[Question #3713] Gram-Negative Bacteria Swab Result.

35 months ago
Dear Doctors,

This is actually a follow up question from my original post. 

To sum it all up (in order) :
- I had a one night stand with with a girl (unknown status) in Indonesia.
- About a month later, I developed a white-cloudy discharge and itchy urethra.
- Went on to take antibiotics - Azithromycin for 3 days and symptoms recurred. 
- Went to have a secretion test and blood tests (excluding Syphilis) which all came back negative, only gram positive bacteria was detected. (Dr Handsfield already mentioned it is a normal bacteria present in the urethra). 
- Took Doxycycline subsequently for 2 weeks and symptoms recurred yet again.
- Did a swab test and my GP prescribed both Metronidazol and Levofloxacin as combination for 3 weeks. It's been 2,5 weeks now and all symptoms have now gone.
- Swab test result finding: Gram-Negative Bacteria - Enterobacter Cloaceae.

My questions to you are:
1. Just curious - Do you reckon I acquired enterobacter cloaceae bacteria sexually or did I catch it somewhere else ?
2. It's been 2.5 weeks now since I took both Metronidazole and Levofloxacin, all symptoms are resolved, but I am feeling EXTREMELY tired and fatique which I think due to taking too much antibiotics. Do I have to stop taking the antibiotics now ? Do you think symptoms will recur once I stop ? What is your experience with patients similar to my case ?
3.  The blood test had failed to acquire my syphilis status due to high concentration of triglycerides (probably from drinking alcohol the day before). I'm just wondering with all the medications I've taken, is it enough and suitable to kill the bacteria that caused syphilis ?
4. Also, did the high concentration of triglycerides might affect the results for other infections (HSV, HIV, Hepatitis, Chlamydia) ?


That's all I wanted to ask, hopefully a single reply will ease my mind.
Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Welcome back to the Forum.  On this occasion I will be answering your question.  I did go back and review your earlier interaction with Dr. Handsfield and will be happy to provide some information which I hope will be helpful.  I agree with all that Dr. Handsfield said to you in your original interaction and have some addition comments now that you have reported your culture results.  It would also be helpful to me to know your age as understanding some of the infections with bacteria like E. cloacae vary with age.  I'll go to your specific questions now:

1. Just curious - Do you reckon I acquired enterobacter cloaceae bacteria sexually or did I catch it somewhere else ?
E. cloacae is commonly present in the genital tracts of both men and women and typically only causes symptoms such as those you experienced when the concentrations of bacterial present increase.  The reasons for these increases vary.  Thus you may have acquired the E. cloacae from a sexual partner or it may have already been present in your body (the latter is relevant depending on your age, urinary tract infections in men are rare before the age of 40).

2. It's been 2.5 weeks now since I took both Metronidazole and Levofloxacin, all symptoms are resolved, but I am feeling EXTREMELY tired and fatique which I think due to taking too much antibiotics. Do I have to stop taking the antibiotics now ? Do you think symptoms will recur once I stop ? What is your experience with patients similar to my case ?
Both antibiotics and infections can have side effects such as fatigue.  Unless there is something your doctors are aware of that you have not mentioned (or may not be aware of), you may not need the metronidazole as it is typically not active against E. cloacae.  You might ask your doctor if you still need to take that medication.  The levofloxacin is the antibiotic you are taking that is most likely to be effective against the E. cloacae.  How long does your doctor want you to take it?- some infections are typically treated with up to four weeks of medicine.  Again, since I have not had the opportunity to examine you and we specifically do not intend to practice medicine on our site, I would suggest you discuss this with the doctor who prescribed the levofloxacin. 

3.  The blood test had failed to acquire my syphilis status due to high concentration of triglycerides (probably from drinking alcohol the day before). I'm just wondering with all the medications I've taken, is it enough and suitable to kill the bacteria that caused syphilis ?
Yes, if you had been exposed to syphilis the doxycycline you took, as well as possible the azithromycin would have cured it.

4. Also, did the high concentration of triglycerides might affect the results for other infections (HSV, HIV, Hepatitis, Chlamydia) ?
No, the high triglycerides should have no effect on your other tests.  If it had, the lab should have informed you of this.

I hope this information is helpful.  As you know, we provide up to a total of three responses to questions so feel free to follow-up if some of what I've said is unclear or raises other questions.  EWH

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35 months ago
Thank you Dr. Hook for your kind and informative reply.

Some clarifications:
1. There are no other things that my doctor is or isn't aware of that I have not mentioned to you.
2. I am a 28 YO male and my one-night stand partner is a 29 YO female (not a sex worker).  Judging from your initial reply, I assume I acquired the bacteria from her. 
3. My doctor prescribed me 2 weeks of both Metro and Levo (Yes, I have made a mistake by saying 3 weeks on my previous post). Both 500MG x 2 per day.

My follow-up questions would be:
1. Since my doctor is not an STI specialist and I want to get a second opinion, do you think the 2 weeks course of Levo is sufficient ? And is the dosage (500MG x 2 per day) about right ? If not, how should I be taking the medication ? 
2. Is it wise to resume masturbation and/or sex with my girlfriend when I finish my medication? 
3. Lastly for the sake of the peace of my mind, are there anything else that I should be worried for the encounter I mentioned ? (Blood test was done 9.5 weeks after exposure). Should I worry about HPV, for example ?


Thank you once again.
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Thanks for the clarifications.   As for your follow-up questions:

1.  Your infection is not considered and STI in the classical sense but a urinary tract infection.  Such infections in men are treated from 2-4 weeks, depending on the doctor's assessments.  The dose you mention is fine.
2.  I see no reason to abstain from masturbation or unprotected sex with your GF, even before you complete your medications since this is not a STI.
3.  I see no reason for concern about other STIs.  Please see other discussions on the Forum regarding HPV.  You may or may not have it from past encounters and we consider this problem nothing more than a nuisance for men on this Forum.  Your risk for HPV from the encounter you describe is low.   EWH
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35 months ago
Dear Dr. Hook,

That is a very prompt reply.
I'm gonna end this thread with a big Thank You for your responses, I greatly appreciate it.

Have a good day ahead !
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Great.  Glad my comments were helpful.  EWH---
34 months ago
Hello again Dr. Hook,

I know this is supposed to be the end of this thread, but since it is still in active mode, I will use this opportunity for my follow up question.

I finished my antibiotic course and felt so relieved as symptoms were resolved. However, Its been 2-3 weeks since I finished my antibiotic medication (Levofloxacin for 2.5 weeks or so), unfortunately my discharge recurred yet again. I don't feel any itchiness in my urethra like what I experienced before but I saw the same discharge from the tip of my penis (thick white-coloured sticky liquid). I went to my GP and he said there's no need to take another antibiotic for now.

Straight to my questions:
1. Has my UTI (from Enterobacter Cloaceae) recurred once again ? Why can't the antibiotics kill the bacteria ? Do you think I need longer course for antibiotic and what kind of antibiotic that you strongly recommend in this case ?
2. Apart from STI or UTI question,  I just had my routine blood test yesterday and the result showed very high level of liver enzymes (SGOT and SGPT). My GP said maybe it was the result of taking too much antibiotics for the last one month or so. Do you agree with this comment ? And if I need to take longer course of antibiotic, do you think it will raise some health issue to my body ?

Thank you once again.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Straight to your questions for my final follow-up.   Before I do however let me point out to you that most men do have a certain modest amount of normal urethral discharge which can take a variety of appearances depending on their recent states of arousal and other factors.  What you may be detecting could be normal but that you would normally be overlooked it were you not so worried.  You do not know that the discharge you have noted is abnormal. It may be normal. 

1.   You have no evidence that your infection was not cleared. You did not mention any recurrent culture results. Even if you were your culture positive for E. cloacae a positive culture could reflect colonization by bacteria normally present on your skin and not an infection which is causing damage. 
2.   Elevation of liver function test is not a unusual side effect of taking antibiotics. When this is the case, upon stopping the antibiotics, the elevation typically resolves without harming the individual and without specific therapy.   My sense is that your GP feels that this is not something to worry about and can be observed. I agree with that sense.

 I certainly see no reason for continued antibiotic therapy based on what you have reported. 

 As you know our forum provides up to three responses for each question. This certainly is your third response from me. Thus this thread will be closed later today without further answers. I hope that the information you have received has been helpful. I would add that it sounds to me like your GP is knowledgeable and  doing a good job on your behalf. I suggest you keep working with him if your concerns continues to be problematic. Take care. EWH
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