[Question #5465] Follow up

22 months ago
Hello again, this is a follow up on a previous question. 2 weeks ago i had a bad viral infection that could have been adenovirus. 3 days into it i started having dysuria. My only encounter was a handjob 6-7 weeks prior.  The other thing i  can think if is the use of gym towels after workouts. Since then the dysuria, frequency, urgency has been occuring on and off. I saw an md and he ordered urine tests with the results as follows: chlamydia and gonorrhea pcr negative on a midstream first void sample. UA however showed trace leukocyte esterase, this was completed by a microscopic analysis showing 1-2 WBCs per HPF. urine culture is pending results.  I know you are infectious disease specialists, i just want to make sure i am not missing anything. I have not taken antibiotics nor am i sure that i need to. Any input us greatly appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back.

Usually the specific source of any respiratory or other common viral infection cannot be known. It's sometimes obvious, e.g. if a family member or ohter known contact has had the same thing. Other than that, it is useless to speculate about any sources, whether in an athletic club or anywhere else. Among other things, most people with such infections have mild symptoms or none and cannot be identified as sournces even if there was close contact. Stop speculating on the source in your case:  you'll never have a clue.

Any urethral infection or inflammation can cause positive leukocyte esterase test. That result goes along with adenovirus and there is no reason to suspect you are missing anything. I would stop testing at all for LE or anything else, and you have said nothing that suggests an antibiotic would help anything. If your symptoms have cleared up, you're done and all is well.

I hope that helps further.

HHH, MD
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22 months ago
Thank you for the reply. 
Specifically i was asking what you thought about the results of the urinalysis with a trace leuk esterase but only 1-2 wbcs on microscopic examination. Is that anything to be interpreted as abnormal, or is it just a normal ua. Thanks. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Sorry, I missed that point. No, this is an entirely normal urinalysis result. For sure no additional testing is needed.---
22 months ago
Excellent, one last question: would the midstream urine affect the Sensitivity if the chlamydia/gonorrhea test. I know a recent study suggested that with the new PCR techniques the timing of urine matters very little nowadays. I would like to know your opinion regarding that. And i assume this will conclude this thread. Thanks again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
The initial studies of test performance used first-void, so that's what the US Food and Drug Administrations requires for the test instructions. But that doesn't necessarily mean midstream is a problem, and most STD clinics have found it doesn't really make a difference.


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22 months ago
Based on your last statement, and given that the only risk i had was manual-genital contact, would you recommend repeating the chlamydia/gonborrhea test on first void urine, or empirically taking azithromycin. Or is the risk is nil and thus nothing is necessary ? I appreciate your help. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Considering all factors -- risk free exposure, your symptoms, negative test results, and symptoms clearing up (including normal urinalysis), I definitely think you should not be treated and should put these events behind you and move on without worry.

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