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Query about urethritis - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Vaginal and Uterus Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2568 Questions
User :   Hey there
User :   Hi
User :   Well, I have an STD question.
User :   Embarrassed that I have to even ask, but I'm sure you get that often. haha
User :   yes, please proceed,I am here to help
User :   So, I am a 24 year old male and have been sexually active with other men for a couple of years now.
User :   ok,
User :   Basically, I noticed a discharge from my penis yesterday that was abnormal
User :   Ok,
User :   I've done some research and think I think what it is
User :   And just went to get a full battery of tests today
User :   But am impatient to find the results
User :   Can you explain me the appearance and nature of the discharge
User :   White underwear, yellowish discharge that drys quite hard
User :   I have been sexually active with the same person 3 times over the past 10 weeks
User :   Don't know if dates are relevant, but any time I am slightly promiscuous I keep track of it.
User :   ok,
User :   do you have burning sensation during urination ?
User :   Moreso than normal, but it's mild
User :   ok, did you experience fever in recent days ?
User :   I would like to tell myself that it's another type of infection but I've never had a penile discharge like that
User :   I haven't taken my temperature and don't feel like I have a fever
User :   But can take it now if you'd like?
User :   do you think its like pus ?
User :   Well, I rubbed some between my fingers and it dried pretty quickly
User :   i would suggest to keep a record of the temperature , one reading may not be useful
User :   Okay
User :   yes, it could be pus then
User :   Great
User :   i\\ may i know what tests have you ordered ?
User :   Let me verify
User :   I'm worried that I may have jumped the gun
User :   Could it be too soon for certain infections/diseases to show up?
User :   That will give you the specifics on the tests
User :   i consider Gonococcal urethritis a chance
User :   the urine test will be able to help
User :   I was reading about that one but hadn't ever heard of it before
User :   i also will suggest you to get a urine culture and sensitivity test for the same but better results
User :   Should I call my regular doctor for that?
User :   yes,
User :   HAH
User :   nevermind
User :   i was looking at another virus
User :   sorry... not medically inclined at all
User :   The symptoms for gonorrhea were what I was leaning to
User :   It said that it could be spread orally as well?
User :   yes,
User :   but commonly affecting the genitilia
User :   Would the same symptoms that I'm having show if transmitted orally?
User :   yes,
User :   invasive involvement of the pelvis may result from oral spread
User :   What is the likelihood or oral transmission?
User :   10%
User :   I'm sorry to be so ignorant, but could you dumb that last statement down for me?
User :   yes,
User :   when in 100 exposures around 10 exposures can lead to an infection through oral route
User :   haha no no, i understand percents
User :   What do you mean by invasive involvement?
User :   oh , sorry
User :   since the bacteria enters the blood , the infection can spread to all organs and manifest more in the pelvic structures like bladder , epididimytis , uterus in females
User :   Thanks
User :   Next question: User :   You are welcome
User :   Given my symptoms, are there other possible infections?
User :   yes , it could be a E Coli ( bacteria ) urethritis , which is not a STD , spread by water or touch
User :   the urine culture will differentiate this
User :   So basically the last time we had intercourse was 4 nights ago.
User :   Ok
User :   Today was late enough to differentiate?
User :   (I'm assuming the chances of E Coli are pretty minimal? )
User :   Its difficult to predict the type of bacteria, that is causing the discharge.
User :   *type of organism.
User :   I understand... part of the reason I don't want to sound any alarms until I'm sure.
User :   From the description, it appears like a bacterial one.
User :   Generally, how long does it take for both of your suggestions to manifest?
User :   You will need a swab and culture test of the discharge.
User :   This will provide conclusive evidence on the type of bacteria.
User :   A bacterial organisms usually have an incubation period of few days to a week.
User :   Symptoms develop within a week or two following an exposure.
User :   So even if the screening comes back negative, I should still have a culture?
User :   Okay... given gonorrhea, is there any chance my partner is a carrier and doesn't show symptoms?
User :   since you report of symptoms and burning sensation while passing urine, the swab test/culture test will be concussive in diagnosing infection.
User :   Gonorrheal infection can present in latent stage and as carrier.
User :   The chances of transmission via a carrier is low when compared to an infected person.
User :   how latent?
User :   Latent phase, is the incubation period, which I mentioned as few days to weeks.
User :   A person who is infected, can be in the latent phase, symptomatic phase and as carrier too.
User :   The chances of transmission are high during the symptomatic phase of the infection.
User :   Are you following?
User :   So if my partner transmitted it to me, it's more than likely that he contracted it recently?
User :   Yes.
User :   How can you contract E coli?
User :   E coli, is a normal commensal of the lower gut and the genital organs of a women.
User :   Ecoli infections are not very common, unless one gets contacted to it, either through mouth (via food) or through a sexual intercourse.
User :   In your instances, the sexual intercourse.
User :   Right. So it's pretty much probably that it's gonorrhea?
User :   I wouldn't want to zero to the diagnosis of gonorrhea.
User :   I realize you're a doctor on a computer screen, so you can't say with certainty, but most signs are pointing to yes
User :   Your symptoms are consistent with the features of bacterial infection and yes, gonorrhea in specific.
User :   Thanks. So, let's hypothetically say that it is: User :   1) What does treatment look like?
User :   2) What are the long terms effects?
User :   3) Is the only want to re-contract it through having intercourse with someone else infected?
User :   You will first need a physical examination by a doctor, followed by the swab/culture test of the discharge.
User :   You will be given a course of antibiotics, usually a broad spectrum antibiotic or pencilln/macrolide group of antibiotics.
User :   Antibiotics are very effective in treating the condition.
User :   And with its right usage, you shouldn't be having long term effects.
User :   Complications are common if you some one doesn't treat it.
User :   So it's not like herpes where it just pops back up?
User :   Early treatment will prevent all complications.
User :   I appreciate your professionalism.
User :   Presence of yellowish discharge are more likely due to a bacterial infection, than herpes infection.
User :   Right. I didn't think it was herpes. I just wanted to make sure it was fully treatable?
User :   And yes, genital infections occur via sexual intercourse.
User :   Remotely, when some one is immunocompromised(such as one with uncontrolled diabetes or on treatment with steroid,
User :   or having a chronic illness including HIV
User :   or with poor nourishment)
User :   the infection can occur spontaneously without a sexual intercourse.
User :   Okay
User :   I hope I have answered all your 3 questions.
User :   Not going to freak out
User :   Yes, it did.
User :   The HIV comment scares me.
User :   I've been tested multiple times.
User :   And all tests have come up negative.
User :   But I read that it might not necessaciraly show for up to 6 months?
User :   HIV infection causing such spontaneous genitourinary infection occur during the final stages of HIV infection.
User :   *necessarily
User :   Can you put a time frame on that?
User :   which is referred to as AIDS.
User :   Right
User :   the time needed for full blown AIDS to occur after an infection varies among individuals.
User :   Maximum?
User :   I shall explain that in simple words.
User :   I think I understand. If there's a chance it's HIV, I'd be in the later state if I'm having discharges.
User :   Full blown AIDS is suspected in individual, who are debilitated physically,
User :   have multiple infections which occur spontaneously.
User :   That went by quickly
User :   Okay... back up and running
Doctor :   Hi
Doctor :   Welcome back.
User :   So was my interpretation correct?
User :   There's a chance that it could be HIV?
Doctor :   Yes, if you are physically fit, and are tested negative for HIV, the chances that your present symptoms are HIV related are extremely negligible.
Doctor :   Hence, you need not worry of HIV.
Doctor :   My comments on HIV are for information alone.
Doctor :   Have you followed?
User :   Sorry... was sidetracked.
User :   Yes, makes sense.
User :   This whole ordeal, which I am probably blowing way out of proportion, just makes me appreciate safe sex even more.
Doctor :   Yes,
User :   Although I have complete confidence in my partners, I guess you just never know.
Doctor :   that is the best means to keep away from all unwanted infections.
User :   So, back to HIV really quickly.
User :   Physically fit, nasal congestion/sinuses is my biggest complaint for 2 plus years
Doctor :   The chances of STD's are higher in individuals who have multiple partners and in homosexual individuals.
User :   I realize the statistics
User :   Should I still have my doctor perform another HIV test although getting one today?
User :   Should I said and get another?
User :   What is the rule of thumb for time period of detection? As in, when would it more than likely be confirmed.
Doctor :   Yes, you will need screening for HIV every time you involve in unprotected sexual intercourse with an unknown partner.
Doctor :   The test includes HIV antibody test after 2-3 weeks of exposure and one after completion of window period, that is after 3 months.
User :   So the screening I just had was for the anitbody?
Doctor :   HIV screening, yes.
User :   So this screening will show if there is something present?
User :   Less the intercourse from 4 days ago?
Doctor :   Antibody test which is done in the name of ELISA or Westernblot test
User :   I guess I'm confused by the 3 month mark?
Doctor :   I shall simplify that.
Doctor :   HIV screening test is done, by testing for HIV antibodies.
Doctor :   The most commonly used test is the ELISA test.
Doctor :   It should be done at 2-3 weeks following an exposure.
Doctor :   A repeat of this test will be needed after 3 months.
Doctor :   A repeat test is necessary in high risk exposure.
User :   Define high risk exposure please?
Doctor :   Repeat test is done to make sure there are no seroconversion.
Doctor :   High risk exposure are as follows
User :   Well, hold up.
User :   Let me just give you a timeline as opposed to beating around the bush.
Doctor :   1. People who have received HIV infected blood or any other body fluids
Doctor :   2. People who share needles
User :   Have been with 3 partners since my last screening: User :   1 at least 5 months ago
Doctor :   3. involve in sexual intercourse with multiple partners.
User :   1 at least 2.5 months ago
User :   1 several times within the past 2 months
User :   so i definitely fit your #3 of high risk
Doctor :   you belong to high risk exposure.
User :   Trying to deduce how likely it is that it could be HIV
User :   If transmitted from the 5+ months, it should show up in today's screening?
User :   More than likely if from 2.5 months ago, should show up?
User :   And if it were an HIV transmission from my current partner, chances are I wouldn't have symptoms yet?
Doctor :   there are no specific guideliness to deduce the chances of infection.
Doctor :   Some report the chances as 3%
Doctor :   * 0.1 to 3%.
Doctor :   I mean there are few studies which report the chances as 0.1 to 3%.
Doctor :   however, they are governed by other factors, that includes time of exposure, the sexual practises involved, use of protective barriers and so on.
Doctor :   but the important point is that if one is diagnosed to be HIV negative based on the antibody test(which I mentioned earlier) after the window period(3 months), the chances that he is infected are close to zero.
Doctor :   hence, I recommend you to stop for involving in high risk exposure sexual intercourse, use protective barriers during all sexual intercourse, and get screened for HIV regularly as suggested by your doctors.
Doctor :   Have you followed what I have suggested?
Doctor :   Are you there?
User :   Sorry...
User :   Yes, I follow. So, given our conversation, what are you thinking is most likely?
User :   I realize I fall into the high risk category so that changes many things.
Doctor :   I will stick on with my previous suggestions.
Doctor :   I will not consider your symptoms to be HIV related, though you belong to high risk exposure.
Doctor :   but , HIV screening will be needed.
Doctor :   The basis for this suggestion is that, genital infections are common in full blown AIDS which is unlikely to occur within few months of exposure.
Doctor :   Hope this is clear now.
User :   Very much so
User :   But very humbling
User :   So, thank you
User :   Final questions: User :   Action steps: Doctor :   The steps that you need to follow are
User :   I have paid for the "downpayment" of this screening. If I want to see the results, I must pay in full.
User :   Should I just cancel that and go see my regular physician this week?
User :   Part of me feels, based on our conversation, that today's screening was a premature decision.
Doctor :   1. Drink plenty of water to help flush the infection out.
User :   Obviously, I must ultimately make that call, but would like to know if you feel going to my regular physician would be more beneficial?
Doctor :   2, See a doctor, at an STD clinic.
User :   Any recommendations on clinics?
Doctor :   exmanination, swab test and HIV screening will be done at the clinic.
Doctor :   3. Antibiotics need to be used regularly as suggested by your doctor.
Doctor :   4. Stop high risk exposure.
User :   Definitely.
User :   Sorry to turn you into my father/mother.
User :   What are you thoughts on the battery I had completed today?
User :   Better to actually see a doctor at an STD clinic?
Doctor :   A doctor at an STD clinic will be better, than a general physician.
User :   Got it.
Doctor :   But if you don't have access to STD clinic, you a general physician will do.
User :   I'm in a pretty big city. Should I consult my physician for a recommendation? Or do you have a website/suggestions?
Doctor :   A face to face consultation will be better
Doctor :   as you will not get a prescription over an online consult.
User :   Right.
User :   But you said an STD clinic doctor would probably be better than my regular physician. Should I ask my general physician for a recommendation for a clinic? Or
User :   do you have one?
User :   Or, is it online?
User :   Alright... I think I've found one.
User :   Thanks so much for your help. Very informative!
User :   Have a great morning/day/evening!
Doctor :   Thanks for consulting me.
Doctor :   Bye for now.
Doctor :   Have a great day!!
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