[Question #8580] Chlamydia gonorrhea

42 months ago

Day 1 - unprotected sex with person A

Day 3 - unprotected sex with wife

Day 5 - unprotected sex with Person A again

Day 6 - person A says her ex told her he had yellow/white discharge from penis and painful urination, spotty underwear in mornings and is getting treated for it (didn’t mention if it was gonorrhea or chlamydia)

Day 6 - took shower in hotel with new soap, was in a rush so left without drying all the soap. When arriving home I went to pee , and saw something in my urethra (fluid) that looks like bubbles, I thought it could be leftover soap since I didn’t dry down there when I left in a rush.

Day 7 - person A mentions she has lower back pain and abdominal pain that feels like burning, at this point I felt sure she had pid or whatever her ex had

Day 9 - took 2 grams of Azithromycin just Incase

Day 17 - wife took 1 gram of azithromycin and I took another gram of Azithromycin again after abstaining from sex for a week

Day 18 - wife took another 0.5g of Azithromycin

Day 18 - 32 hours after me and wife took Azithromycin, we resumed unprotected sex

Day 40 - wife mentions lower back pain

Day 45 - wife mentions frequent urination - full bladder not just drops. We are both young.

I have not had sex with anyone other than my wife since day 6. I have been self examining myself vigorously all the time. I do not see any discharge from my penis in the morning or throughout the day. But if I am driving for over 3-4 hours or if I’m sweating after a workout and immediately check my penis, I see fluid inside, not sure if it’s urine or precum or something more serious. When I see the fluid, I milk my penis multiple times to try and get it out and examine it , but by the time the fluid reaches the top of the urethra there is no fluid to examine and can’t seem to make it come out because of how little the amount is. Basically, I can only barely see the fluid when I look down my urethra but extremely difficult to get it out. I beleive I’ve noticed this before this whole scenario , usually after the gym. I am circumcised. I am unsure what this is but I have been self examining and trying to get the fluid out to no avail 9 out of 10 times. I have been self examining since day 6 , every morning and before I pee. I have no discomfort in urethra or burning or anything. Just this random fluid that may have been there before but I’ve been noticing it now that I’m checking. What could this fluid be? Also, what are the chances me or my wife have chlamydia or gonorrhea after I took 3 grams total and she took 1.5 grams? It is extremely taboo and hard to test for this in the country I’m in.

H. Hunter Handsfield, MD

42 months ago

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

It it likely Person A has an STD -- certainly that's the only likely explanation of her other partner's symptoms. That person's reported "yellow/white" discharge and painful urination are most consistent with gonorrhea, although chlamydia and nongonoccal urethritis also are possible. Person A's own s symptoms indeed are consistent with PID, which could be gonorrhea or chlamydia. So you can assume you were exposed. However, that you had no symptoms yourself as long as 9 days later is pretty good evidence you weren't infected, and therefore that your wife also was not infected. This is especially true if Person A turns out to test positive for gonorrhea, which almost always causes obvious symptoms (like partner A's other partner) within 5 days.

I'm sorry to hear you and your wife took azithromycin without being medically evaluated and tested first. However, I understand that in some settings it isn't practical or may be nearly impossible. (What country are you in?) As already noted, probably you weren't infected -- but now you'll probably never know. Your azithromycin dose would have eradicated gonorrhea if you had an asymptomatic infection, and for sure would have cured chlamydia. Your wife's two 1 gram doses were somewhat less reliable against gonorrhea, but good against chlamydia. It would have been better for you and your wife both to hold off on antibiotics and get tested for gonorrhea and chlamydia (regardless of person A's own test results). In any case, by now person A's own test results should be available. If she had either gonorrhea or chlamydia, both you and your wife should be tested for them once 3 weeks have passed since you took your last doses of azithromycin.

Your symptoms are against any STD. Small amounts of urethral moisture are normal, especially several hours without urinating, and having had the same issue previously, there is no reason to suppose an infection is responsible this time. However, I urge you to stop looking so hard: repeated vigorous massaging and squeezing the penis can cause enough irritation to increase the amount of urethral fluid, which would only confuse things. If you have any infection at all, it will be obvious without looking so hard. And I'm not worried about your wife's lower back pain, which rarely is a symptom of any STI.

So at this point, all I recommend is that you and your wife both be tested for gonorrhea and chlamydia to be certain you don't have it now (i.e. either never infected, or possibly infected but cured by the azithromycin). Also, given the likelihood person A had gonorrhea or chlamydia, I would advise both you and your wife to be tested for HIV once 6 weeks have passed since both your sex with person A and your sex with your wife 3 days after that. (Or you can skip HIV testing if person A was tested for it with a negative result). For completeness, a syphilis blood test would also be a good idea. Azithromycin usually is effective against syphilis and would have aborted an incubating infection -- but some syphilis strains are resistant to it.

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

HHH, MD

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42 months ago

Thank you for your answer. Few questions:

1) I took 2 grams Azithromycin , didn’t have sex for 7 days and on the 7th day I took an additional 1 gram. My wife took 1 gram on day 7 as well and 0.5g on day 8. 30 hours from her first dose, we had unprotected sex. Could she have reinfected me?

2) it is now day 50 since my last encounter with person A. Assuming worst case that the fluid I have is bad discharge, is it normal for it to stay for 50 days? If not, is it possible that I was reinfected by wife which would explain this continuous fluid? Why does it only happen when I sweat or when I drive for several hours?

3) if it was a discharge, wouldn’t it drip out of penis tip in mornings by itself without needing me to continuously milk it out?

4) is my wife’s 1.5g dose enough to cure her from anything I might have transmitted to her?

5) is it a good sign I’m not having a burning when urinating? Can you have discharge with zero burning and zero irritation? Can discharge be the ONLY symptom?

6) person A had 2 ex’s briefly before me, both had extreme pain when urinating and yellow/white discharge including stains. My only thing was the bubble fluid that one time after I showered and didn’t dry the soap. Is this a good sign I probably didn’t get anything?

7) before being with me, she said she took some antibiotics when she went to the doctor. I don’t think it was azithro or anything else because if she took those I’m assuming she wouldn’t have had pid symptoms later.

8) overall, do you think I’m safe and can continue my life normally?

H. Hunter Handsfield, MD

42 months ago

1) No, very unlikely.

2) Irrelevant -- extremely unlikely. I can't answer the questions about timing, association with driving, etc. But no infection behaves this way. Believe it!

3) Yes. As I said in my original reply, "If you have any infection at all, it will be obvious without looking so hard."

4) 1.5 g azithromycin has not been studied against gonorrhea. 2 g is recommended. I think 1.5 g would work, and there was no chance you had gonorrhea, so it's not an issue anyway.

5) This, amidst all the other information discussed, contributes to the evidence you had no infection.

6) Answered in my reply above. These symptoms strongly suggest gonorrhea, and I gave you the reasons you probably didn't catch it. You would have had similar symptoms.

7) Not knowing what antibiotic this was, I cannot comment on what effect it might have had.

8) Yes. This should be obvious from all that I said above.

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42 months ago

Thank you my last question is are cramps a symptom of anything std related in woman?

42 months ago

I’d like to add that these cramps are not during period but also she been taking antibiotics at the same time and then cramps started

H. Hunter Handsfield, MD

42 months ago

Menstrual or low abdominal cramping would rarely if ever be the only symptom of any STD. Neither would the combination of this with low back pain. These problems are entirely unrelated to the sexual exposure you are so concerned about. However, these sound like symptoms that should be medically evaluated; if your wife is concerned her symptoms, she should see her doctor. But there are many causes of such problems in women other than STDs. Also please note all the other reasons to be sure you have no STD you could have transmitted to her.

That completes the two follow-up exchanges included with each question and so ends this thread. Do your best to accept the reasoned, science-based reassurance I have tried to convey. I hope it has helped you do that. Best wishes.

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