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STDs (Expert Forum)
Possible causes of discharge
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Possible causes of discharge
by worriedsickhelp, Feb 17, 2007 12:00AM
I had negative blood test results for all stds (herpes, hiv, etc). Before that test, I hadn't had sex in almost a year. Then, I had unprotected sex (4 weeks ago). 2 days later, I got an itch around the head that lasted a day. 2 weeks after that, I noticed a milky discharge at urethral tip as well as tiny painless abrasion which happened (I presumed) because of forceful masturbation. Some tingling accompanied urination, but it was not painful. I immediately went to a local clinic and doctor told me the spot was definitely not a sore or ulcer and was simply a tiny abrasion. She also swabbed some discharge and told me I probably had chlamydia. She assured me I don't have herpes and put me on doxycycline for 7 days. The swab test results came back negative for chlamydia and gonorrea. This confused me, because I also started getting the milky discharge again two days ago. I also have been getting a few tiny painless rashes on my foreskin (and a couple on glans) in the past 1.5 weeks. I went to see a dermatologist, who told me the rashes were candida (he also scraped and examined the yeast under the microscope). He told me I definitely do not have herpes and that the couple of spots i had were definitely not sores, ulcers, blisters or anything remotely indicating herpes. When I asked him about the discharge, he said it was of bacterial origin. My questions: (1) Does my case sound like a herpes infection to you? (2) could the discharge be related to my yeast? (5) what, besides herpes, could this discharge be? Thank you so much for your help.
Doctor's Answer
by H. Hunter Handsfield, M.D., Feb 17, 2007 12:00AM
, Feb 17, 2007 12:00AM
First, it is clear you had urethritis, nongonococcal (NGU). About 30% of NGU is due to chlamydia, so the negative test is no surprise. However, NGU is an STD and your partner needs to be informed, examined, and treated. She might have nothing apparently wrong; the bacteria that cause nonchlamydial NGU in men often cause no disease at all in women. But to be safe, she should be treated.
Herpes is one cause of nonchlamydial NGU, but only a few percent of cases. Further, herpetic urethritis typically is very painful; I have had occasional patients who said it was the worst pain they ever experienced. In general, dermatologists probably are the most expert of all providers in recognizing herpes lesions; the fact that a dermatologist sees no sign of herpes is further strong reassurance against that possbility.
Candida is an entirely separate issue, and part of the normal organisms on everybody's skin. Taking antibiotics sometimes triggers overgrowth, resulting in a symptomatic infection. So that occurrence probably is just a natural consequence of taking doxycycline for NGU.
I think those remarks answer all three of your questions. Best wishes--
HHH, MD
Herpes is one cause of nonchlamydial NGU, but only a few percent of cases. Further, herpetic urethritis typically is very painful; I have had occasional patients who said it was the worst pain they ever experienced. In general, dermatologists probably are the most expert of all providers in recognizing herpes lesions; the fact that a dermatologist sees no sign of herpes is further strong reassurance against that possbility.
Candida is an entirely separate issue, and part of the normal organisms on everybody's skin. Taking antibiotics sometimes triggers overgrowth, resulting in a symptomatic infection. So that occurrence probably is just a natural consequence of taking doxycycline for NGU.
I think those remarks answer all three of your questions. Best wishes--
HHH, MD
Member Comments (4)
by worriedsickhelp, Feb 17, 2007 12:00AM
To: H. Hunter Handsfield, M.D.
Thank you for your response. I still have the discharge, though, which makes me wonder what could be causing it, seeing as doxycycline didn't get rid of it. Also, peeing on a urine dipstick produces a color indicating high leukocyte count.
by H. Hunter Handsfield, M.D., Feb 17, 2007 12:00AM
, Feb 17, 2007 12:00AM
You clearly have persistent or recurrent NGU, which occurs at least 20% of the time following treatment of nonchlamydial NGU. Some cases are due to trichomonas, and standard guidelines (e.g., CDC) are that the second round of treatment should include metronidazole (Flagyl) or tinidazole (Tindamax). (I strongly prefer tinidazole, which probably is more effective in men.) Or you might be infected with Mycoplasma genitalium, a recently discovered cause of NGU that doesn't respond well to doxycycline. Having failed doxy, your next treatment (per CDC) should be the combination of azithromycin (Zithromax) and metro or tinidazole. That will probably take care of things.
by worriedsickhelp, Feb 17, 2007 12:00AM
To: H. Hunter Handsfield, M.D.
Thank you so much for all your help!
