or urination. Ghonnorhea,chlamydia, HIV rapid test, and syphilis test all negative from planned parenthood at 4 weeks.Might have peed right at an hour before test.

1. Any worries about the conclusiveness from tests above?

Next week went to urologist and had high amount of white blood cells in urine. Told urologist that I was negative for the above..Prescribed doxycycline 2 times a day 100 mg for 14 days and urine culture sample taken.  5 days in medication I decided to pay for trichomoniasis test at another lab and cane back negative.

2. Would trich have shown even on medication and slight discharge remaining?

Overall symptoms  started to show improvement immediately and discharge cleared at about 7-10 days. Tests came back from urologist and no bacterial growth reported. I stopped taking medication at around day 10 since nothing was found. After about 2-4 weeks after medication ended started to have slight testicle pain/ache in right side but no discharge,itchiness,or pain urinating. Pain might be to irritation and straining from pushing with testicles.
6 week follow up urine test showed normal and no evidence of high white blood cells or reason for infection although I think I'm starting to notice a cloudiness when my first urine in the morning hits the toilet water.

3. Should I be checking for anything else as something else might be building back up again although urine shows no evidence for infection at 6 week follow up with urologist?







Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Welcome to our Forum. I'll be glad to comment.  You do not mention your age but for men under the age of 40 a urethral discharge of the sort you describe is usually an STI.  with negative tests for gonorrhea and chlamydia and many white blood cells in your urine it is likely that you had non-gonococcal urethritis caused by something other than chlamydia.  While trichomonas could cause this your test was negative making this unlikely.  Most such infections do respond to therapy with either azithromycin given as a single dose or at least a week of doxycycline.  It sounds like you are improving which would be the anticipated response. 

On to your specific questions:

1. 1. Any worries about the conclusiveness from tests above?

Currently available tests for STIs are very good. I would believe the results.  Further, no that you have been taking doxycycline, it is unlikely that such tests would now provide an accurate result.  I would recommend that you believe you test results.

2. Would trich have shown even on medication and slight discharge remaining?

Doxycycline does not affect trichomoniasis.  I would be confident in your test if it was performed using a modern PRC-type nucleic acid amplification test.

3. Should I be checking for anything else as something else might be building back up again although urine shows no evidence for infection at 6 week follow up with urologist.

Your testicular discomfort and cloudy urine are non-specific findings and are the sort of thing we see when patients are vigilantly looking for signs of infection, most often because they are noticing sensations and findings that are normally present but that they usually don't notice.  It also sounds as though your are improving.  Unless there is a recurrence of symptoms, I would not worry further.  EWH

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46 months ago
Thanks again for the advice. Yes under 40 and I forgot to mention received unprotected oral as well. Just a couple more questions as a reply..
1. Could the discharge have been from mycoplasma genitalia or would the urine culture showing no bacteria growth at the urologist negate this?
2. Are there such things as undetectable STI's that can cause the discharge symptoms and have no severe health affects or be a danger to future partners?

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Thanks for the additional information.  Receipt of oral sex can also lead to non-chlamydial NGU from time to time so this may be part of the explanation as well.  Even if this is the case, I would expect the doxycycline to be effective therapy.

1. Could the discharge have been from mycoplasma genitalia or would the urine culture showing no bacteria growth at the urologist negate this?
Unlikely.  While most clinicians do not test for Mycoplasma genitalium, it also does not typically respond to doxycycline therapy making this possiblility less likely.

2. Are there such things as undetectable STI's that can cause the discharge symptoms and have no severe health affects or be a danger to future partners?
Sort of.  When NGU is not caused by chlamydia, trichomonas or Mycoplasma genitalium it appears to often be caused by the inadvertent introduction of normal, non-pathogenic, non-STI organisms into the urethra during sex.  The body recognizes these organisms as "not self" and inflammation results.  In the United Kingdom many STI specialists choose not to provide therapy or evaluation for partners to persons with non-chlamydial NGU.  Here in the U. S. we are a bit more conservative but the value to this (partner evaluation and treatment) is unknown.  EWH


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46 months ago
Thanks again doc!
Last Reply.... how accurate is HIV rapid test at 4 weeks?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

At 4 weeks rapid HIV tests would detect about 90% of recent infections.  At that time a 4th generation, combination HIV antigen/antibody testis 100%/completely accurate.


As you know, this will end this thread.  I hope my comments have been helpful to you.  EWH

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