[Question #1626] Yellowish Discharge from Penis

44 months ago

Hi.  My partner (31y/o white female, English) and I were both tested at our local GUM clinics in September, before we met.  We tested negative for gonorrhea, chlamydia, HIV and syphilis.  We had no new sexual partners between those tests and when we met and we have been having unprotected vaginal and oral sex for 8 weeks now. I've underlined the word 'new' as we both had sex with the partners we were with during the time of those last tests and I am unable to confirm whether both were free of STDs, despite their assurances to the contrary. Yesterday (approx. 24 hours since we last had sex) I felt an odd sensation (an unhelpful description, I concede) within the area between my anus and scrotum and while this was not itchy I did feel a need to massage the area slightly.  This morning I felt the same sensation within my penis, assuming it to be centered within my urethra.  I pushed (or 'milked') my penis from the bottom upwards and there was some yellowish discharge, perhaps around the size of a tear.  This was a different coI continued to do this for a minute or so and managed to bring up more of the same discharge (again, tiny amounts).  There is no pain associated with this, nor has there been any increased toilet trips or more to the point pain when urinating.  I am aware of a slight tingling sensation on my anus and at times during the day within my penis (urethra, I think!) although I'm not able to say with any certainty that this isn't all mind focused.I called my local GUM clinic who will see me next Monday (due to a business trip I was unable to attend later this week however I am hoping to attend a drop-in clinic on my travels tomorrow).  In the meantime I have researched some previous questions/answers on your site which, as I've found before, are helpful.  However I have been unable to find a close-to-identical question/answer, hence this post.  My research has led me to believe that this 'milking' of my penis is not advised and so I'll do my best to stop.  Are you able to offer any insight into what this may be?  Thanks again in advance. 

 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question.

A new and apparently abnormal urethral discharge always is cause for concern, and color (creamy, yellow, etc) usually means an infection of some sort. The discomfort in the area also may be significant. OTOH, 24 hours is very fast; 2-10 days is more typical. However, if it continues in the next day or two, it definitely should be professionally evaluated. Don't get too hung up on "milking":  the reason for advice against it is directed primarily at anxious persons who have never seen discharge but still vigorously, repeatedly, and often ompulstively keep squeezing -- sometimes creating an inflammatory reaction and discharge that doesn't mean anything. Gentle milking a couple times a day won't hurt anything and might reveal continuing dishcharge a bit sooner than otherwise.

Routine STD testing doesn't detect all STDs. Chlamydia accounts for only one third of cases and no tests are routinely done for other known causes (Mycoplasma genitalium and a few others) nor even possible for the 50% of NGU of unknown cause. And the standard tests can miss some gonorrhea and chlamydia. Pre-relationship testing as you did is always a good idea, but it isn't foolproof. Also, some NGU may be urethral adjustment to a new mix of normal bacteria from a partner's genital tract or mouth, i.e. without a particular harmful implications.

So you (and your partner) should have another round of evaluation and testing, as you are planning. If discharge remains infrequent and scant, doesn't reappear, and you don't develop painful urination, I think you can safely wait another 5 days the GJM clinic's expertise. Otherwise, follow through with your drop-in clinic plan. Rapid onset and yellow color are suspicious for gonorrhea, for which treatment indeed should not be delayed longer than necessary. (For either site, try to avoid urinating for several hours before being examined.) Either way, I suggest your partner make an appointment to be seen at the GUM clinic within a week, regardless of the outcome of your own evaluation. In the meantime, it would be best to hold off on additional sexual exposures.

Please return with a comment to keep me posted after you have been evaluated. In the meantime, don't be overly worried. Absent pain or more profuse discharge and with treatment (if necessary) within a few days, there is little likelihood of a harmful outcome.

Best wishes--  HHH, MD

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44 months ago
Thank you, Dr. Handsfield, for your detailed response.  Very much appreciated.

I'll return with an update once my partner and I have been tested and results have been given (we'll be tested on Monday).  

In the meantime and for my own education, you mention that "Routine STD testing doesn't detect all STDs. Chlamydia accounts for only one third of cases and no tests are routinely done for other known causes (Mycoplasma genitalium and a few others) nor even possible for the 50% of NGU of unknown cause. And the standard tests can miss some gonorrhea and chlamydia."  This being the case, if tests fail to detect any presence of a STD or the discharge I am experiencing is being caused by something like Mycoplasma genitalium, or even if it is as a result of a NGU of unknown cause, is there a possibility of future complications if undetected and therefore untreated or do such infections (if not detected during testing) clear up on their own?  I'm keen to learn, should this be the case, how long we should hold off before we have sex again, i.e. until there is no further discharge?

I sweated quite heavily during my sleep last night, have had diarrhoea and also have a bit of a raw throat today: perhaps all are unrelated entirely to whatever infection I have however I wonder if these are symptoms you'd expect with a STI such as gonorrhea or chlamydia.  I'm still experiencing discharge but only when 'milking' and there is only a small amount each time.  Additionally, still no pain when urinating and no uncomfortable sensations elsewhere.  

It should be said that I was sexually inactive for over six years and I've had more sex in the past 8 weeks than I've had in my life.. I wonder whether over-exertion could be the cause?  Or is this overthinking and perhaps wishful thinking?

Many thanks again,

David


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Re "over-exertion":  Over the decades when NGU was recognized but no cause unknown, with uncertainty even whether it is an STD, a common theory was that increases in sexual activity and frequency might contribute. And while stories like yours arenot an everyday occurrence, they are not rare, and I cannot rule out the possibility that nothing is wrong and you're just having increased secretions from the prostate or seminal vesicles. The wrinkle in this is the yellow color, which is suspicious for infection.

Other than chlamydial infection, no serious health outcomes have ever been documented for NGU. And although M. genitalium (an uncommon cause or NGU, only 10-15% of cases) probably causes some symptomatic cases of PID (fallopian tube infection) in women, it isn't known to cause anything bad in men. One current theory about NGU without chlamydia is that it may simply be a transient adjustment of the urethra to a new mix of bacteria -- from a partner's normal vaginal or oral bacteria to which that guy hasn't previously been exposed, but without a specific infection in the usual sense.

Your sweating, diarrhea, etc are entirely separate, not related at all to your discharge or sexual activity. No STD is a likely cause of these symptoms.

So I think it is entirely safe to wait a few days and visit the GUM clinic, with a fair likelihood they will find nothing requiring treatment. And even if you do have NGU, there might be no risk for serious outcomes in either you or your partner. I'm still interested in hearing the outcome when you have done that.

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44 months ago
Dr. Handsfield,

I attended my local GUM clinic on Monday.  I was examined and provided a urine sample and took the opportunity to give blood to test for syphilis and HIV while I was there.  The Doctor also examined my penis and was able to take a sample of the discharge from my urethra for immediate examination in their lab.  She explained that they are normally able to detect gonorrhea under the microscope but not chlamydia.  She was unable to detect gonorrhea and expected a NGU infection.  I was given Zithromax tablets (500mg) to take in one dose and today received negative results for all of the STD's tested for.  

The antibiotics appear to have worked quickly as the discharge has reduced significantly and has become a little more clear/watery.  

I'm unsure what's caused the infection but am of course relieved at the negative results!

Thanks again for your useful input.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Thanks for the report. Sounds like the GUM clinic is on top of things:  from what you say, their management is exemplary, exactly what I would recommend and our clinic would do. Presumably they found increased white blood cells in the urethral sample, although you don't mention it. That said, the "negative" results so far don't mean you don't have an STD. I don't think there is any doubt you have NGU, which is virtually always sexually acquired and transmitted -- the main additional diagnostic issue is whether the chlamydia lab test will be positive. (I agree gonorrhea is almost certainly ruled out by negative microscopic examination, although not conclusively -- still a slight chance that test will be positive.) Your partner should also be examined and tested, if not yet done, and will need treatment -- presumably the GUM clinic discussed with you.)

Normally threads are closed after two follow-up comments and replies, but I'm leaving it open in hopes you'll report the chlamydia and gonorrhea test results, and anything else you hear from the GUM clinic.

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43 months ago
Hi, sorry for the delayed response. 

I am pleased to report that all tests (including for chlamydia and gonorrhea) were negative.  The antibiotics also cleared up the infection quickly, with discharge disappearing within 3-4 days of taking them.

Your assistance has been very much appreciated and I hope this information is useful to you!

Thanks,

David 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Glad to hear all is well. Thanks for the thanks -- that's why we're here. Best wishes and stay safe.

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