[Question #572] Discharge Update
107 months ago
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Edward W. Hook M.D.
107 months ago
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Welcome back to the Forum. I looked for your earlier post and could not find it to refer to. Perhaps you used a different screen name. Irrespective I will be pleased to address your questions. Before I do however, let me suggest that you MAY have recurrent non-gonococcal urethritis, a relatively uncommon but by no means unheard of problem in which men repeatedly experience urethral discharge which may not respond to therapy of may respond only transiently. The important thing to know about this syndrome however is that people who continue to have discharge of the sort you describe after repeated rounds of treatment are typically not infectious to sexual partners and do not need to worry about causing them harm unless they subsequently become infected with a known pathogen. Also, I need to tell you that Mycoplasma genitalium typically does NOT respond to doxycycline therapy so your apparent transient response to doxycycline suggests that your urethral irritation is NOT due to Mg but something else. Further, I would add that in addition to its antibiotic effect, doxycycline has some anti-inflammatory effect (like aspirin or ibuprofen) and thus your response to doxycycline may be a reflection of decreased inflammation, not the response of a bacteria to an antibiotic. Now on to your questions.
Does the fact that the Doxycycline worked, then it didn't, and then finally did when I did a second round of treatment seem normal to you?
See above. As I said - Mycoplasma genitalium typically does NOT respond to doxycycline therapy so your apparent transient response to doxycycline suggests that your urethral irritation is NOT due to Mg but something else. Further, I would add that in addition to its antibiotic effect, doxycycline has some anti-inflammatory effect (like aspirin or ibuprofen) and thus your response to doxycycline may be a reflection of decreased inflammation, not the response of a bacteria to an antibiotic.
107 months ago
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Edward W. Hook M.D.
107 months ago
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This is a difficult question. The problem of recurring, non-pathogen associated NGU became apparent when patients, (and their doctors but mostly patients) got tired of repetitive cycles or discharge, repeat treatment and no change or evidence of harm to their partners. How tired of this are you? Is it possible you are seeing the small to modest amount of urethral secretions that most men will see from time to time if they look hard enough?
If you have not had new partners and the discharge resembles prior episodes, personally, I would not worry or seek evaluation (I might take an ibuprofen or Naprosyn and see what happened). On the other hand if you have had new partners or the discharge is more obvious or otherwise changed from earlier episodes, I would seek evaluation. EWH
107 months ago
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Edward W. Hook M.D.
107 months ago
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As per Forum policy, this will be my final reply as part of this thread.
First, there are many ideas about NGU which occurs without an obvious pathogen. This is an area of active research. Clearly at least some of it comes from affected persons themselves. As I said above however " people who continue to have discharge of the sort you describe after repeated rounds of treatment are typically not infectious to sexual partners and do not need to worry about causing them harm unless they subsequently become infected with a known pathogen."
The fact that you took doxycycline and your discharge seemed to improve may be unrelated. Whatever was happening may have simply run its course or the anti-inflammatory effect of the doxycycline may have contributed.
This will end this thread. I (once again) urge you to move on and to try not to focus on your genitals quite so much. EWH