[Question #7113] Ongoing Symptoms

60 months ago

Dear Drs

Although this follows the same timeline as my previous question (#7030) which Dr HHH kindly advised me on, it is separate and concerns ongoing discomfort. I will not repeat the entire timeline as stated in that question, however I have additional information below:

06/18 Went to Urologist:

- Ultrasound Kidneys/Bladder (Normal)

- PCR Urine Test for Gon and Chlam + Urinalysis

- Received 1.5g Aithro single dose and 500mg Levofloxacin daily 7 days

06/20 Results: RBC 3-5, WBC 4-6. Epithelial NIL, Bacteria NIL, Culture Sterile

06/23 PCR Results: Chlam detected (Gon not detected)

Restarted 1g Azithro + 500mg Azithro daily for 7 days

07/01 Visited Urologist with continued discomfort (after urination – felt irritation at tip of penis and like I was leaking when I was not – no discharge). Did Swab + Chlam Urine Antigen Test (Negative)

07/02 Urinalysis (RBC 0-1, WBC 8-10, Epithelial Squamous, Bacteria NIL, Culture Sterile)

AND Urine PCR for Gon, Chlam, Urea U., Urea Parvum, M Gen, M Hom, Trich (symptoms persisting - all negative).

Started Doxy 100mg x 2 daily for 10 days and Suprax 400mg for 6 days;

07/05 PSA blood test (total and free) – normal

07/09 Urinalysis (RBC 0-1, WBC 1-3, Epithelial NIL, Bacteria NIL)

07/14 Post-Doxy Urinalysis (RBC 1-2, WBC 1-2, Epithelial 2-3, Bacteria NIL)

Still mild ongoing discomfort. Urologist suspects prostatitis and that I need to be patient as it takes time to go. Gave me Pepon Plus supplement for 1 month.

07/25 – Urinalysis (RBC 1-2, WBC 4-6, Epithelial 1-2, Bacteria NIL).

What caused the WBC to increase from 1-2 to 4-6 again? Urologist told me not to worry about that.

I don’t know what to do its driving me nuts; symptoms come and go, esp when sitting rather than standing. No sexual contact at all since the start.

Thanks

Edward W. Hook M.D.

60 months ago

Welcome back to the Forum. I’m sorry that your difficulties continue. On this occasion I happened to pick up your question. I have reviewed your earlier interactions with both Dr. Handsfield and me and agree with Dr. Handsfield’s most recent recommendations. I also agree with your urologist’s assessments. Clearly this is not an STI and your chlamydia infection (as well as your wife’s infection IF she was infected) would cured cured at this time.

Like your urologist, I suspect that your symptoms reflect prostatitis which can be a challenging, time consuming problem to deal with. Your prostatitis is more likely coincidental than related to your chlamydia infection. Prostatitis can take weeks to resolve. The urinalysis WBC is an imprecise measure of inflammation and low levels of WBCs in the urine can fluctuate depending on the interval since last urination and any number of other variables. The fact that you had 1-2 WBCs earlier and 4-6 now is not worrisome or unexpected.

At this time the best way to move forward is to work with your urologist, do your best to be patient, and not overthink this.

I hope this perspective is helpful. Stick with your urologist and do your best to be patient. EWH

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60 months ago

Thank you Dr. Hook for your response and advice. I am happy to say that my symptoms have completely gone now and I'm back to normal. Do I need any further testing which I have not yet done?

My wife’s PCR tests all came back negative thankfully with the exception of Ureaplasma. I have never had this before so I don’t know where it came from (my recent test was negative as well). From what I have read on ASHA and from my searches, Ureaplasma is not a classical STI and is normally found in the genital tract and can be shared among sexual partners. Her OBGYN will prescribe her Doxy 100mg twice a day for 3 days (since she previously took 1g Azithro and Suprax), he said that should take care of it. Can this cause complications for women? Also, could I have ever caught this from receipt of unprotected oral in the past which were my only exposures and given it to her, or is this passed through vaginal intercourse only? My wife has never been tested for Ureaplasma for as long as I've known her.

I have what is hopefully a final question – we had done ICSI procedure (egg extraction under general anaesthesia) – I gave my semen sample on the same day which then went through 2 rounds of washing and processing etc, then using the swim up technique, the healthiest single sperm was taken and injected into the egg to form the embryo. This embryo was not yet placed back into my wife, but I am worried about having given the sperm whilst positive for Chlam. This took place the next day after I took my first 1.5g Azithro and 500mg Levofloxacin. Would the drugs have worked quickly to tackle my problem?

I spoke to my Urologist and the OBGYN about this and both said, had it been IUI then the semen sample would need to be discarded. However, ICSI is safe and the processing that the semen went through, and the individual sperm would not be harmful as although Chlam is found in semen, it would not affect the individually selected and injected sperm, especially after the processing that it went through.

This may not be your area and I apologize if not, but just wanted to know if you had any thoughts on this based on your knowledge and experience in the STI field. Medical journals I have read online seem to support this.

Thank you again Dr for your valuable guidance.

Edward W. Hook M.D.

60 months ago

I’m pleased to hear that your symptoms have resolved. Given all of the therapy you have received, as well as your test results, I am confident your infection is cured. I was not aware that you and your wife were in the midst of IVF around the time your chlamydial infection was detected on June 23 and am not able to comment on the nuances related to infection in and around the time of IVF. I do agree that Ureaplasma is normally found in the genital tracts of both men and women and that there is typically no need for treating this organism when it is detected in normal, healthy persons, including women who are seeking pregnancy. It’s significance in your wife’s circumstance is beyond my expertise and on that matter I defer to her doctors.

In addition, I can tell you that chlamydia does not directly infect sperm cells and that if you had taken azithromycin or levofloxacin the day before you would be most unlikely to be infectious. Like your other doctors, while as I mentioned above, it is not my area of expertise, I suspect the processing that took place after you provided your ejaculate would further make infection most unlikely.

I hope these further comments are helpful. EWH

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60 months ago

Thank you Dr Hook.

We have put the IVF process on hold indefinitely so that's not a concern for now, just want to make sure we are both fine.

I have not had any intercourse since day 1, but retested this week again anyway for peace of mind in case any of the meds I had taken suppressed positive results and caused false negatives on my last panel. Thankfully these results were also negative for everything including Ureaplasma.

My wife has also just completed 7 days of Doxy for the Ureaplasma.

I wanted to ask, should she be retested for Ureaplasma or anything else? Can 400mg Suprax she took affect NAAT test results for STIs? I read on this forum about false negatives caused by certain medication so that got me concerned.

As for Ureaplasma, I also read on this forum (and on some online medical journals) that, since it is normally found in healthy adults, it is still likely to return after treatment is completed for those colonised, and that even testing for this from the start (or receiving any treatment) is not recommended in the absence of symptoms. Now, the fact that my tests are negative, how much of a risk am I contracting this or developing any issues should we resume unprotected intercourse or should this not be a concern for me? Have any studies shown that this can be contracted from receipt of oral sex?

Just not sure where to go from here. I have never had a positive test for Ureaplasma and I have done the 7-STI NAAT panel many times with and without symptoms. I'm still a bit anxious about this as its all new to me.

I understand this will be my last follow-up as per forum rules, and just want to thank you again for your valuable guidance and support, as always. All the very best.

Edward W. Hook M.D.

60 months ago

I understand your desire to be as safe as possible as you move forward with your IVF. I hope that the answers I provide in this final follow-up response will be helpful to you.

I would not have suggested testing for ureaplasma to start with. Thus I see no reason for re-peat testing unless this is something that your fertility specialist feels is needed.

Any effects that Suprax might have on test results would be entirely gone as long as testing is done more than 3-4 days after the medication is taken.

there are no data to inform an answer regarding whether or not you are likely to contract ureaplasma. I would not suggest testing or worrying about it. I think you are overthinking this issue.

Hope this helps. Take care. EWH

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