[Question #8513] Negative for Sti

43 months ago

Hi,

I’ve had a discharge problem for about 2 years now. Been tested multiple times for gonorrhoea and chlymydia, and even trich. Negative for all.

I recently restarted sexual activity, and am now on prep. I had insertive anal unprotected with another male, I’ve also received oral before this event.

I felt like my discharge got worse after this, and it has where I am experiencing it more times a day. It is usually watery, and clear or milky. No smell. I also feel itchiness in my urethra.

6 days after the anal, I got an NAAT urine test for chlymydia and gonorrhoea, it is negative. I was completely expecting a positive result due to the increase in discharge. Was this enough time for the infection to show on tests?

I’ve been to a specialist last year who said it could be normal discharge and didn’t do anything for it.

I’m wondering whether this could be someone bacterial? Perhaps I can tell them to test for something else? Should I insist on antibiotics?

Just looking to get another opinion on this, thank you

H. Hunter Handsfield, MD

43 months ago

Welcome back to the forum. Thanks for your continued confidence in our services.

I'm surprised by your sexual history. Your previous two questions spoke of great care in sexual safety, with no penetration, even with condoms. And now you're having unprotected anal and oral sex??

About your longstanding discharge problem: no STI causes such prolonged discharge. A non-infectious problem is likely. This forum doesn't deal with non-STI genital symptoms, and I cannot speculate further. If the problem continues and seems not be due to an STI (on top of this preceding problem), keep working with your specialist doctor (a urologist, perhaps?).

However, unlike previously, now you are at high risk for STIs. Any new, increased or otherwise altered discharge should be evaluated for STI: conceivably you acquired nongonococcal urethritis (NGU) on top of your previous non-STI discharge. Increased amount of discharge plus "itchiness" in the urethra certainly are consistent with sexually acquired urethritis. In addition to increased amount, has your discharge increased in frequency or appearance? (Cloudy if previously clear? Yellow or pus-like?) You've done the right thing by getting tested -- and yes, 6 days is plenty for reliable gonorrhea and chlamydia testing. However, half of all sexually acquired urethritis is caused by things other than gonorrhea and chlamydia -- so although those results are reassuring, they do not exclude the possibility of nongonococcal urethritis (NGU) due to other infections acquired by unprotected anal or oral sex.

For those reasons, whenever your discharge increases in amount or frequency, or if it changes appearance (e.g. cloudy if previously clear, yellow color, etc) it is important that you not rely only on self-testing by a lab: you need in-person evaluation by a knowledgeable health professional. If you have not yet done that with your recently increased discharge, please do so now. The specialist you saw last year probably would be appropriate. Whether or not you should receive antibiotic treatment should depend on such an evaluation. That said, with unprotected sex recently, it may be reasonable for you to be treated with doxycycline -- to be discussed with your doctor(s). (I don't suggest you "insist" on antibiotics, but these definitely are things to discuss with your doctor(s).)

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

HHH, MD

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43 months ago

Thank you,

I should have mentioned the unprotected sex was with someone who is also on PrEP, I know condoms are recommended, so will definitely continue to use those from now on. I also started prep after the previous encounters I wrote about on here, and this has helped me immensely with my HIV fears.

I’d consider the unprotected anal a very rare thing, I’d likely not engage in again, but I felt I was safer with prep? And oral receiving (me being given oral) I assumed a very low risk for hiv. Especially being on Truvada.

Before the discharge only occurred when I held in urine for a period of time, for example in the mornings, or if I haven’t urinated all day at work, and was not that much in quantity, clear/milky.

Now, it has increased, where it will come back around an hour or 2 after I urinate. It can be clear at times, or white milky. And yes I’d say it’s more in quantity as well

I’ve read about M. genetilium, is this something relevant?

H. Hunter Handsfield, MD

43 months ago

PrEP makes you safer in regard to HIV, with virtually 100% protection, but of course has no benefit against other STIs.

Your increased discharge sounds significant; you probably have NGU. If urethritis is confirmed by professional evaluation, including elevated WBC in your urethra, doxycycline is the recommended treatment.

M. genitalium is a potential cause of NGU, but under 15% of cases, and frankly not very important in men having sex with men, in whom there have been no reported complications or serious outcomes of any kind. The main concern is in heterosexual couples because of possible serious outcomes for genital infection in women. Testing or treatment for M gen is recommended only if initial treatment (e.g. with doxycycline) fails. So no worries at this time.

Your ongoing discharge sounds like it's probably minor leaking of prostate fluid, which probably is consistent with your specialist's statement about "normal discharge".

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