[Question #5018] Very concerned over symptoms

24 months ago
48 y.o. caucasian male.

2/16 -Unprotected vaginal and oral with very high end CSW (known her for years if that matters statistically).
2/19- Unprotected vaginal sex with wife
2/22- 0400-normal urination, full void, no pain/discomfort.  0600- copious amount of discharge before urination that looked exactly like semen (about .75-1ml).  No pain/discomfort whatsoever.  Normal urination rest of day/night.  No discharge at all.  No pain.
2/23- Normal.  No pain/discomfort or discharge all day/night.
2/24- 0500- Bright white discharge before urination (size of a ball point pen) after milking of penis.  Very white, nothing cloudy about it.  Did not look like semen.  No pain/discomfort on urination.  0530 - wife reported scant/spotting amount of bright red blood.  Applied a tampon.  (Full week before expected monthly cycle.)  She never has this.  0630- wife reported no blood on tampon.

Thats all I can think of Dr's.  I am very, very worried about this and appreciate your opinions.   I should mention, I have been examining myself every few hours the past 2.5 days.  Could that have caused my discharge this A.M.?  Shouldn't I have some burning/discomfort on urination?  I am going to get tested, but my geographical situation at the moment is preventing that for another 5-6 days (short of me going to an ER with the wife).  

24 months ago
Dr’s, I need to add that anxiety is getting the best of me here. So, I got a uti test strip and used it properly.  Neg for Leukocyte and nitrite. Not even a trace.  Does this help with perhaps putting odds more in my favor?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your question. 

It certainly is coneivable that your discharge is from urethritis (urethral infection), i.e. an STD -- either nongonococcal urethritis (NGU) or, less likely, gonorrhea. The timing is about right, especially for NGU. But probably not. Your question implies that you know that intermittent rather than continuous discharge and absence of pain or discomfort on urination argue against urethritis and STD. You also don't mention underwear staining, which is the norm with urethriits.

I wonder whether the dishcarge is associated with defecation, or only urination. Many men experience discharge during or immediately after bowel movements, due to straining, feces passing over the prostate and seminal vesicles (where semen is stored), or a combination of both. For some men, it's quite common.

It is also true that self examination, especially with repeated squeezing or "milking" of the penis in a search for discharge can itself cause urethral irritation. I'm not sure whether it can cause discharge, but eventually it will lead to pain or discomfort during urination. In other words, stop it:  you won't express any discharge that matters, and there is a good chance of screwing up the diagnosis when you are medically evaluated.

The 5-6 of enforced waiting, until you can get to medical care, is probably a good idea; even without that aspect, I would have recommend waiting a few days to see what happens. At that time you should get it checked out, preferably by a physician experienced in STDs. Of course don't wait if other symptoms typical of STD start happening (continuous yellowish discharge, underwear stains, painful urination), in which case you should find a way to get it checked out right away. But my guess is that this will fade and that your symptoms are unrelated to your extramarital sexual adventures. in the meantime, steel yourself against repeated self examination.

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

HHH, MD
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24 months ago
Thank you Dr.  The discharge certainly isn’t continuous.   Am I to understand that discharge should NOT be intermittent or  only in the early morning?  It should be more consistent?  I don’t wear underwear, ever. But I have been checking and there doesn’t seem to be anything other than a little clear or cloudy fluid every once in awhile in really scant amounts. 

Does the timing of the “spotting” for my wife mean anything here?  She says it has not come back all day and has had no other symptom.  No itching/burning etc.  

Also, what do you think about the urine dip stick test I mentioned?  I took another one about an hour ago. Not a trace of Leukocyte or nitrite.  

If that discharge this morning was due to an STD wouldn’t that test have been glaringly positive for leukocytes?  Thank you sir. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
A little genital spotting is extremely common in entirely healthy women. If your wife dosn't think anything is wrong or abnormal, I would not be concerned.

Yes, urethritis causes more continuous discharge. And as you surmised, absence of WBC in your urine (i.e. negative leukocyte esterase on the dipstick) is additional evidence against urthritis.

So this information doesn't change my overall evaluation and advice. I doubt you have any STD.
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24 months ago
Update as of this morning Dr. Handsfield.  For the first time in 35 years, I wore underwear to sleep in.  When I woke up, no staining.  I also did not see any discharge coming out.  I used another test strip and the LET pad turned purple.  Not the entire pad though.  Just a portion of it in one corner.  Nitrite pad was negative.  There is still no burning or discomfort whatsoever.  Would you consider it normal to have negative LET during the day, and then show positive early in the morning?  What could be happening here?  Does this change your opinion, or do you still have the same doubt about me acquiring any STD? 
24 months ago
Dr, I might add that I drink quite a bit of water during the day.  Typically I will urinate every couple of hours.  Could this have affected the test strips yesterday during the day?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
I'm not sure what's happening here, but I continue to believe it is unlikely you have urethritis. Increased urine flow should not make the tests falsely negative, especially if done at least 1-2 hours after the previous urination. However, the dipstick tests are calibrated primairly for diagnosis of UTI in women -- I cannnot vouch for their accuracy in this situation. I continue to be confident you have no STD, but the only way to be 100% confident -- if your symptoms continue -- is to be professionally evaluated if the intermittent discharge continues. (But it sounds like it's gone?) In the meantime, I suggest no further self dipstick testing or self examination. If no underwear staining or more or less continuing discharge, and if intermittnent discharge stops, just move on.

That concludes this thread. I hope the discussion has been helpful.
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