Thanks as well for your careful and detailed medical history. As I started reading, my thought was that urethritis is unlikely, and wondering -- as you did -- about minor trauma or perhaps chemical irritation. (Spermicides and soap -- commonly used as lubrication in masturbation -- can cause acutely painful urination.) However, onset 3 days later is more consistent with urethritis. In addition, it sounds like you may well be having abnormal discharge, even if only apparent after erection. Finally, the continuing discomfort plus split urine stream are consistent with urethritis.

Although true that gonorrhea usually causes obvious discharge in large amount -- typically overt pus dripping from the penis -- there are plenty of exceptions. So although chlamydia or NGU are more likely, gonorrhea is definitely in play. And insertive anal sex with male partners is just about the highest risk for all these of all sexual practices.

So you should see a knowledgeable health care provider ASAP. If you are familiar with and/or have access to a physician or clinic with particulare expreience in STD and/or care for men who have sex with men, that would be ideal. Depending on where you are, a local or state health department STD clinic would also be an excellent choice. Evaluation should include testing for gonorrhea and chlamydia; careful exam for discharge; and a urethral swab for microscopic exam. And probably treatment. And be prepared to discuss the situation with both partners.

I hope this information is helpful. I look forward to hearing more after you've been evaluated and perhaps treated. 

HHH, MD

So, based on your interpretation, you would say it’s very highly likely that I have an STI of some kind? Would you say it’s all all likely that I do NOT have one, or should I brace myself for an inevitable diagnosis?

This may be outside the purview of what you have expertise in, but do you think the symptoms could be at all indicative of prostatitis instead?  Or is that likely to be “wishful thinking” on my part?

Some bu tnot all your symptoms could be due to prostatitis, but probably not the split urine stream:  that implies a problen in the urethra and not further upstream. If you have had prostatitis previously and the symptoms are similar, that would raise the chance. But even then, you clearly need the STI evaluation ASAP, both for your own health and well being and that of both partners. And by the way, your evaluation should include HIV and syphilis testing:  although too soon for either to be positive from your recent encounters, they are always included in routine STI evaluation -- and also will need to be repeated ~6 weeks after the second exposure.

Threads normally include just two follow-up exchanges after the initial question. So I suggest we hold off on further discussion until you've been medically evaluated.

I checked in with the woman who I had sex with, but I didn’t disclose my concern about the STD possibility yet. It turns out, she’s currently taking a round of antibiotics for a respiratory infection/stomach bug. She thinks it’s viral but her doctor prescribed 875 mg of amoxicillin with 125 mg of Clavu(...?) Potassium - 20 tablets to be taken twice daily. 

If I have a bacterial STD which I passed to her, would her round of antibiotics either:

1) Treat the presence of gonorrhea/chlamydia/other NGU, or

2) Make it HARDER to treat the STD?

I know that antibiotic resistant strains of STDs are a concern and I’m worried now that her current prescription could affect later treatment if needed. 

Also, since I’m using my last reply, I have a final question. I have noticed in the last 24-48 hours that my symptoms have largely subsided, and they’ve been wildly different from day to day for a few weeks. Is it normal for STD symptoms to subside on their own? I find conflicting info online about whether STD symptoms “come and go.”

Most infections in humans are eventually cleared by the immune system. (In the pre-antibiotic era, 90% of people with bacterial pneumonia survived). Any of the infections you're likely to have could be resolving spontaneously. Resolution this quickly (~4 weeks) may slightly favor gonorrhea.

The sooner you are profesionally evaluated, the better. I'll leave the thread open for one more cycle -- which I hope will be your report of exam and testing.

I do have a few extra concerns. 

1) I thought I would receive the antibiotic as a series of pills (the doctor who examined me said it would be four 250mg pills). Instead, I got a powder. I was worried it would be a horrible flavor, so I drank it in a glass of chocolate milk instead of water. Now I’m wondering if that was safe to do? Would have have reduced the antibiotic’s effectiveness?

2) My female partner and I were planning to meet and possibly have intercourse this coming weekend. But if she doesn’t take her azithromycin till Monday or Tuesday, will that be too soon to resume sex safely? Or is that a big risk for reinfection? (She will also still be on Augmentin till Saturday, if that makes a difference.)

3) Do we need to have any follow up testing some weeks or months later? How likely is it that the antibiotic won’t successfully clear the infection and we still end up being infected after the medicine leaves our system?

1)  The standard dose is 1 gram, single dose -- either powder or tablets. The powder form of azithro is standard in many clinics and equally effective as the tablets. Mixing it with milk (chlocolate or plain) shouldn't reduce effectivenss. However,

I think Im technically out of questions, but since this is still listed as active... when you say to wait a week after treatment, if she receives doxycycline, do we need to wait a week *after* she completes the antibiotics or just however many days she’s on the medicine?

Indeed we are well beyond the usual two follow-up exchanges, so that will have to conclude this thread. I hope it has been helpful.