[Question #7388] Yellowish discharge
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57 months ago
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Hey there ... I just entered a new relationship and tested negative for STDs before entering into it. My new partner assured me she had as well (said she still had sex a few times with one person after being tested) I never saw any paperwork or anything and don’t know her THAT well.. anyway. One week after we started having unprotected sex ((yesterday) I woke up and had a yellowish discharge from the tip of my penis.. I went to an urgent care and they urine tested me .. but the doctor wasn’t sure it was an std because I have no pain on urination, and the discharge only happened once .. I thought it was left over semen.. throughout the night I noticed very mild clearing discharge , and this morning noticed again yellow discharge at the tip of my penis. I have no burning on urination, but feel very slight discomfort in urethra while not urinating. I’m awaiting test results and plan to back to get preemptive treatment today.. but what does this sound like to you? Thanks.
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H. Hunter Handsfield, MD
57 months ago
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Welcome back to the forum. I'm glad you're here: after a number of questions in which it was pretty clear you had no STD, this time you do.
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Your symptoms are typical of mild urethritis -- and for all practical purposes, urethritis always means STD, especially when starting soon after a new sexual relationship. Your first doctor was wrong to dismiss STD because urination wasn't painful. The mild nature (no pain and small amount of discharge) suggests nongonococcal urethrits (NGU), although gonorrhea also is possible. I'm glad you're getting proper care. If the doctor(s) examining you were able to observe abnormal discharge, treatment should be been started at that time, without waiting for test results.
The tests in progress undoubtedly are for gonorrhea and chlamydia -- at least those are by far the main concerns here. However, you (and your doctors) need to remember that chlamydia accounts for only about one third of NGU cases; most cases test negative for everything. That doesn't mean you have no STD: you do. Nonchlamydial NGU is an STD. So no matter what the test results, you should be treated with ceftriaxone 250 mg by injection, and either azithromycin (1 gram single dose) or doxycycline (100 mg twice daily for a week). Your partner also needs to be examined and treated, and she should receive the same treatment -- without waiting for her own test results.
Final comment: For many years, azithromycin and doxycycline were considered to be equally effective, and azithro was usually the first choice because of the convenience of single dose treatment. However, it is now known that azithro fails to cure 5% of chlamydia (up to 15-20% if the rectum happens to be infected), whereas doxycycline never fails. Doxy also is now preferred for nonchlamydial NGU. Bring this up when you return for your test results and treatment. And assure that your partner is tested and treated in the same manner. (If your doctor or hers seem uncertain about any of htis, consider printing out or otherwise showing them this discussion.)
I'd like to hear the outcome of your tests and treatment -- looking forward to a follow-up message when you have that information. In the meantime, let me know if anything isn't clear.
HHH, MD
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H. Hunter Handsfield, MD
57 months ago
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Clarification: If your gonorrhea test is negative, ceftriaxone won't be necessary -- just doxycycline (preferred) or azithromycin for chlamydia or nonchlamydial NGU. Same for your partner, if indeed she tested negative recently for gonorrhea.
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Also, your new partner gets no blame for this. She can rely on her recent negative test results. As noted above, nonchlamydial NGU usually has no proved cause -- and happily, it usually isn't harmful to women. She should be treated to be safe, and to assure you don't get reinfected when you resume sex. But this isn't her fault in any way. Don't let this event interfere with your growing relationship.
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57 months ago
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Hey doctor thanks for the reply. I went back to the doctor before reading this and requested treatment .. as I don’t want to wait around for a week for results and possibly let this get worse. I was given the injection and prescribed Zithromax and Flagyl .. both single doses. I took the Zithromax , but I’ll wait on your suggestion for the other one (used to treat trich from my understanding) .. I didn’t request the doxy.. should I go back or see if the Zithromax improves symptoms first ? 5% seems like a low chance of failure .. but I understand it’s a big deal on a large scale clinical level.. my doctor assured me that it wasn’t , but I have a phobia of herpes .. yellow discharge as the only symptom doesn’t indicate that at all does it? I don’t blame the girl either , I’m ocd about stds so I happen to be somewhat knowledgeable about them.. I understand these things can happen
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57 months ago
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Oh 2 more questions .. about how long until I can expect the discharge in the mornings to clear up (I just took the 1g Zithromax) and .. if my tests come back negative and it is NSU how can I know that the medicine worked and I’m no longer infectious if I can’t retest? Can I assume if my symptoms clear up that the infection has as well.. thanks again for everything you guys do!
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57 months ago
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I went ahead and just took the flagyl as prescribed about 90 minutes after the z pack
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57 months ago
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I also received oral from someone different about 11-12 days ago one time (before I started dating this girl) , idk if these symptoms sound like anything transmitted orally? Or if it’s more likely from the week of frequent unprotected sex
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H. Hunter Handsfield, MD
57 months ago
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The metronidazole (Flagyl) probably was unnecessary and is not recommended in this situation -- but it won't do any harm. You're correct that azithromycin is highly reliable; a 5-10% risk of treatment failure isn't all that high. I would not recommend adding doxycycline at this point. If your symptoms don't clear up after 7-10 days, or if they improve but reccur in the next 3-4 weeks, doxycycline would be recommended at that time.
You can expect to see symptoms start to improve i 2-3 days, but as just implied might take 7-10 days to clear entirely. Plan on no sex with either partner (or anyone else) for at least a couple of weeks.
NGU can be acquired orally. So can gonorrhea. Given that history, it probably will not be possible to ever know which parter was the source of your infection. But most likely you acquired it by vaginal sex with the more recent partner. She still needs to be treated as suggested above. However, do follow up on your test results. If it turns out to be gonorrhea -- which probably it won't -- then both partners will need treatment.
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57 months ago
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Okay thanks! Nothing here sounds like herpes does it? I have a pretty intense phobia , doc said no need to be retested with swab, as these symptoms aren’t suggestive of HSV (I just tested neg a month ago) would u agree? Hoping to see the discharge improve over the next day or two .. I took the Zithromax 9 hours ago. But again I ask , how will I know if the infection has cleared for sure if my tests are negative? Can I assume that clearance of symptoms means I won’t infect anyone? These are my last questions , thanks so much!
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H. Hunter Handsfield, MD
57 months ago
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Absolutely not herpes. (Your previous several threads suggest you're obsessed a bit with herpes. But for sure no worreis now.
Assuming your tests for gonorrhea and chlamydia are negative, your own intuiation is correct: you'll know you were cured and cannot infect anyone when your discharge goes away and doesn't recur over the next 2-3 weeks.
The other thing to know is that nonchlamydial NGU is a harmless condition. There are no known complications of any kind and no long term consequences either for affected men or their partners. Some cases probably are no more than the urethral's adjustment to the natural bacteria in a partner's genital tract or mouth. Don't let this bug you once your symptoms are gone. In my 45 years in the STD business, I've never seen anyone with an important health consequence of this trivial problem.
That concludes this thread. I hope the discussion has been helpful.
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