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Dr. Andrew Rynne

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Tested negative for herpes. Have gonoreah. Not cured by medicine. What should be done?

Answered by
Dr. Sudarshan


Practicing since :2005

Answered : 1391 Questions

Posted on Sat, 29 Dec 2012 in Sexually Transmitted Diseases
Question: hi, sorry for my bad english
i got infected with gonoreah , im treated with rosphin, thixromax , and other antibiotecs, but i stell have inflamation , in my rinating opening , i tested negative vdrl & tpha 18 days after expoure m i also bot the penicillin shot ( just to be sure ) , the inflamation looks like that the track is going to bleed m but it does not m i also tested negatibe for herpes 1 and 2 , the inflamation gets grater after ejacluation , a doctor i know idvice me to apply elocum cream, by the way i already use flagyl because im also afraid of Trichomoniasis .
Answered by Dr. Sudarshan 3 hours later

Thanks for writing in.

As you have already been treated for syphilis ,gonorrhea,trichomoniasis and negative for herpes the possible infection can be granuloma inguinale.
It requires a longer than usual treatment.It responds to doxycycline 100mg twice daily for 3 weeks i.e.21 days atleast.

Other possibility is chancroid but it usually affects skin more than mucosal /urethral area.In your case the mucosal surface is more involved.

Also I would like to know-
Do you have any pain/palpable lymph glands in groin?
Any fever /malaise?
Is the burning while urination at the start of it or at the end?
Any discharge pus/blood from urethra?

Answer the questions to help you better.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sudarshan 2 days later
Dear Doctor,
Thank you for your reply; I think that you need more data about my case so I will try to give you the full history.
My exposure was on the 1st of November 2012 , I live in Dubai , I met one Russian prostitute in Dubai, we had un protected oral sex , I rimmed her also , and I just was playing with my Penis closely to her vagina and ass , then we had a protected anal intercourse, the condom did not break and after the intercourse I took a shower and I found Betadine and I used it to clean my penis and mouth.
2 days later Saturday 3rd of November I found a discharge from my penis when I walked up , the discharge was white near to yellow , directly I suspected gonorrhea , on the same day I got a Rocephin (ceftriaxone) 1 gram im injection + 1 gram of Zithromax (azithromycin). I repated the zithromaz 1 gram every 12 hour, and the rocephin every day for 2 days , I went to a doctor who gived me rociphin I gram iv , and he prescribed tavanic 400, the sympthoms remained but with little improvement the discharge came back transparent and only when I squeeze it.
On the 8th no progress m and I got feeling that I have a wound in my throat ,I went to another doctor because the symptoms are the same , but without burning while urinating he adviced me to stop all antibiotics for 5 days and come back to to tests. , on the same day i got the last tavanic and I got one more rociphin injection and 600 mg of doxicycline.
On the 14th of November I did the following tests, ( which I recived after 4 days )
•     Urethral dis . D.Smear : ( Gram,s stain ), the result is reported as : origin of specimen = urethral dis., Direct Smear = Many gram positive cocci in pairs and clusters seen, wbc (hpf) 3-4 (PMN ) EP. Cell ( hpf) 8-9 , comment no gram negative diplococci seen.
•     Throat Culture : ), the result is reported as : origin of specimen = throat , Kind of organisms Strep parasanguinis isolated., final id is Streptococcus parasanguinis , it was to levofloxacin and amoxicillin .
•     Urinalysus & Parasitology , everything was ok except the w.b.c was 10-12 , and Crystals Ca. oxalate : Many.
•     Urin Culture : kind of organism No Growth.
On 17th of November , I ejaculated , then I found some inflammation in the opening of my urethral. I was afraid it could be syphilis .
On the 18th of November I received the above results , I discussed with the doctor about the results and the inflammation and the transparent discharge ,the doctor told me that every thing is okay and it happens that sometimes after treatment inflammation and discharge remaine for 2 months before it goes away , he injected me with spectinomycin 2 gram and that I do not need any further treatment ., at night I went to the first doctor to read the results , he told me the same just asked me to restart tavanic ( with out telling me for how long ),he also told me that I might have a stone in my kedny because my testecals are paining and because of the hight crystals in my blod and that might cause inflammation as what we have seen , I did the X XXXXXXX and the doctor told me there is a stone in my right kidney and it is about 5.6 mm , he adviced me to ring a lot. At the same night I also discussed with a friend pharmacist of mine who advice me to use augmentin 1 gram.
On 19 I started augmentin every 12 hours with tavanic 400 once a day.
On the 20th of November I did the following tests
•     CBC ( edta Blood ) , wvery thing is ok except MCV is low m & MCH is low and the RBC was high. , the C-reactive protein ( TURB ) was high ( double )
•     TPHA Titer AGGL <1:8
•     VDRL Negative
On the 21st of November I ejaculated about 2 times I was wearing my clothes and a jeans, I went u urinate and I found the same inflammation is so freaky and read and I see it like an ulcer, I was afraid tell death , I went to tack a dry swap to test this ulcer Using molecular biology profile PCR, the result came back after 8 days negative for syphilis and herpes.

On the same day 21 st I visited a 3rd doctor , and I told him about all pains that I have, he used ultra sound and told my that I have a prostatic inflammation and that the inflammation reached the Testicular , he gived my the following treatment
Forum amp 1 gm iv bid for 5 days., gentamycin 160 mg iv bid for 5 days, and voltarin 75 mg im bid for 4 days. + saw palmetto + nbg 24:7 , I took the same medications in addition to the Tavanic and augmentin.
And he did the following tests: which I got results later after about 5 days as following:
•     Urin ( MSU ) Gram stain ( no bacteria seen ) , Culture ( no growth after 48 houres ) .
•     Urethral swab , Gram stain : Epithelial cells : (+) , No bacteria seen, Culture ( XXXXXXX – XXXXXXX ) : no growth of Neisseria gonorrhoeae , Culture : Physiological flora of the skin ( Contamination ) ( + ) , Interpretation : No significant growth of Pathogenic bacteria.
•     HSV 1 Igm (EIA) : <.8 = negative the result was .3
•     HSV 2 igm ( EIA ) <.8 = negative the result was .7

The ulcer started to improve , but when I ejacluated after 2 days it became red again, at that time next day I think I got a Sore throat maybe because of the air conditioning my throat was inflamed , I was afraid of syphillis again.
On the 27th of november I did a hiv 1& 2 Abm Ag combi test and it came back negative.
I read about thichomonasis on the 29th and I suspected it is causing this red ulcer inside the urethral , I used it 2 grams flagyl as a starting doase and I use 400 mg every 8 houres tell now
On the 30 of November , I got a retartpen l.a 4.8 miu /penicillin g benzathine ( ( benzathine benzylpenicillin injection ) ( 2.4 each butt )
1 december I got 1 gram zithromax again , and 200mg doxcyciline ( vibramicine ).
On dec 6th I found your website, I wrote to you and you told me about that desease which is really scarry , tried to find labratories in dubai to test for it but no one knows about it in dubai , I think that if it is true maybe someone from asia infected that russian sex worker . , I visited my doctores again and they told me that it could not be garnuloma because I do not have pain / palpable lymph glands in groin ( which you asked me about ), and the answer of the rest of your questions are no feverm or malaise , some times it burn when I urinate if I did not pee for long time, and some times I find transparent discharge m and after ejacluation it comes red as fire but it did not bleed I think because never find any colored spots.
On 7th of dec I got the seconed time of retartpen l.a 4.8 miu /penicillin g benzathine ( ( benzathine benzylpenicillin injection ) ( 2.4 each butt )

Im using now vebramicyne 100 gm towice dayily + the rest of medication including flagyl , tavanic , and augmantin .
Please note the following :
•     I have a Congenital defect in my urethal ( 2 openings ) as u can see in the picture I sent you.
•     The ulcer emprove and come back but it never increase , it is always red but sometimes it looks like it will heel soon , just if I ejacluate it comes red again !!
My questions are as following
1-     How do you rate my risk , is it high ?
2-     How relaiable are my tests above , I know that we are in the official window period for all deseases . , specially the syphillis and hiv tests. And do you think I need to re testm I will remid you with my important test dated
3-     ( vdrl & TPHA 19 days after exposure ) & syphiliss pcr after 21 days
4-     ( hsv 1&2 19 days after exposure ) & herpes pcr after 21 days
5-     Do u think it may develop hsv2 because my result was .7 while the borderline is .8 to 1.1 ?
6-     May the antibiotects affect the result of my syphilis tests ?
7-     May the cyrstals in my urin with the congenital defect cause this inflamation ?
8-     Do you still think I have garnuloma ?
9-     What tests can I do for detecting granuloma ? is it available in stool ?!!
10-     Is the doxicyline afftect the pinicillen effect ? I take higher doase of pinicilline for that because im afraid if there is syphiliss it comes resistant to penecillin .
11-     Other doctors told me to forget about it and that it Is only a matter of time for these ulceres or inflamation goes , even one of them prescribed elocum cream while the othe prescribed betnovate cream , but I did not use them because I am afraid of the side effects.

Thanks doctor , sorry for the long history , I am waiting for your reply

Answered by Dr. Sudarshan 7 hours later
Thanks for the details of your treatment history.
It seems that you have taken all possible antibiotics for all STDs.

Now to answer your questions.

1.You have small but definite risk.
2.tests for syphilis are reliable they need not be repeated.What was your HIV test was it ELISA or PCR?
My advise to you would be to get RNA PCR for HIV done it is most reliable .If this test is negative then you can be assured of your negative status.
3.VDRL and PCR for syphilis are very reliable need not worry.
4.Test for herpes 2 may have to be repeated due to borderline value.
5.HSV2 may have to be repeated for IgM and IgG .
7.Crystals may cause this inflammation as all other possible infective causes are ruled out.
8.As you dont have lymph node granuloma is unlikely.
9.Only test is aspirate from enlarged lymph node and staining.
10.Syphilis never gets resistant to penicillin .You have been treated adequately.
11.It can be due to crystals.Treatment of that along with betnovate for few days is ideal.You can apply it for 7 days it doesnt have side effects in short duration of 7-10 days.

Hope this helps.
I will be available for follow up.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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