[Question #3592] STI Question

37 months ago

Hello Dr’s,

I was wondering if Dr. Hunter Handsfield was available to answer. If not I appreciate any Doctor advise.

 

Im a 28 yr old male. Just over a year ago, I made the mistake of having a one night stand type deal and had unprotected vaginal/anal sex with a girl. A week or so later I had symptoms (biting/tingling sensation in urethra and a tiny bit of discharge). I went and got tested. They gave me antibiotics for chlamydia/gonnorhea (shot and two pills). The discharge went away shortly after.  It’s been over a year, and I’m still experiencing the biting/tingling/tickling sensation in urethra. Since my positive test, I had about 3 urine tests I believe, one blood test for other stds/STIs, a cystoscope, and a CAT scan (for possible kidney stones) All is negative and looked fine. But I’m STILL having the symptoms. I don’t believe they tested hsv because they said their test wouldn’t differentiate between hsv 1 and 2...and since I’ve had cold sores growing up, they said it would probably be positive. I sometimes get itchy down in the pubic hair region and it does rash up if I itch it. My doctor said he doesn’t suspect hsv 2 and said I would know by now if I had it (being a male). I am looking for advise on what it could be. I’m worried I could possibly transmit something. Also, is it true chlamydia can live in your stomach even after being cured? And having it come back on it’s own? I’ve read that in a couple places. But others say it isn’t true....Thank you. 

Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Welcome to ur Forum.  I happened to pick up your question and will be answering.  FYI, Dr. Handsfield and I have worked together for over 35 years and while our verbal styles vary, we have never disagreed on our messages and advice.  Persistent symptoms are a real challenge in this field.  I have several comments in this arena. 

Fist, the therapy you had, which sounds like a shot of ceftriaxone and a gram of azithromycin (the 2 pills) and is recommended therapy for gonorrhea, chlamydia and NGU, all of which are possible causes of your symptoms.  It also sounds as though your tests for gonorrhea and chlamydia were negative (is this correct?).  The therapy you took is highly effective and the multiple negative tests you mention all indicate that gonorrhea and chlamydia are not the problem.  There are several other possible explanations:
       1.  Persistent infections may occasionally be caused by an emerging pathogen called Mycoplasma genitalium.  Research on this pathogen is ongoing but what is known is that it is a relatively common cause of persistent symptoms.  While not widely advertised, most commercial laboratories do have tests for this organism and I would suggest that you have a urine test for Mg. 
       2.  Another possible cause of persistent symptoms of the sort you describe is trichamonas.  If you have not been tested or treated for trichamonas, I would consider this as well.
       3.  Finally, we frequently find that when our clients look hard for symptoms, they tend to become aware of normal genital symptoms which they would otherwise overlook.  In such persons, urine tests show no white blood cells and tests for Mg and trichamonas are negative. 
       4.  Your continued symptoms are not suggestive of herpes which would not cause symptoms continuously for this long.  Because the tests are not very good, I would not recommend blood or other tests for herpes unless you have visible lesions.   

Finally, the question of chlamydia in the GI tract is also a subject of much research and controversy, particularly as a possible source of recurrent infections.  Your repeat tests however have been negative and for that reason, I would not be worried about this.

I hope these comments provide further direction for  you.  If there are additional questions, please do not hesitate to ask using your two follow-up questions.  EWH
---
37 months ago
I’m sorry, I failed to mention that my test for chlamydia was positive. That was just over a year ago. And all the multiple tests afterwards have been negative. The discharge I had went away after the antibiotics, but still lingered with the symptoms. I do not believe I have been tested for Mycoplasma. I did bring up to my doctor about the possibility of trich. I would have to double check if I in fact did get tested for that, but my doctor said he doesn’t believe that is the case. Basically my doctor has told me that it is in my head and because of the guilty conscience, I’m having these symptoms. But even when my mind isn’t on it and I’m completely focused on something else, I’ll still get like a tingling/biting sensation, almost like it just “zings” me out of nowhere. It’s just become very annoying....Also, I’m not sure if this has to deal with anything, but on the back of my tongue, on each side, I have two raised taste buds. That I’ve seem to notice since all this started. Kind of like a popcorn husk stuck back there. That is annoying at times as well. But I couldn’t find anything in relation to STIs on that. Doctor said it was normal. It just seems that they weren’t that enlarged before. Also after I started seeing a urologist a couple months ago, they just recently prescribed me ciprofloxacin (which after research I asked if there was an alternative because the side affects looks terrible, so he gave me Bactrim. I haven’t started taking it yet. He also gave me Tamsulosin along with Phenazopyridine to take if the Bactrim didn’t help out. Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Thanks for the additional information.  With a positive chlamydia test at the outset and negative tests since, it is most likely that you had chlamydia and it is now resolved.  Sometimes persons are infected with more than one pathogen but this is relatively uncommon.  Talk with your doctor about trich and Mg (many doctors are not aware of the mycoplasma issue- it is an emerging issue). 

I must say, what you describe about your taste buds sounds normal and we do find it common that when persons start to look for signs and symptoms, they find things they were not aware of in the past.  The more I hear, the more likely it is that this is not an STI.

From what you say about your urologist, the treatment he/she is providing is therapy for prostate infections (prostatitis is not an STI and could be present coincidentally) .  The Bactrim is probably worth a try.  EWH
---
37 months ago
Thank you Doctor Hook.

As far as the possibility of Mycoplasma, I seen that a common antibiotic for treating that is the one I have taken when I got tested for Chlamydia/Gonorrhea. Would that of likely taken care of that as well if that actually was the case of getting two pathogens at one time? (Although it is uncommon to get more than one, like you said). I have not had intercourse since this encounter over a year ago (I have been too afraid I still had something that could pass on). I have been starting to get back out there and have been talking with a girl, but I couldn’t live with myself if I were to pass something. I’m am trying to tell myself that I do not have anything because of the many doctor visits I have been to and keep getting told that they don’t see anything wrong. I know better to use protection next time, but if I get married and want to have a family, I don’t want to have to worry about having something....

I will look into the possibility of Mycoplasma and Trich when I see my doctor...when I do get tested and if the results are negative...how would I continue with this after? Is it quite possible these symptoms are in my head like my doctor was saying....from after worrying too much about it all? I don’t believe it is in my head sometimes, but I know it can be quite common from what I’ve heard. 
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Azithromycin may be the antibiotic you are referring to.  IT is effective against many cases of M. genitalium but not all and resistance rates seem to be increasing.  Thus your therapy may have taken care of it if it was even present.  You asked about possible causes and I replied.  At this point asking further "what if" questions really may not help much.  Similarly, your questions about "what if I am infected, and pass it to someone I am trying to have a family with...." betray more anxiety than is appropriate.  My own suspicion is that you do not have an STI can should move on but have outlined possible further evaluations to consider in an effort to be thorough and address the questions you asked. Thus my advice is to discuss the possibilities I have suggested with your doctor (feel free to print out this post) and decide upon a course of action. If you choose to not test and move forward I suspect you will be OK. OTOH, if you choose to test, if the tests I suggested are negative, then it is also time to move forward without additional concern as well.  Obviously, if a test is positive, you would have something to treat.  That wraps up the possibilities.
At this point I have provided three replies.  Thus, as per Forum guidelines, this thread will be closed shortly without further replies.  Take care and please try not to worry.  EWH
---