[Question #8095] Penile discharge

48 months ago

Hi. 23 days ago I had an encounter with a stripper with unprotected oral on me, mutual masturbation, frottage & french kissing over 3 hours. She did try to get me to penetrate her (unprotected) but I pulled back & refused. I don't think there was any penetration but, if there was, it would have only been the tip for a fraction of a second. 17 days after this encounter (6 days ago), I had a puss-like discharge from my penis. I went to the doctor that morning and was tested for a UTI (WBC present), chlamydia & gonorrhea and was given Azithromycin (4 tabs), ceftriaxone injection & 7 days of cipro. I read that a urine sample for chlamydia & gonorrhea should be a dirty catch less than 50ml but the doctor had me do a clean catch and I gave more than 50ml. Given my concern about the sample, within 24 hrs, I had another chlamydia & gonorrhea test using a dirty sample as well as HIV1 RNA, HCV antibody, HSV1&2, Syphilis RPR & HBsAg. All came back negative with the UTI culture of less than 10k colony forming units of bacteria. However, I have the following questions:

1. Could the 1st test have been a false negative given the >50ml clean catch urine sample?

2. Would the 2nd test within 24 hours of treatment still return positive if I was really infected?

3. Should I tell my regular partner anything? We haven't had intercourse since this but did have mutual masturbation 6-7 days after the encounter. She's currently on antibiotics for bacterial vaginosis which was diagnosed 5 days ago.

Thanks

H. Hunter Handsfield, MD

48 months ago

Welcome to the forum. Thanks for your question.

This is an uncertain and somewhat confusing situation. Urethral discharge is almost always an STD, and the timing is consistent with the exposure described. On the other hand, you had an exceedingly low risk exposure. I guess we should assume that vaginal penetration probably did occur, however briefly: that's the only aspect of this event that could have caused the discharge.

Whatever the exact mechanism, your test results indicate nongonococcal urethritis (NGU), not due to chlamydia -- which in fact is the most common of all STDs resulting in urethral infection. You can be sure you had neither chlamydia or gonorrhea ; the details of specimen collection make no difference, regardless of official advice about the amount of urine collected, clean versus "dirty" catch, etc. These make no difference in test performance. In any case, you were treated correctly with ceftriaxone and azithromycin; if your urethral discharge cleared up and has not recurred, you're home free.

Those comments pretty well cover your specific questions, but to assure no misunderstanding:

1.2) All your test results are reliable. You didn't have chlamydia or gonorrhea. As noted above, neither do about half of all people with urethral discharge acquired sexually.

3) Without intercourse, you could not have infected your regular partner with anything. You needn't mention any of this to her.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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48 months ago

Thank you Dr Handsfield. I have a some follow-up questions - apologies for the number of these:

1. To clarify your comment - all test results are reliable - does that mean, even in the unlikely event that the first test failed, the second test within 24 hours, even after treatment, would still have picked up chlamydia or gonorrhea if I was actually infected?

2. If there was no penetration, could the non-chlamydia NGU be caused by the unprotected oral as a result of bacteria in the mouth and what is the typical treatment for NGU not due to chlamydia?

3. Can non-chlamydia NGUs cause long term problems like chlamydia and gonorrhea if left unresolved and can it be transferred from a male to female?

4. Do you see any need for retesting for HIV,. Syphilis etc. given these were tested for very early after exposure (rather than waiting 6 weeks)?

5. Should I be tested for Trich if symptoms continue?

Thank you for your help.

H. Hunter Handsfield, MD

48 months ago

1. I meant that one test by itself is conclusive, and that the second was excessive and unnecessary.

2. Thanks for reminding me of the oral sex exposure. Somehow I missed that when I replied initially. I apologize. The answer is yes, this almost is surely what is going on. Oral sex clearly can transmit NGU, probably due to normal oral bacteria. As I said above, you were correctly treated with ceftriaxone (in case gonorrhea was the cause) and azithromycin, one of two standard treatments for NGU. As I also said, that your symptoms cleared up is evidence the azithromycin was effective. (The other standard treatment is doxycycline for 7 days.)

3. There are no known complications or long term health problems of any kind known to result from nonchlamydial NGU. There also is no documentation of any health problems in affected men's sex partners. There is a potential exception for NGU caused by Mycoplasma genitalium -- but that rarely is present in the oral cavity and therefore not known to be transmitted by oral sex.

4. It is standard practice for all persons with any STD to also have conclusive testing for HIV and syphilis -- not because they necessarily are common, but in both cases they can be dangerous and even deadly, so it makes sense to be certain even if the risk is extremely low. I would put your exposure in that category. Because of the standard practice, I would advise you to have repeat syphilis and HIV blood tests 6+ weeks after the event. But you definintely can expect both tests to be negative.

5. Trichomonas is not carried in the oral cavity and not transmitted by oral sex (or by hand-genital contact). It's not an issue and you do not need testing.

Apologies again for missing the oral sex component of your initial question. I hope things are now even more clear. Let me know if not.

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48 months ago

Thanks again and no need to apologize - I really appreciate your help. Just to close this question out, I have three short clarifications from your last response:

1. You state "(in case gonorrhea was the cause)" - we can be almost 100% certain is was not because of the test results, correct?

2. With respect to your comment about Mycoplasma genitalium. Is it like most other STDs that it can only be transmitted through penetration? Is there any risk of this from frottage or transmission via hand to genital contact or mutual masturbation where semen on the hand could touch the vagina (in case of potential M to F transmission)?

3. Appreciate that the second test was excessive and unnecessary, but out of curiosity, assuming someone was infected with chlamydia or gonorrhea, would that person still test positive for chlamydia or gonorrhea if tested again 24 hours after treatment?

Thank you.

H. Hunter Handsfield, MD

48 months ago

1. Correct: the gonorrhea tests are highly reliable and you can be sure your negative test result was valid.

2. M. genitalium probably is transmitted only by penetration, and very rarely if ever by hand-genital contact, figurer, etc.

3. After successful treatment, it takes a few days for gonorrhea and up to 3 weeks for chlamydia tests to become negative. When test of cure is done, it should be delayed at least a week for gonorrhea and 3 weeks for chlamydia.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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