Hi,

Update and resume of my case :

Day 1 : 18 weeks ago,  I received an handjob by a brazilian transsexual sex worker. She first masturbaded  her dick for 2 minutes, touching his glans several times during it, and then, just after that, she gave me a handjob for approximatively 5 minutes with the same hand. When I ejaculated, she pressed my dick twice all long from the base of my shaft to the meatus. Just after that, I cleaned my glans with a wet wipe with the hand I used to masturbated her.

Day 14 : I started to feel some burning on the skin of my scrotum and the body of my penis, the skin was reddish and very sensitive. I saw no ulceration. This will last for 3 weeks, and was more painfull when the skin was in contact of something (hand or clothes).

Day 21: i took 2g of azithromycin fearing STD (Note that i take 250mg of azithromycin daily for lungs problems for years now, with each month  alternatively 2g/day of ciprofloxacin or 3g/day of amoxicilin )

Day 28 :, PCR on urine for Chlam and gono : negative. (Started to use Kamillosan cream for the skin of my scrotum and the burning sensation went away after one week.)

Day 35 , went to another clinic and had another PCR on urine for Chlam and gono : still negative, blood test for syphilis negative too

Day 42, had another blood test for syphilis : negative

No more symptoms for 2 weeks.

Day 56, noticed some white things on my glans, like peeling skin, mainly visible on erection. And the skin of the glans become very sensitive when touched, even painfull.

Day 66 : noticed some discharge from my urethra. Little clear drop, like seminal fluid, with consistance of white of egg that can stretch over between fingers. I saw this discharge 2 or 3 times a week, no related to sexual arousal. Thought was related to fungal infection.

Day 73: saw a doctor who gave me daktakort. Used it one week on my glans and the skin was better. But still discharges, 2 or three times a week.

Day 84 : noticed on right side, a groin lymph node that seemed a little bigger than 1 month ago. Had also sometimes groin pain, left  or right, from,2 or 3 weeks, when I were standing for too long or when Ieaning forward to tie my shoelaces. 

Day 86: polakiurria all the afternoon and evening, with felling of urine still present in urethra after peeing. No pain. This feeling will last more or less 10 days, felt also like tenderness in the urethra, no itching or pain, and no more pollakiuria.

Day 87: PCR for trichomonas and mycoplasma genitalium : negative.

Day 91 : urine analysis and culture, another PCR for Chlamydia and gono :all was negative. Still discharges,  2 or 3 times a week. 

Day 101 : no discharge for one week (maybe there was some but I saw nothing). Saw an urologist for prostate analysis and urine output. All was ok. He said the groin lymph node was ok too for him. He said no need to urethral swab because PCR on urine was gold standard, and with all my negative results, I probably had nothing. 

Day 116 (10th of july): the discharges came back after two weeks without noticing it. From this day noticed it 2 or 3 times on the week, but the groin lymph node come back to normal.

Day 118 : saw another urologist. He said that discharges like that was not normal (I showed him a picture of the mark generated by the drop in my underwear). He said that I surely have an urethtritis. Probably an STD because he said fungal infection don’t generate discharge.  But with all the antibiotics I take daily, the PCR and analysis wont surely never show something. He gave me a prescription to go for another tests (urine analysis and urethral swab) . I Have to go to the laboratory fast and only when I’ll see the discharge. (All the PCR and analysis done before were never the days I saw the discharge)

Day 123 (today) : see another discharge yesterday evening, but too late to go testing. The feeling of irritation of urethra has also come back from one week now. It comes especially after urinate or defecation, never during. Moreover, when I stay sitting on a chair several hours, I’ m starting to have pelvic pain. 

After these for 4 months, I’m somewhat desperate. I still have symptoms but no clue of what is the cause.

Seen the discharge and urethritis, it seems that I get a STD from my encounter 4 month ago (no other sexual exposure after this one). But all analysis and PCR were, until today, negative. 

1°) it is true that my daily intake of antibiotics influences the results of these analysis ? Can’t I trust all the PCR done ? Do u still think it is not possible that this mutual masturbation has caused it ?

2°) So could it still be a gonhorea or chlamydia resistant to azithromycin ? Should I go to hospital (emergency) to take ceftriaxone and doxycicline ? seen the guidelines to urethritis and discharge is this treatment .

3°) Or could it be another STD ? Or something else (but What ) ?

4°) Could this urethritis become worse if no treatment  ? and could analysis never show the pathogenic agent because I cant stop my daily intake of antibiotics? what are the risks ? seen this problem lasts for 4 month now?

 3 weeks after i took 2g of azithromycin fearing STD (Note that i take 250mg of azithromycin daily for lungs problems for years now, with each month  alternatively 2g/day of ciprofloxacin or 3g/day of amoxicilin )

PCR on urine for clhamydia and gonohrea at day 28, 35 and 91 after exposure, all negative, ECBU  negative at day 91.

PCR for trichomonas and mycoplasma genitalium : negative at day 87

BUT uretral discharges 2 or 3 times a week, for 2 months now (from day 66 after exposure).  Little clear drop, like seminal fluid, with consistance of white of egg that can stretch over between fingers. no related to sexual arousal.

saw another urologist last week. He said that discharges like that was not normal (I showed him a picture of the mark generated by the drop in my underwear). He said that I surely have an urethtritis. Probably an STD because he said fungal infection don’t generate discharge.  But with all the antibiotics I take daily, the PCR and analysis wont surely never show something.

1.  Although antibiotics can change the manifestations of STI’s, if the discharge you have experienced were due to an STI, your tests would be positive.

2.  Increasing numbers of gonorrhea strains are resistant to azithromycin, however your negative tests prove that you do not have gonorrhea or chlamydia.  I am not the least concerned that your symptoms are due to gonorrhea or chlamydia.

3.  As noted above, I find it most unlikely that the discharge you have experienced is due to any STI. A certain amount of intermittent urethral moisture is normal in most men and can vary substantially in quantity. Alternatively prostatitis or the syndrome called the chronic pelvic pain syndrome (CPPS) which is well described in Wikipedia far more likely.

4.  Please see my comments above. I find it unlikely that the symptoms you’re experiencing are due to any STI. I also doubt that were you to stop the antibiotics you were currently taking, or to not take further antibiotics would change the course of disease. 

I hope the information I have provided is helpful to you. I think you need to talk in greater detail with your urologist. EWH

So it can't be a prostatitis. 

1.  Your careful description of symptoms and findings describe suggests to me that you are looking at your genitals and genital secretions more closely that is the norm. That is not surprising and is a frequent occurrence in persons who have reservations about recent sexual encounters. When this occurs persons tend to see variations in their genitals, the appearance of their genitals cameramen genital secretion switch they might not have noticed in the past. These are typically of no consequence.  Having a residual drop of ejaculate present following initial ejaculation is not necessarily uncommon and I see no reason for testing.

2.  Three main infection which is detected by testing of ejaculate is prostatitis or lingering testicular infection. Typically these are not STI’s.

3.  Currently available PCR technology is the most sensitive means of detecting STI’s in history. Even in the absence of discharge your results are almost certainly reliable.

4.  I have not had the opportunity to examine you or your prostate. I presume that your urologist did a prostate massage and then cultured and microscopically evaluated the material which was expressed. The gold standard for such testing is called a three glass test in which urine is collected before and after prosthetic massage. I trust that your Dr. Did this.  . That is what I would do if I were seeing you.

EWH 

I had a swab on my discharge last friday (july 22th). Results are : 

b) cocci gram + positif, Staphylococcus Haemolyticus, but resistant to betalactam, macrolides, quinoles et tetracyclines but sensitive to trimethoprim sulfamethoxazole.

So my urologist prescribed me Bactrim Forte 800/160 mg (sulfamethoxazole/trimethoprim) 2 times a day for 15 days, for the staphylococcus haemolyticus. i have to start treatment today (July 28th).

He prescribed me nothing for mycoplasma hominis. Because of the resistance, he didnt know what to prescribe. He told me to go see an infectiologist for an appropriatte treatment. 

He told me to have protected sex with my wife as long as i see the discharge. 

1) Is the high number of mycoplamsma hominis found a sign of infection ? what treatment can i try seen that it is multi(pan ?) drug resistant? 

2) Can this lead to more complicated infection if not treated? Do i need to go to the urologist?

3)Could i have been contamined by this mycoplasma and staphylococus from the virtually no risk event that  I described above ? It seems that it's the cause. 

5) Are they both STI ?

1.  See my comment above. Mycoplasma Hominis in the urogenital tract does not require treatment.  Because mycoplasma Hominis is present normally in the urogenital tract, when it is treated it typically returns after a period of time.

2.  I have suggested that you see a urologist in the past. Not necessarily for the bacteria that are present but for a more thorough evaluation.

3.  No

4.  I do not have a good explanation for your periodic urethral discharge other than the topics already discussed.

5.  As stated above, neither of the organisms present is an STI. They are normally present in the urogenital tract are likely present both in your urogenital tract and your wife’s urogenital tract and not causing problems.

6.  The problem of folliculitis is an independent problem and I’m related to your concerns about your urethral discharge

7.  It’s already stated several times, both of these organisms are normally present in the urogenital tract. It is likely that you and your wife share the same bacteria but it is unlikely that they are causing any harm.  Personally, I would not have advised you to use condoms if your only sex partner is your wife.

 Sorry I don’t have more to offer.  As you know, we provide up to three responses to each clients questions. This is my third response. This this thread will be close shortly without further responses. I hope that you will be able to move forward. EWH