[Question #9964] Penile Discharge but negative Gonorrhea and Chlamydia tests…

27 months ago

Hello doctors … I had an issue a few weeks ago and didn’t really get a good answer from the urgent care clinic that I went to. Anyway I had unprotected oral and vaginal sex with a friend of mine and about a week later I began getting a discharge from my penis. No pain urinating or anything else. Just discharge. I went to the urgent care and they urine tested me for chlamydia and gonorrhea. The doctor told me that 90% of the time the discharge is either from chlamydia or gonorrhea. They went ahead and gave me the shot and the 1 time dose pills and sent me on my way. They called with my results which were surprisingly negative for both chlamydia and gonorrhea and that they just found a small infection in my urine. The discharge went completely away after a few days after I was treated with the antibiotics. I guess what I’m wanting to figure out is what was it that I possibly had ? Was it just a bacterial infection of some sort or what ? The negative tests just have me confused. I also contacted my friend and she assured me that she had nothing… Any help would be greatly appreciated. Let me know if anything is not clear I’m just confused

Thank you

H. Hunter Handsfield, MD

27 months ago

Welcome to the forum. Thank you for your confidence in our services.

There's really no mystery here -- except for the mystery why the urgent care clinic, or the provider you saw, has such poor understanding of urethral discharge and its causes.

It is wrong that 90% of people with urethral discharge have either gonorrhea or chlamydia. That total is 40- 50%. You had nongonoccal urethritis, or NGU. The known causes are chlamydia, around 30% of all NGU; Mycoplasma genitalium, ~15% of all cases; and a few others (like trichomonas, herpes, adenovirus, and others) together ~5% of cases. If you're following the math, that means that in 50% of NGU, the cause is unknown (and with current technologies, unknowable). However, it's still an STD and needs to be managed as such. In other words, you had chlamydia negative NGU.

That said, you were treated appropriately. The injection was ceftriaxone 500 mg, in case of gonorrhea; and azithromycin 1.0 gram, which covers chlamydia and most NGU with unknown cause. That your symptoms cleared up and have not returned means you were cured; no further treatment or testing is necessary.

Your partner "friend" a week before your symptoms is the source of your infection and she should be treated as well; you'll need to discuss this with her. Her treatment should be either azithromycin as you received, or doxycycline 100 mg twice daily for a week, and preferably she should be examined. (Presumably you have not had sex with her again since then, right? Also no other partners before you were treated?)

So all is well, despite the mistaken information from urgent care.

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

HHH, MD

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27 months ago

Thank you so much doc for the reply in which it has eased my mind and answered the questions that I had. I figured it was non chlamydia NGU because of reading other peoples post similar to mine, but guess hearing it from you personally made me feel better. To your questions.. No I have not had sex with her again and there was no new partners prior to my treatment. Also my symptoms are still gone and never came back. Thank you so much once again

H. Hunter Handsfield, MD

27 months ago

Thanks for the follow-up. I'm glad to hear the problem is resolved. ---

26 months ago

Doc, for my last question…. I went ahead and also took an Oraquick in home HIV test at a little over 12 weeks ( 85 days ) post exposure just to make sure I was HIV negative. The test result was negative. Is this test conclusive at 85 days ? I seen where 12 weeks is conclusive with this test before but just wanted to make sure with you .. Thanks in advance for all of your help

26 months ago

This Oraquick that I took was the oral fluids test .. Just wanted to clarify. Thanks

H. Hunter Handsfield, MD

26 months ago

The Oraquick oral fluids test misses a small proportion of HIV infections (probably 2-3%) no matter how long after the last exposure. The exposure described was almost zero risk for HIV, regardless of getting NGU; that plus the negative test result can be considered conclusive. If I were in your situation, I wouldn't feel a need and would be completely confident I didn't have HIV. But you want a test result that by itself if 100%, you'll need a third or fourth generation HIV blood test.

That concludes this thread. Best wishes and stay safe.

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