[Question #5875] A question for Dr. Handsfield.

18 months ago
32 year old male in a monogomus (until 10 days ago) relationship with a female. 

10 days ago I had unprotected Oral, brief unprotected sex (less than 5 seconds), then protected sex with a female friend that I have known for years. 

2  days ago I had unprotected oral and unprotected sex with the same female friend. Friend claims I am the only recent sexual partner... I tend to believe her but who knows. I do not believe my girlfriend is cheating on me. I have only had 2 sexual partners in the last 2 years. 

About 18 hours later (after unprotected sex)  I noticed frequent clear discharge. I tried to forget about it. About 36 hours later, the discharge is more prominent (constant wet stains in underwear) and has turned a creamy color (tinge of yellow). I have no discomfort at all while urinating however it does tend to burn slightly AFTER urination. 

#1. Is 2 days too soon to go get tested/treated? Or is the presence of discharge enough to provide a positive test if I have Gonorreah or Chlymydia or whatever this could be. I could wait a few more days however I would rather be treated sooner obviously. 

#2. I had sex with my gf 3 days after the unprotected oral/protected sex 10 days ago. If I aquired a Gono/Chlym/NGU during that encounter could anything have been transmitted to my gf (after 3 days)

#3. Should I test for Trich? 

#4. I was diagnosed with a unexplained UTI in highschool before I was sexually active. Could it be I am prone to UTIs and exposure to new bacteria caused this?

#5. Do you think this could be NGU or a UTI based on the lack of burning sensation while urinating? I ask because I dont want to worry my friend if what I have is because of me and not a STD she gave me.

#6. What is the reccomended treatment for Gono/chlym/ngu. Also, how long am I infectious after antibiotics? 

#7 If the Dr determines its NGU is that transmitable to my gf? 


Thanks in advance. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your confidence in our services. FYI, it is only by chance that I am responding:  as described in the introduction to fhe forum, users do not select the moderator who responds to their questions.

It seems clear you have urethritis -- gonorrhea, chlamydia, or nonchlamydial NGU. Creamy/yellow discharge favors gonorrhea, but it could be any of these. If gonorrhea, maybe from the most recent exposure -- although 18 hours is faster than usual even for gonorrhea. If chlamydia/NGU, onset is most consistent with the earlier exposure:  typical incubation period 7-14 days. Or as you imply yourself, perhaps from your regular partner. If it's gonorrhea, 3-4 days is typical. As you undoubtedly understand, when one person in a relationship finds a need for outside partners, often the other is in the same boat. But you know your partner and I don't.

The main thing is to not attempt to test yourself, e.g. by finding a lab online. You need to see a professional in person for proper evaluation and treatment.

1. It's not too soon. In presence of these symptoms, testing will be valid for all the main possibilities.

2. Both your partners need treatment, including your girlfriend, regardless of the specific diagnosis. You can't get around it; it's an absolute requirement on both medical and ethical grounds. You could wait until after you have been professionally evaluated. On the other hand, since it is obvious she needs treatment, you may as well discuss the situation with her now, since she will also need exam and testing in addition to treatment. And also go ahead with the necessary discussion with your new partner. Even if she isn't the source, she has been exposed since your most recent sex with your GF.

3. Initial evaluation usually doesn't include trichomonas, which rarely causes symptoms in men. Trich usually comes up only if a) diagnosed in a woman or b) if initial treatment for NGU is unsuccessful.

4,5. UTI in men rarely causes discharge, only painful or urgent urination. This is an STD. There is a lot of variation in pain or urinary discomfort with urethritis. Lack of pain is more typical of NGU than gonorrhea, but there are plenty of exceptions.

6. Gonorrhea treatment is ceftriaxone (by injection) plus either azithromycin or doxycycline by mouth. If initial evaluation does not show gonorrhea, the ceftriaxone normally is omitted. However some clinics and physicians treat all such patients for both while awaiting conclusive test results. Usually non-infectious within a couple days, but for a safety margin, plan on no sex with either partner (or anyone else) for at least a week.

7. Yes. NGU is an STD.

I hope these comments are helpful. I'll be interested in hearing more after you have seen a doctor and treatment has been started. Let me know if anything isn't clear.

HHH, MD
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18 months ago
Went to a urgent care today. The PA took my word for the discharge I was having. Did a urinalysis dipstick test and everything came back negative. He was not familiar with NGU.

Based on the discharge I was given a 250mg shot of Rocephin and prescribed 1 gram of Azithromycin. 

My girlfriend went to a different walk in clinic. Her urine was sent off to the lab. They observed no abnormal discharge and she still has not observed any symptoms like I have however she told the Dr that her boyfriend has yellow discharge.

She was prescribed 2 grams of Azithromycin and 7 days of Doxycycline. 

#1. Is the treatment I received adequate for Gono/Chlym/NGU?  Also, should I retest? If so, how far out?

#2. I noticed she did not get the CDC recommended treatment for Gono. Would her treatment likely iradicate Gono/Chlym/NGU? Would you reccomend she also get tested again? 

I will update when I receive results.

Thanks again
18 months ago
Also to add... Late last night, after submitting my initial question, I paid more attention to my discharge. There is almost a constant drip of clear fluid. Ever so often there will be drop of light yellow mucus but it varies. For instance there are only about 3 light yellow spots in my underwear from an entire night. This was all before antibiotics as well. 

Im a little perplexed that my dipstick test showed no issues...
Blood-Negative
Bili-Neg.
Urobili-Neg.
Ketone-Neg.
Protein-Neg.
Nitrite-Neg.
Glucose-Neg.
Ph-6.5
Sp Gr. 1.015
Leuk -Neg

#4. Does the clarification of discharge along with the dipstick test change your opinion on anything? I feel like since I have discharge there should have been some indication on the dipnstick test. It has been well over 4 hours after my last void when I gave my urine sample. 

TIA

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Wow! You had an embarrassingly inadequate evaluation. "Take the word" about dischrage without examination??? Holy cow! And the notion of a PA who never heard of NGU is embarrassing. Hard to know what was meant by "everything came back negative:  I hope testing was done for gonorrhea and chlamydia, but those results take at least a couple of days. At least your treatment was appropriate. Your GF was not treated correctly:  she should have had the same treatment you did, and it is quite atypical to give both azithromycin and doxycycline.

What about your other partner? She also needs examination, testing, and treatment.

1. As noted above, your treatment was good for gonorrhea, chlamydia, and NGU.

2. Correct, as noted aboe:  she should have had ceftriaxone. However, the combination of azithro and doxy she received probably would cure gonorrhea if she has it. But if any of you has a positive gonorrhea test, she will require a repeat test in a couple of weeks to assure she was cured.

Your description is less typical for urethritis than previously described. But that's still the best bet. Your urinalysis was normal, but that's usually the case in gonorrhea, chlamydia, and NGU. Standard urinalysis of the kind you had is pretty much useless in this situation and its normality dosn't help sort things out one way or the other. (However, it does exclude a non-STD urinary tract infection.)

I'll be interested to know everyone's STD test results. I won't have anything more to say until those results are available.
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18 months ago
Tests for Chlamydia and Gonorrhea came back negative for myself. A urine culture was also done and came back "no growth". 

 I was dissapointed with the knowledge of the first provider so the next day (day 4 of my last exposure, 2 days after beginning of discharge) I went to another walk in. I was seen by another PA who examined me and noted some clear discharge who agreed it was abnormal but stated it "wasnt bad". PA also suspected Gono or Chlamydia. He suggested I do a another test but stated the antibiotics less than 24 hours before could affect the results. I asked for tests for Trich and M Genitalium. He said no tests exist for Trich and it does not infect men. The PA had also never heard of a test for M. Genitalium. I received those results today (from 2nd visit) for Gono/Chlym...they were also negative. 

The Dt. Office called my gf and requested a new sample from her....no idea why. She has not retested. 

#1. Can I rule out Gono/Chlym? I only ask because my first test was 2.5 days out (with discharge), and the 2nd 3.5 days out from the last exposure. Should I test again?

#2. Correction on my g/f's treatment. She talked the doctor out of a shot. She received Suprax 400mg, 2g Azythromycin, and Doxy (Doxy upset her stomach and she stopped) I have read some of your posts saying this treatment is highly reliable for Gonorreah. Is this still true? (Post was 2 years old)

#3. Does the urine growth culture showing "no growth" rule out anything?

#4. My anxiety and research has now lead me to Trich and M. Genitalium. Assuming my treatment (roecphin/azithromycin) would not cure either, should I attempt to seek out tests/treatment? Or wait to see if my symptoms clear. 

#5. Im on day 3 after antibiotics, clear discharge is still the same. I have not seen yellow discharge since the day i was tested.  When should I expect to improve if this is NGU, and at what point should this be ruled out as being something else if I havent improved. 

#6. Both people I have slept with say they have had "clean" pap smears recently. Is Trich/M Genitalium commonly tested for with pap smears? Ive read that Trich can stay dormant for years. 

#7. Im assuming I should refrain from sex until discharge stops?

#8. Can Trich and M Genitalium be found in a monogomous relationship of 2 years? 

#9. In your opinion, what should my next step be and what could the cause of my discharge be? 

Thanks in advance. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
1) It takes a few days of antibiotic treatment to make the tests negative. If testing was done at your initial evaluation, it will be accurate; and even if not done, the second should be accurate as well. So you'll know in a few days whether  or notyou had either or both of these STDs.

2) Some STD experts consider cefixime (Suprax) to be equally effective as the cetriaxone shot. Your gf was adequately treated -- in fact over-treated (only 1 g azithromycin needed).

3) A negative urine culture means there was no non-STD urinary tract infection, but there was no reason to suspect UTI anyway. It says nothing about STDs.

4) I told you previously there is no need to test for trich, unless/until your symptoms don't clear; or if either partner is diagnosed with trichomnonas. Forget it for now. M genitalium testing indeed is not yet widespread. Even when available, testing is not recommended unless/until NGU is found and persists or recurrs after doxy or azithromycin. Also to be ignored for now. 

5) It usually takes 5-10 days for symptoms to clear entirely. Return to one of the providers (probably the second) if you still have discahrge after about 10 days.

6) No, pap smear testing doesn't usually include trich or M gen testing, unless physical exam shows evidence of infection and gon/chl testing are negative. If your partners have no complaints (vaginal discharge, abnormal odor, etc) and their exams were normal, all is well and no other testing normally is recommnded. These things could change in the future, with wider availability of testing, esp. for M gen. But that's the current state of knowledge and recommendations.

7) Yes, no sex until at least 7 days and symptoms are entirely gone. You shouldn't even be tempted at this point. Of course you don't want to exposure (or re-expose) any partners if symptoms suggest a problem that hasn't been cured. 

8) Probably yes, but rarely.

9) No further comments -- see above. Don't freak out about either M gen or trichomonas. Both are mostly harmless in men, and probably in most women. They may cause symptoms, but few if any complications or serious health problems.

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