[Question #5497] Exposure, Follow Up

22 months ago
Hello Doctors,

I am sorry that i come back and purchased new question but want to learn more regarding some questions i didn't have the possibility to make on my first post.

You can check my last question regarding my symptoms. Now i remember a condom break times ago but never tested due to no symptoms, i can't tell the breaking was inside or after but my pennis was exposed after pulled out. I dindt have any symptoms at all on that time.

Now, after oral exposure and after the treatment with Doxy for 15 days i did a semen analysis and it show 4500 Leukocyte, normal range was 3000. Doctor give me bactrim. After finished all the medication weeks later did a urine analysis, Leukocyte 2-5, Erythrocyte 10-12, and some bacteria but no bacteria on uroculture.

Days ago after 2 hours urination i made a urethra swab test and Mycoplasma Hominis, Ureaplasma Urealiticum, Trichonomas Vaginalis , Neisseria Gonorrhea etc negative.

1. Pozitive for gardnerella vaginalis (Clue Cells) i don't know, whats is this and what treatment would be good ?

2. I can't see Mycoplasma Genital and Chlamydia on my Tested kit on the clinic and also how to test for wbc ? I cant fund NAAT test in my country.

3. Would be better to take both Ceftriaxone as shott and Azithromycin for all included gonorrhea ? Because Doxy may not cure all of them.

4. What test will you suggest me to do ? Just to know for my mind. I tested for Hiv1/Hiv2, Hepatitis, Syphilis negative. Have i forget any other testing ?

5. Would be good for my partner to get treatment?

My main symptoms right now are like many others, pennis tip red, discomfort after urinating on the urethra, foreskin a bit tight, bladder or prostate tension (strange feeling to describe).

Thank you for your service.
Have a good day!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back. You had a UTI due to E. coli. As we discussed then, almost certainly it was not sexually acquired; it probably had nothing to do with the oral sex event you described. There was no evidence then of any STD.

Have your symptoms continued? All evidence suggests your UTI has been cured and I see no need for any additional treatment.

You have had several tests not normally recommended or done by STD or sexual health specialists, at least not in my country. I don't understand why semen analysis was done. This is not usually part of the evaluation or follow-up of urinary tract infections in men and I have never done semen analysis on my patients and do not know the normal values for white blood cells (WBC, leukocytes), or whether moderately elevated WBC is common or nomral this soon after a UTI caused by E. coli. I would not be inclined to treat with Bactrim or any other antibiotic only because of increased WBC, only if a culture test were positive for a UTI bacteria. However, the decline in WBC to very low levels suggests an infection that was cleared up with that treatment.

Mycoplasma hominis and Ureaplasma urealyticum are entirely normal bacteria in the urinary tract; even if positive, no treatment would have been necessary. Therefore, we never test for them in my STD clinic. Trichomonas testing is valid if it was a nucleaic acid amplification test (NAAT, i.e. a DNA test or PCR), but that is usually done on urine and I don't know how to interpret a urethral swab test. The most important of these results is the negative test for gonorrhea, assuming that also was done by NAAT. However, if you had had it, either the doxycycline or Bactrim probably would have cured you, so I do not understand testing for it.

1) Clue cells are not the same as Gardnerella; and Gardnerella is another normal bacteria in the urinary tract. Clue cell testing is never done in men, at least not to my knowledge. I do not know how to interpret that report.

2) There is no need to test for M genitalium in the absence of active infection, which you did not have when the test was done. And it would be impossible to have chlamydia after 2 weeks of doxycycline plus the recnet treatment with Bactrim.

3) I see no need for ceftriaxone, azithromycin, or any other antibiotics at this time, for gonorrhea or anything else.

4) I do not recommend any additional testing.

5) From all you say, you do not have (and never had) any STD. I see no need for your partner to be treated.

As already noted, you have been managed very atypically up until now. If you're still having symptoms that concern you, consider getting a second opinion, perhaps from an STD or infectious diseases specialist, or maybe a different urologist.

I'm curious where you are (city, country). In the meantime, I hope these comments are helpful.

22 months ago
Hello doctor,

I have again some urethra discomfort after urinating, and after pee like there is still pee inside urethra , and like a bladder or prostate pain or tension , i am not sure maybe due to bacteria and 10-12 Erythrocyte? And why this happened, never had this problem before.

I did the semen analysis just to check for the numbers of sperm etc, because the doctor told me because of varicocele ( something like this if i remember right ).

I didn't do any NAAT here because i can't find any hospital clinics that test for it, the country is Albania. The test i did was a urethral swab, i inserted a swab on my urethra , and made a test for pathogenic microorganisms. And that test show up gardnerella and clue cells.

I am not sure how accurate might be.

I tested for Hiv1/2, shypillis, hepatitis just to know because never tested before.

I was thinking for ceftriaxone with azithromycin becuase might clear all the possible ngu and gonorrhea and other bacteria.

The main problem is that i have as i said, a condom brake vagcsw in Europe but never tested for it because of no symptoms. But i learned that many of them are asymptomatic. I never noticed discharge, that's what worries me and that's why i am afraid for my partner.

Did the doxycycline treat all Std that i might have?

The urology doctor told me i will not give you anymore antibiotics and stop testing but the only antibiotic i took was doxy and later bactrim. But still same. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Albania -- interesting. I have no knowledge or experience of the status of professional expertise in urology, STDs, etc in your country. But it sounds like you have a knowledgeable urologist -- even if he has done some tests that I would not have thought necessary.

The minor symptoms you have probably are just residual discomfort from the original UTI and/or whatever problem was causing the elevated WBC in semen. No antibiotics should be given in absence of objetive evidence of inflammation/infection, and you have none. There is no chance you had or still have gonorrhea. Asymptomatic gonorrhea is extremely rare in males, and would have been detected by the testing you had and cured by the treatment you received.

In other words, I agree with your urologist. Just live with your minor symptoms -- they probably will clear up over the next few weeks. If they do not, the first thing to do would be to repeat the urinalysis and culture for non-STD UTI. But disregard any and all STDs:  you were at very low risk for STD and any you might have had now are gone.

That concludes the two follow-up comments and replies included with each question, and so ends this thread. I hope the discussion has been helpful.