[Question #5768] Lost After Testing Negative for STIs Yet Still Have Symptoms

73 months ago

I have a clear discharge that is most extreme when I wake up, my urethra is inflamed and I have conjunctivitis, which I believe is the same infection. Again, the discharge is always clear like precum.

After taking 1G of Azithromycin and 25G of Rocephin on a Monday, the symptoms got worse, and on that Thursday I finally gave a urinalysis, which came back negative for Chlamydia and Gonorrhea. I got an eye swab and discharge swab sent off, and I wanted the walk in clinic to do a full spectrum (adneovirus, mycoplasma, viruses, etc), but it was JUST, again, for Chlamydia and Antibiotic Resistant Gonorrhea (they gave me 2G of Az and 1G of Rocephin that Thursday AND put me on 30 days of Cipro) <Thinks I may have a prostate infection>. The swab results hasn't come back yet, but based on everything, I don't think it's Gonorrhea (maybe you do?).

The symptoms are still present after a week. I have a long history of taking z-packs for bronchitis and 4 years ago had Chlamydia and had to get on stronger antibiotics to kill it. I don't remember what they were.

1. The doctor said that if I had an antibiotic resistant Gonorrhea that it would have STILL shown up positive on the first urinalysis even though they started treating it before. True?

2. My partners from the last year have all tested negative for Chlamydia and Gonorrhea vaginally. If this NGU is non-Chlamydia or Gonorrhea, then what could it be and what tests do I need ran to find out? I'm assuming I caught whatever it is from oral sex from a woman I met a few weeks ago (only received oral). I haven't had sex in a few months prior to that.

3. Briefly, can you explain whether it could be that Azithromycin may not work in me anymore or that whatever it is I have is resistant to it?

4. I live in the USA: if it is antibiotic resistant Gonorrhea, what next antibiotic wise to kill it?

Thank you so much!

H. Hunter Handsfield, MD

73 months ago

Welcome to the forum. Thanks for your question.

With both conjunctivitis and urethritis, plus the negative standard STD tests, it is likely you have an adenovirus infection, which (you apparently know) causes a small proportion (2-5%) of nongonococcal urethritis (NGU). Too bad they didn't test for it, as you requested! It is primarily a respiratory virus, prone to cause conjunctivitis (and often other common cold symptoms). Urethral infection typically is aquired by oral sex, but might occur in some men who only get a respiratory infection. Your symptoms are textbook, right down to the details of meatal redness, clear discharge, and conjunctivitis: your story could be used to teach medical students.

It would appear the doctors you have seen are unaware of this syndrome. Here are some sources both to inform yourself and perhaps offer to your doctors.

https://www.ncbi.nlm.nih.gov/pubmed/26574571

https://www.ncbi.nlm.nih.gov/pubmed/25433050

https://www.ncbi.nlm.nih.gov/pubmed/16388480

At this point, I would strongly recommend you not take a month's worth of ciprofloxacin (which is a more dangerous drug than often appreciated -- the US FDA recently recommended it never be used if an alternative antibiotic is available, especially for more than a week). Most important, it won't help your symptoms. They will clear up (both conjunctivitis and urethritis) over the next week or two. There are no known long term complications of adenoviral NGU. It will clear up entirely.

Any other possibilities? In the syndrome called reactive arthritis, conjunctivitis and urethritis sometimes occur due to immunologic mechanisms, i.e. not due to infection. This will be a consideration if joint paint or other signs of arthritsi appear, or perhaps if the problem continues more than a few more weeks.

Those comments directly or indirecrly address your specific questions, but to be explicit:

1,2,4) If you had gonorrhea, antibiotic resistant or not, it would have shown up in the tests you had. And it sounds like you are at little or no risk for gonorrhea (or chlamydia).

3) No antibiotic works against any viral infection. The persistence of all your symptoms despite all those antibiotics is part of the strong evidence for a viral infection, like adenovirus, and for no bacterial STD.

I hope these comments are helpful; let me know if anything isn't clear. If you follow up with your doctors, I'll be interested to hear their reaction. You could print out this thread as a framework for discussion.

HHH, MD

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H. Hunter Handsfield, MD

73 months ago

I neglected to mention that it may not be too late to test for adenovirus. If done, it would be reasonable to test swabs from the throat, conunctiva of the involved eye, and urethra. Negative results would not rule out adeno -- after a week, your immune system may have cleared the infection, even though it takes longer for symptoms to resolve. But a positive result would confirm the diagnosis, and conclusively rule out other causes.---

73 months ago

Dr. Handsfield!

I'm so psyched that YOU specifically responded. I'm a fan!

My symptoms are almost completely gone. I stopped the Cipro and overwhelmed my system with Kefir and probiotics to replenish my system. Thank you so much for your lucid and timely response!

Since I have the opportunity to have one follow up response, I was hoping you could clear a few things up for me. Again, I’m honored to be able to ask you!

1. What's the current situation in the USA with antibiotic resistant Gonorrhea? Ability to cure it, reality of prevalence, antibiotics they use when 2G AZ and 1 G Roc doesn't work, etc.

2. I've taken Azithromicin for years for bronchitis situations. I believe I've built up a "tolerance" to them, since five years ago when I had chlamydia and they gave me it to cure it, my symptoms of discharge didn’t go away for a month, even after I retested and came up negative! In the future, should I ever catch Chlamydia or Gonorrhea, what should I suggest to the doctor I take? Was the continuance of discharge after testing negative a sign that the antibiotics aren’t working as effectively or something else?

3. There’s so much debate on this and I’ve never heard what YOU think: once and for all, is Chlamydia catchable from receiving oral sex? I have heard that it cannot live in the mouth or throat, and that if it is transferred through receiving oral sex, it’s due to some sort of “real time group encounter transmission”, where the bacteria is alive long enough in the mouth to transfer from one person to another. What say you?

Blessings Dr. Handsfield!

H. Hunter Handsfield, MD

73 months ago

Thanks for the kind words, and glad to hear your urethritis is clearing up. The improvement is unrelated to the antibiotics you were given.

1. There is no gonorrhea in the US with dangerous levels of antibiotic resistance; all cases are readily curable with standard treatments in use for many years, in particular a single injection of ceftriaxone. Any dose 250 mg or greater is sufficient, 1 gram never needed. Azithromycin resistance is pretty common, however, and the next round of CDC recommendations (several months away) probably will delete co-treatment unless chlamydia has not been ruled out; and will not recommend azithro alone in any dose for gonorrhea. CDC and all public health agencies are on the alert for importation of highly resistant strains and/or their evolution in the US. But so far, no signficant problem.

2. Antibiotic resistance is pertinent to the particular bacteria causing an infection, not to the person taking the drug. If and when you are infected with an azithro-sensitive bacteria, the drug will work just fine. That includes chlamydia if you should get it. However, we also know that the large majority of bronchitis episodes do not need any antibiotic; they clear up just as rapidly without azithro or any other antibiotc. So I would recommend you reconsider your frequent use of the drug -- this sort of habit is one of the main drivers of increasingly dangerous bacterial resistance to antibiotics. As discussed in my reply above, continuing discharge had nothing to do with the antibiotics you received. All viruses, including adeno, are unaffected by antibiotics.

3. This really isn't controversial among legitimate experts. It was once thought that chlamydia rarely infected the throat. Newer, more sensitive tests show throat infection is more common than previously believed, but still rare: typically under 2-4% of people with chlamydia have throat infections. And in people with NGU whose only exposure was oral sex, chlamydia is almost never the cause. Undoubtedly it can be transmitted by oral sex in the presence of throat infection, but it's not highly transmissible and oral sex accounts for very few genital infections.

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73 months ago

You rock Dr. Handsfield! THANK YOU!