[Question #923] STI Risk

52 months ago
About 12 weeks ago I had unprotected sex with a girl. I am 25 years old not sure about the woman but close to my age. Met her on vacation in the US.  3 weeks after I felt a discomfort in my penis tip and urethra.  She also gave me oral sex. Other symptoms were redness around urethra hole. Felt like increased urination but not sure cuz I never paid attention to it. Never saw discharge or stains in my pants or pain peeing just irritated urethra really. Went to the doc and they said saw small amount in white blood cells were found in my urine.  Test for Gonarea and Clamydia were negative. Gave me 7 day ciprofloxacin. After 5 days of that went back to doc before I finished the med and urine was clean they sent me on my way as the irritation left. Anyway irritation returned by not really a strong irritation and has just been nagging me since and I haven't been back to doc. I did have sex w 1 girl I know on the first day of me taking the ciprofloxacin. Prob not related by 8 weeks after the sex I was taking a poo and squeezed Very hard. A urine texture came out of the tip of my penis that was cloudy white. I hadn't ejaculated in a few weeks before this so I figured it was just semen. Happened again during a rough poo the next day, but hasn't happened since at all. Do you think I had an STI? Should I tell that girl I had sex with during the time I was taking medication? Could it just have been a UTI because I didn't urinate or clean the area for probably 6 hours after sex? Should further tests be done other than the Gonarea and Clamydia ones? Thx. 
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

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

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52 months ago
Thx for your answer, a few other things from your response that I have a question on.  Because I was treated with Ciprofloxacin, and the white blood cells have not been detected since, does that mean the infection has cleared? The doc I saw said whatever it was was cleared after my urine was clean after the 5 days of Ciprofloxacin.  Good to hear about the discharge being normal. As for the retreat meant, how would you recommend being treated? As with clean urine I doubt my doc will prescribe me anything. As for the other girl I had sex with shes pregnant but she doesn't have any symptoms. Is NGU dangerous? I read if Clamydia and Gonnorea are ruled out that NGU is not dangerous at all and just a nuisance. Is there a test for NGU?  
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

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

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52 months ago
Thx Dr Hook. I will talk to my doc about getting treated for NGU with the recommended antibiotic and am glad to hear that the risk for myself or pregnant sexual partner is very low for anything serious since Clamydia has been ruled out. I will recommend she be treated as well with Azithromycin. Lastly, probably an odd question but something I have heard...does urinating for men or women directly after sex reduce the chances of her contracting an STI, a bacterial infection specifically?  And from my other post I didn't see an answer for, is there a specific test for NGU? Or do you have to test for the different specific bacteria that cause NGU? I am just curious as to how to approach my doc. Thx for all the help u were awesome. 
52 months ago
Sorry doc. No I'm only allowed 3 messages but left one thing out. Got a call today from the girl who is pregnant, and her urine came back clean with no white blood cells as she said she has a urine test every time she goes to the doc for pregnancy. Is that relevant at all in this situation? That's my final message. Thx again. 
Edward W. Hook M.D.
Edward W. Hook M.D.
52 months ago

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

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