[Question #377] discharge, no STDs

107 months ago

Hello-

33 year old heterosexual male here.

Approx. 6 weeks ago I noticed a discharge at the tip of my penis. No pain, no burning. Just a little white/creamy liquid. This would sometimes appear clear, and manifest itself early in the morning or at the end of the day.

I visited a clinic and was tested for every STD. Negative on all of them. The doctor also tested my urine and it revealed "moderate white blood cells".

I was given azithromycin and told not to worry about it.

My symptoms persisted, so I saw a urologist. I was given ciprofloxacin 500 mg tablets , ceftriaxone injection 125 mg, flagyl 2000mg.

I was given a prostate exam. Everything was fine. And again, STD results were negative.

The urologist told me not to worry and that it would clear up. He didn't believe in giving me more antibiotics considering how many I had taken already.

But the discharge is still present and I am approaching the 2 month mark.

Any thoughts would be hugely appreciated.

H. Hunter Handsfield, MD

107 months ago

Welcome to the forum. Thanks for yorur question.

The most common cause of urethral discharge is nongonococcal urethritis (NGU), which is an STD but the most common causes don't show up on most routine STD tests -- i.e. negative results for gonorrhea and chlamydia. However, you say nothing about your risks for STD. New partner recently? Or partner like to have other partners? Sex with men, women, or both? Vaginal, anal, or oral exposures?

The standard recommendation for NGU is to treat with either azithromycin, as you had, or doxycycline for 7 days; and if that doesn't work, to switch to the other regimen. In other words, I would have expected that you would have been given doxycycline after azithromyin didn't clear up your symptoms. So that's something to consider at this time. However, only if you still have objective evidence of persisting inflammation, i.e. increased white blood cells still found in your discharge and/or urine.

Another consideration is the possibility you have Mycoplasma genitalium, which causes 10-20% of NGU, is not detected with routine STD testing, and usually is resistant to all the antbiotics you have had (including doxycycline). So if doxy also doesn't work, testing for M genitalium might be considered if it is locally available. (There are no FDA-approved tests for it, but several labs offer DNA testing for it.) Alternatively, the antibiotic moxifloxacin might be worth a try; it usually is effective against M genitalium.

Having said all that, it is also possible you have prostatitis -- not an STD at all -- which often is nonbacterial, i.e. not due to any known infection. Antibiotics often are tried, but usually don't make much difference. I'm guessing this is your urologist's view of your problem. And he probably is correct that your problem is not serious or dangerous and is likely to clear up on its own.

Let me know if anything isn't clear, or if you would like to fill in some of the STD risk details, and also whether your sex parnter(s) have been treated when you were. Best wishes in the meantime--

HHH, MD

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107 months ago

Doctor- thank you for your swift reply.

Regarding my sexual history: I am heterosexual. I was in a monogamous relationship until late October. We engaged in unprotected vaginal and oral sex but were both STD-free. I did not experience any of the symptoms during this relationship.

In November, I visited an escort and received unprotected oral sex for a few minutes and engaged in protected vaginal sex.

Is it possible that my monogamous partner passed on Mycoplasma genitalium to me but it only showed up after we broke up? Or that the transmission occurred so late in the relationship?

it sounds to me like doxycycline and moxifloxacin are the two antibiotics that I did not take, and which might help my situation. I am assuming I need a prescription for these (and one which you are unable to provide?). In which case should I simply request them from my doctor?

I am also keen to get tested for Mycoplasma genitalium and will bring it up with my GP in the new year.

Thanks and happy new year!

H. Hunter Handsfield, MD

107 months ago

If I correctly understand the timing, your apparent NGU probably is related to the escort exposure, not your former partner. But it's certainly possible your partner was the source. When a relationship is winding down, it's common for either or both partners to start having sex with others. NGU can occur from oral sex, although probably not usually due to M genitalium. Some NGU from oral sex may be the urethra's adjustment to new but harmless oral bacteria, and clinical experience is that such cases often don't respond well to antibiotics. You'll probably never know for sure when and from whom you acquired this problem. That said, you should inform both the escort and your former partner so they can be examined and perhaps treated as a precaution.

I don't think testing for M genitalium is the highest priority here. Knowing the exact cause won't help anything except perhaps your own curiosity. Instead, I recommend treatment with doxycycline, which might end the problem. If that doesn't work, then maybe moxifloxacin, with or without MG testing.However, many problems like yours fade with time, and if your symptoms are improving -- and if exam and testing does not show clear evidence of urethral inflammation (excess WBC in urethral smear or urine), further treatment may not be needed.

As clearly described on the forum home page, we do not provide direct medical care. I am not making a diagnosis in your situation, just stating possibilities; and there is no way for me to prescribe treatment. These are issues for you to discuss with your own GP and/or urologist. You could consider printing out this thread as a framework for discussion. In the meantime, don't be serioiusly worried. This is unlikely to be a harmful problem for you or future sex partners.

Thanks for the thanks. Happy new year.

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107 months ago

Thank you very much.

Last question for you: if I leave this issue alone and allow for it to (hopefully) clear up with time, how does that reconcile with the fact that untreated NGUs might lead to long-term complications? That's really my biggest concern- that at the 2+month mark this is still giving me trouble, and that I am scared it might be damaging my reproductive system.

Thank you and happy new year-

p.s. can you please tell me how to change my first name on this thread? thanks

H. Hunter Handsfield, MD

107 months ago

As I said, if exam and testing shows WBC and your symptoms clear, there is no need for treatment. You can't develop a complication if the NGU is gone. And in fact, there are no clearly known long term complications of nonchlamydial NGU. It isn't known to result in urethral stricture or epididymitis, the main complications of gonorrhea or chlamydia.

To summarize, if symptoms are continuing and inflammation is confirmed, doxycycline makes sense; then moxifloxacin if that doesn't clear it up (with or without testing for Mycoplasma genitalium). And don't forget to tell both your partners.

That completes the two follow up questions and replies for the original posting fee, and so ends this thread. Best wishes and happy new year!

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