Possible infection

[radagast76]

Hi,

One week ago I had an encounter with a woman. She performed unprotected oral sex on me and we then engaged in vaginal intercourse. During the intercourse the condom broke, but I withdraw from her immediately and changed condom. Being very paranoid about STDs I took 1g of Azitromax the day after the encounter. However I ended up with a very bad stomach directly after taking the medication so I am a bit afraid it might have less efficient?

5 days after the encounter I noticed some small white spots (probably discharge) in my boxers. At 6 days after the encounter (yesterday) I noticed a large spot from discharges (1cm diameter). I havn't experienced any pain while urinating or otherwise - I might be urinating a bit more often but this could also be anexity. Figuring that the first round of medication might not have helped a took an additional 1.5g of Azitromax yesterday evening.

Today I am still experiencing some very small discharges. Because of me current location I have no easy access to testing - can you give me any advice? Does the symptoms above indicate Chlamydia or Gonnorhea or what could be a probable casue?

I am very thankful for any advice or input on this!

Thanks!

[H. Hunter Handsfield, M.D.]

Infectous discharge usually is most prominent in the morning after an overnight sleep, not during the day.  Beyond that, this information doesn't help me judge the cause.

I'll be happy to comment further if you want to report the outcome after you have been professionally evaluated -- but won't have anything more to say until then.

[radagast76]

Thanks for your answer! If this continue I will try to see a physician. However from what you write I guess it shouldn't be gonorrhea. The discharge is more of a "clear" type - not the white/yellowish thing that I suspect is usual when having gonorrhea. Also I did not have any discharge at all during the night - it seems to happen only at daytime - maybe when moving/being physically active?

[H. Hunter Handsfield, M.D.]

This is very unlikely to be gonorrhea, the discharge of which is typically yellow (pus) and which almost always causes pain on urination.  "Sticky" fluid, especially if clear, may be from the prostate gland -- or may not be abnormal at all.

It is time to stop trying to find answers on line.  You need to be professionally evaluated.  See your personal physician; or if not confident in his or her STD expertise, an STD or Planned Parenthood clinic.  It is best to be seen when you haven't urinated for several hours, which can wash abnormal discharge out of the urethra, making diagnosis more difficult.

[radagast76]

Just an update. When getting home today a could actually se some fluid coming from the urethral opening. It was kind of sticky - much like pre-ejaculate fluid or semen - but I havn't had any erection during the day for sure.

Should I presume resistant form of gonorrhea? Is common to have this without any pain or can I assume that things will get worse in the coming days?

Thanks again!

R

[H. Hunter Handsfield, M.D.]

I don't know how to interpret the "white stains" you describe.  If it's white, flaky material when it dries, my guess it it's just a bit of normal pre-ejaculate fluid, or leftover semen (if you had an erection or ejaculated during the night, for example).

Urethral discharge isn't mysterious.  If you don't see cloudy mucus or pus in the urethral opening, then you can assume you have no abnormal discharge.

[radagast76]

Thanks a lot for the answer.

No - I haven't seen any visible "dripping" from the penis - but I can't remember having _white_ stains in my shorts before - is it possible to have this from urine?

Is there anything in particular (to look for) that can be of interest when identifying abnormal urethral discharge?

Thanks

R

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

The large majority of sexual contacts like yours (even entirely unprotected, with no condom at all) do not result in any STD.  Of course condoms should be routine for casual or non-monogamous sexual encounters involving vaginal or anal intercourse, but a brief unprotected exposure like yours is unlikely to result in any infection, even if your partner had an active STD.

While I would not have recommended azithromycin without prior testing, it probably did no harm and provided good protection against gonorrhea, chlamydia, NGU, and syphilis.  Azithromycin commonly causes the gastrointestinal symptoms you experienced.  As long as there is no vomiting within 30 minutes of taking the drug, it is fully effective.

If you have not experienced visible dripping of discharge from your penis, my guess is the "discharge" in your shorts is urine, or stains from minor genital moisture.  That is, your own anxiety explanation seems most likely.  However, if you are convinced that you really have an abnormal urethral discharge, it would mean that you are infected with something resistant to azithromycin, such as a resistant form of gonorrhea or nongonococcal urethritis (NGU).  So if you indeed have something, additional doses of azithromycin are not likely to make any differencce -- so you should not have taken the additional dose and for sure don't need any more of it.

So my advice is to avoid azithromycin or any other antibiotics and wait a couple of weeks.  If you don't have obvious symptoms, you can consider yourself home free.  But if in doubt, you'll need to see a doctor or clinic in person for professional evaluation.

Best wishes--  HHH, MD