[Question #923] STI Risk
103 months ago
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Edward W. Hook M.D.
103 months ago
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Welcome to the Forum. I'll be glad to provide some information and try to help.
The symptoms you describe following unprotected sex with a new partner 12 weeks ago, as well as the presence of white blood cells in your urine are suggestive of a problem called nongonococcal urethritis or NGU, the most common penile STI syndrome in men. This problem can be caused by a variety of different STI bacteria and in some cases no pathogen can be found. Irrespective of test results treatment of this problem in men is recommended using either a single 1 gram dose of azithromycin or a week of doxycycline, 100 mg taken by mouth twice daily. Ciprofloxacin is NOT recommended to treat this problem and experience says that while it may improve symptoms, they the treatment is not entirely curative. I would suggest re-treatment with one of these medications might be a good idea.
Several other comments:
1. It would be best if your more recent partner was treated with azithromycin or doxycycline as well, just to be safe. While not all exposures lead to infection, many do. This should be done whether or not she has symptoms as such infections in women are often asymptomatic.
2. In men under 40, UTIs are very, very rare and what is often called "UTIs" often turn out to be NGU or other STIs.
3. The discharge you noted during defecation should not worry you if that is the only time you noted it. Typically when a man strains to move his bowels or is a bit constipated, bowel movement can push a little bit of normal prostatic fluid out of the tip of the penis. this is not an infection.
4. If you are treated with azithromycin or doxycycline, I would then urge you to go forward without further concern and not to focus too much on looking for additional symptoms. It has been our experience that, when people look "too hard" they tend to notice normal sensations which they would otherwise overlook.
I hope these comments are helpful. EWH
103 months ago
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Edward W. Hook M.D.
103 months ago
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Personally, even though the white blood cells have cured, I would want to have received recommended therapy. This is what I meant by the term "retreatment" and would suggest either azithromycin or doxycycline as described above if you were my patient (you are not).
As for your other partner, considering her pregnancy it would be appropriate for he to be treated as well. Doxycycline is not recommended for pregnant women but azithromycin is OK.
As you have read, there are few data to suggest that NGU which is negative for chlamydia is dangerous. Despite that, conventional wisdom and practice is to treat it. EWH
103 months ago
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103 months ago
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Edward W. Hook M.D.
103 months ago
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Feel free to share this correspondence with your doctor if you wish.
Your question about urination is a good one. As you might imagine, this has not been formally studied. There are no good data about this. Urinating certainly could not hurt but whether or not it helps is unknown.
The only "tests" for NGU are a stain performed on secretions taken from the penis with a swab (no one's idea of a good time). At this juncture I see little benefit from further testing per se.
As for your partner, either men or women can be infected without having white blood cells present. To be on the safe side, I would still recommend treatment.
As you point out, this will complete this exchange. I hope we've been helpful. Take care. EWH