[Question #5033] Follow Up. #5018

24 months ago
Good morning Dr’s. I wanted to continue the discussion I recently had with Dr. Handsfield. 

I went ahead and made an appointment with my PCP to get tested.   However, I cannot see him until this coming Monday.   6 days is a lot of time to wait.   

DrHandsfield, in your last responses you mentioned that discharge needs to be more or less continuous.   It is not, but it’s still there. Anxiety is killing me here so I had some more questions. 

Early this morning, I had that very bright white discharge again.  Very small amount but certainly noticeable.   And frankly, it is alarming me.  This has never happened.   Again, no staining on my underwear last night or the night before. After first urination (with no pain whatsoever), it is gone again.  In regards to pain/discomfort,  I have thought a few times that maybe there was a little tingle/pain, but I am attributing that to anxiety.  There just isn’t any noticeable problem on urination. 

So, I am going crazy with what on earth this could be. 

Can Chlamydia, gonorrhea, etc present itself with super white discharge only in the morning?  Without any type of discomfort/pain.  Or have symptoms that remain very very mild and never progress?

I would appreciate any additional insight you might have based on the timeline in the previous discussion and the fact that the white discharge is still there ONLY in the early morning.   

Further, I have not used another dipstick test to check for white blood cells. 

Finally, I am attributing that “spotting” I mentioned about my wife to her monthly cycle. She started it yesterday and aside from being extraordinarily heavy, she has mentioned no other problems. No symptoms like mine.  

Thank you Dr’s. 
24 months ago
Dr's, I forgot to mention something.  Dr. Handsfield, in your first response, you were wondering if there was any association with a bowel movement.  On Friday, when I had that large, copious amount two hours after getting up, I had had a bowel movement about an hour or two before that.  Saturday and Sunday, no discharge noticed, either in the morning or with bowel movements.  Yesterday morning and this morning, it was also not associated with a bowel movement.  I wanted to clarify this in the event that it may help you in further discussion of my fear/concerns.

Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Thanks for your follow-up.  On this occasion I happened to pick up your follow-up question.  Dr. Handsfield and I share the Forum and having worked together for over 30 years, I can assure you that while our communication styles vary, the substance of our messages do not.  I have reviewed your earlier interaction with him and agree with the assessment he provided.  I completely understand your frustration with the delay in evaluation.  The painless, intermittent nature of this discharge is not typical of urethritis caused by an STI.  It is also not particularly typical of prostatitis (which is not an STI) or a urinary tract infection.  I trust that, as recommended, you are not self-examining yourself further.  I also agree with his recommendation that you seek professional evaluation and share your frustration that you cannot be seen by your doctor until Monday.  This is not acceptable, and I would suggest checking around for alternate services.  I am not sure where you are located but in many places there are sexual health clinics which can provide a more timely evaluation (same of the following day) which is what I think is needed here.  That should include an stained smear of a specimen taken from your penis and, in addition to evaluation for white blood cells on the smear specimen, tests for gonorrhea, chlamydia, trichomonas and in your case, perhaps Mycoplasma genitalium.  

I also feel very strongly that it would be unacceptable for a health care provider to simply give you antibiotics without testing since if this were the case, you would not know whether or not your wife might have been exposed and whether and what sort of treatment she might need.  Please do not let this happen as you seek more timely care.

I hope this comment is helpful.  Please let us know what you find out. EWH
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24 months ago
Thank you for your reply Dr. Hook. Ok, here’s what is happening. I spoke with the Dr’s office again. The office gal told me if it couldn’t wait until Monday, I needed to go to the emergency room. So, I have found a clinic that can have results in 2  days. I wasn’t exaggerating when I mentioned a geographic problem in my first discussion. The clinic is about 100 miles away. I am driving there immediatelyand will let you know what they say. Thank you very much for your time!
24 months ago
Ok. Dr. Hook, I just finished at the clinic. I think I am more confused now than I ever was. 

All of the tests were done.  I am supposed to have results back by late tomorrow or the next day. 

Here is what is confusing.  The doctor said he didn’t think I had any STD.   They did the LET urine test here.  WBC was positive. Similar dip stick to what I used   I asked why on earth he thought I had no STD after the WBC showed up and I am having that scant, very white discharge early in the morning. He said a lot to me and surely, I don’t remember all of it, but I would like to paraphrase here on some general statements that he made.  And, considering he is young (around 40), I would like to know if you agree with him. 

“ Mr. X, I am of the opinion you are over reacting to this.  Regarding your urine WBC, it’s not really strange for you to have some, and with the way you have been examining and milking yourself, I’m not surprised that they are showing up. Yes, you need to be tested but I believe your tests will come back negative.  The reasons being are many, but among them are the fact that I could not express discharge from your penis. If you have an active STD that produces discharge first thing in the morning , it should be there during the day. You also have no burning. If an STD is causing pus discharge, you should have noticeable discomfort on urination. This doesn’t mean that there is absolutely no STD.  Stranger things have happened, but aside from one, mind you ONE totally asymptomatic case of gonorrhea, I have never seen any STD cause the morning discharge you describe without some associated discomfort during urination and discharge of the same amount and likeness during the day. As far as diseases that don’t present in this way genitally, we will have to wait on the blood tests. But as far as STD’s that present with discharge, I don’t believe you have one.  You just don’t get “copious” discharge one morning, and then have two days off, then have scant white discharge two days later. You would notice it more.”  

That’s all I can think of that he said. He was very nice and compassionate but firm and rather blunt at the same time. 

Do you agree with what he said to me?
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Thanks for the follow-up.  It sounds to me like you saw a thoughtful, doctor.  I do agree with what he said. As Dr. Handsfield (and now this doctor and me) told you, repeated examinations can cause irritation and your symptoms really are not characteristic of typical STIs.  I think this doctor was right on target.  

My advice, wait for your test results.  If they are negative (and I too suspect they will be), then you can be entirely confident that you do not have an STI.  At that point, if the occasional, intermittent discharge continues, then my advice is to see a urologist to look for non-STI causes.

Please let us know what your tests show.  EWH
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