[Question #4971] Clear Liquid Discharge From Penis (I assume gonorrhea), what to expect?

24 months ago
I got this symptom since about 9 days ago. slight liquid discharge from penis occassionally (without color). but it happened so randomly. there were days when i couldn't feel any symptom at all. The naive me, i didn't actually go to doctor the first. I asked for 2g of azithromycin directly in pharmacy but apparently it didn't help me. 7 days later, i could still see some mark on my underwear after i wear it for hours. (that's how I know there's liquid discharge)

And yeah, I finally went to doctor about 2 days ago, and I was injected by ceftriaxone and was prescribed 14 tablets of docycyline (100mg each). The doctor wanted me to finish them within 14 days. One thing that 'bothers' me is that I actually asked for bacterial resistency test (something like urine test or swab test) just to make sure what do I have and to check bactery resistency but the doctor said i don't really need that. he asked me to get tested for HIV, syphillis, and hepatitis but not the ones that are relevant with my symptoms (gonorrhea, chlamydia, trich, and maybe mycoplasma genitalium). 

Questions:
1. Assuming this is gonorrhea, how many days do gonorrhea usually survive after first injection of ceftriaxone and first docycyline pill? 7 days?
2. Same question with number 1 but for chlamydia, trich, and mycoplasma genitalium
3. I wore condom for vaginal sex but I did not wear condom when I got fellatio (oral sex as a receiver). I think that means the most possible scenario here is indeed gonorrhea? I heard you cannot get chlamydia from unprotected oral sex? how true is that?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your question.

Urethral (i.e. penile) discharge is the most common STD symptom in men, typically indicated urethritis -- infection/inflammation of the urethra, generally due to gonorrhea or nongonococal urethritis (NGU), with NGU caused by chlamydia in about one third of cases, other or unknown causes in the remainder. However, the discharge with these conditions is generally colored or at least cloudy; occurs more or less continually until treated; and most persons have at least some degree of uncomforable or overtly painful urination. Occasional or intermittent and entirely clear discharge generally does not indicate urethritis. If there has been sexual arousal with erection, it's usually pre-ejaculate fluid ("pre-cum"); other times it's just normal mucus. That said, you migth have had continuous discharge, i.e. if you could pretty much always see a stain in your underwear. In other words, you migth have had NGU (but almost certainly not gonorrhea).

As you seem to realize, it was jumping the gun for you to take azithromycin without first getting examined and tested for these STDs. And it sounds like you were not examined before treatment with ceftriaxone and doxycycline, right? That was unfortunate and inappropriate. Probably your doctor did not recommend gonorrhea/chlamydia testing because you took the azithromycin -- maybe not an unreasonable decision, but it should have been done since you still had symptoms. 
And the standard nucleic acid amplification tests (NAAT) remain positive for a few days after treatment. But at this point, assuming your discharge is gone and no other symptoms, you're never going to know whether you in fact had NGU, chlamydia, or gonorrhea.

To your specific questions:

1) Gonorrhea is very unlikely; it almost always causes thick, yellow discharge (pus) and painful urination. But if you had it, 2 g azithromcyin probably cured it (in fact this is a recommended treatment in people who cannot take ceftriaxone, e.g. allergy). If still persistent after that, you would be non-infectious within a few hours of the ceftriaxone injection.

2) Chlamydia probably would be non-transmissible within a couple days of the first dose of doxycycline. You weren' treated for trich. M genitalium uncertain, no data on this; and although MG often responds to doxycline, it's probably only around 70-80% reliable. However, you can be very certain you do not have either trich or MG, because....

3) ...these two STDs are not carried in the oral cavity and cannot be acquired by oral sex. This exposure history favors either gonorrhea (unlikely for the reasons above) or, most likely, NGU of unknown cause. It is true that chlamydia is rarely acquired by oral sex. Until a few years ago, it was thought to be extremely rare or maybe not occur at all. With improved tests and more research, chlamydia isn't all that rare in the throat and might rarely be transmnitted by oral sex. However, studies of NGU in men whose only exposure was oral sex, chlamydia testing almost always is negative. Nonchlamydial NGU, not gonorrhea, probably is the main risk from oral sex. Such cases are believed to be due frequently to entirely normal oral bacteria, not any traditional STD.

If your discharge goes away and stays away, nothing more need be done. By the way, you're being overtreated with doxycycline according to most standard guidelines. One week, not two weeks, is the norm, especially in the US. In UK and Euroope, some clinics routinely presctibe 10-14 days treatment, but there is no evidence it's necessary to go that long.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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24 months ago
hello, thanks for the answer, Dr Hunter.

Your answer is very helpful but yeah last night i still had stain on my underwear after i wore it for hours. that's how i know i have some disease. because precum don't cause that kind of stain as far as i'm aware. However, once again, I don't always have this kind of stain. it only happens sometimes, there were days where i couldn't see the stain on my underwear but the next day i could see another stain again. Weird...

And i have another question

" Nonchlamydial NGU, not gonorrhea, probably is the main risk from oral sex. Such cases are believed to be due frequently to entirely normal oral bacteria, not any traditional STD"

^ but this normal oral bacteria, can it be cured with 7-14 days of docycycline dosage? thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
NGU acquired by oral sex appears to respond nicely to doxycycline.  That the bacteria are normal in the oral cavity doesn't imply they would be resistant to doxy or any other antibioitc. The discharge probably will clear up soon.---
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