[Question #7026] Gonorrhea Treatment failure?

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62 months ago
Hello Dr! 
After having unprotected vaginal sex I tested positive for gonorrhea on the 5th, everything else was negative (I was experiencing all typical symptoms), I was treated with ceftriaxone injection and azithromycin. After 4 days the penile discharge gradually became less and went away on the fourth day, So thats 10 days of being all clear of discharge. On the 19th i noticed a small amount of discharge in the morning(all ways in the morning) and this has been going on for 3 days now. It is much less than what I was originally experiencing at the beginning but it is still worrying me.I have not had sex at all since i was originally diagnosed on the 5th.   Any advice please? 
Thank you.
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Edward W. Hook M.D.
62 months ago

Welcome to our forum and thanks for your question.  I'll be glad to comment. In thinking about your situation I have a few additional questions as well as what I hope will be helpful information.  Questions 1rst. 

1.  When you say "everything else was negative", could you tell me what tests were performed?

2.  Also, can you tell me if your recurrent discharge has changed at all since you noted its onset.

Now my comments:

1.  The ceftriaxone/azithromycin treatment you received is the recommended treatment for gonorrhea and can be expected to cure >99% of gonococcal urethritis. 

2.  While I suspect that your gonorrhea was cured, occasionally a second pathogen is present which can cause either continued but milder symptoms or recurrent symptoms after an initial response.  The organisms which cause post-gonococcal urethritis include chlamydia (although the azithromycin would be expected to cure over 97% of chlamydia), trichomonas, or a recently described bacterium called Mycoplasma genitalium.  In addition small proportion of men have post-gonococcal urethritis without an obvious pathogen being demonstrable.  This is the reason I asked about what other tests were performed.

3.  I trust that your partner was informed that you acquired gonorrhea and has been evaluated.  On occasion in such situations, something (like trichomonas in particular) is seen in the female partner but not obvious in the male until after initial treatment.  Have you spoke with her?

4.  Finally, on occasion, after unexpectedly finding that a person has an STI, they become hyper-aware, looking for signs and symptoms of continued infection.  In these situations some folks note otherwise normal secretions and sensations which they would otherwise overlook.  Your situation does not sound like this but I thought I'd mention this for completeness sake. 

I hope these comments and information is helpful.  Rather than trying to guess what is going on here, it would probably be best to get re-tested.  I'll likely have further comments after you respond to the questions I asked.  EWH

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62 months ago
Yes sir, Thank you for responding!
To answer your questions
1. Trich,chlymidia,Gonorrehea,HIV and Herpes were tested.
2.It is the same color pretty much(light yellow) but its less drippy and much less in quantity almost as much as a Qtip sized if not a little less, I want to say to the consistency is similar to whip cream. 
also Dr. I should add I did drink alcohol the day following but when i did some research it said that they don't react with alcohol but i just feel that it should be mentioned. 
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62 months ago
Yes sir, I informed the person I slept with and let them know of my results. 
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Edward W. Hook M.D.
62 months ago

Thanks for the additional information.  The fact that you were tested for trichomonas is particularly helpful.  At this time I would be concerned that your post-gonococcal urethritis may be due to Mycoplasma genitalium.  This organism can be tested for using an initial void urine specimen.  My suggestion would be to get tested for this organism (not other types of mycoplasma) and to consider seeking therapy with moxifloxacin, the preferred therapy for MG. 

Having drunk alcohol either at the time of your exposure or subsequently would have no effect on treatment effectiveness.

Hope this is helpful.  EWH

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