[Question #4213] Follow up to Question #4203

32 months ago
Hi Doctors - 

Well I had no intention of asking further questions, but I'm afraid my physician consultation left me a bit perplexed. I was able to get in to see a Dr. yesterday. I informed the dr. of my risk and he performed a POC Urinalysis(?)  and PCR test for Chlam/Gon. While the results of the PCR Chlam/Gon test were not immediately available, I anticipate they'll be negative as I previously had a negative NAAT test while symptoms were present. The urinlaysis was "clear" according to the dr. My diagnosis when I left was urethral irritation. Based on my previous neg tests and the clear urinalysis he was skeptical that this is an STD.  Honestly, this would be a lot easier if I had just tested positive for Chlamydia! 

To my questions:

1) One thing I may not have mentioned in my previous post is that I have been having pain in my back. He suggested that I may have prostatitis and suggested my next move be to a urologist. He Rx'd Doxy 100 mg for 10 days (he initially wanted to prescribe cirpo, but per your previous recommendations I asked if Doxy was suitable).  Do you agree that prostatitis is a possibility? 

2) The discharge has decreased substantially since my initial symptoms - it more resembles a tiny bit of clear urine at the tip of my penis than the thick discharge that initially presented. Could this mean that my immune system is clearing the infection? I didn't take the first dose of Doxy yet, because I wanted to ask a follow up here first. Should I see if the discharge abates completely on its own or go ahead and take the Rx? I don't like taking antibiotics if I can avoid them because they majorly upset my digestive system. 

3) I mentioned in my first post that I'm very guilty of obessively checking my penis for discharge (milking it, pulling back my urethra, etc.). I read on an Australiian health department resource that over manipulation could cause temporary discharge. Is there any chance that I may have injured my urethra and that is the culprit? 

I don't want
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
I'm afraid you're asking for more than the forum offers. We cannot diagnose anything. Now that you are in medical care, that doctor -- or others to whom they may refer you -- should be the source of information about this problem. I'll just say that the overall context, including your lifestyle and symptoms, strongly suggest sexually acquired urethriyits. The evaluation by the doctor should have included looking for increased white blood cells in your urethra, preferably on a urethral swab. If WBC are found, urethritis is confirmed. Even without that, and even with symptoms improving, it remains very likely. Based on all I know, you should be treated for NGU and so should your partners. However, this is now a decision to be made by you and your physician together.

1) Back pain is overblown as a prostate symptom. And in any case, prostatitis is not likely based on your symptoms and is not sexually acquired. And it rarely if ever causes discharge.

2) It is possible you have had urethritis that is being resolved spontaneously.

3) Excessive manipulation may indeed do this. I have no way of judging whether it has been an issue for you.

Keep working with the doctor in charge of your care. Good luck.

HHH, MD
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31 months ago
Hi Dr HHH 

Quick follow up question. I took 100 mg of doxy 2x daily for a week. All symptoms basically resolved for what is assumed to be ngu. My wife was planning on receiving the same treatment but she simultaneously developed a bad sinus infection, for which she was rx’d a z pack. She never had any symptoms but would this be adequate treatment for her for ngu?  

And, for how long should we wait after she has finished the z pack to resume sex? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
I'm glad you were treated and very pleased to hear it cleared up your symptoms. The apparently clear response to doxycycline confirms the likely infectious cause of the problem, i.e. the diagnosis of NGU. Your wife's azithromycin (Z pack) treatment should be just fine. You and she can safely resume sex as soon as you both have completed treatment, i.e. a day or two after her last dose.---