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Thread: non STD

  1. #1
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    remove

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    Last edited by frankm007; 12-23-2006 at 07:26 PM.

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    Well, my first question is What Was The Diagnosis? If it wasn't an STD, then what was the Diagnosis that warrented the prescription of antibiotics? Might want to call and see what the Diagnosis was. Also, how did they test you for STD, and which STD's did they include??

    Here's more than enough info. about your inquiry to get you started:

    What is penile discharge?

    Penile discharge is the abnormal loss of fluid that is not urine or semen from the urethra (urine tube) at the tip of the penis. It is commonly the sign of a sexually transmitted disease (STD), and requires prompt and accurate diagnosis and treatment, usually by staff at a specialist genitourinary medicine (GUM) or STD clinic.

    What are the symptoms?

    The discharge can vary in amount from scanty to profuse, and in colour from clear to yellow/green. The timing can vary from loss in the morning only, to throughout the day. The discharge is often accompanied by other symptoms such as:

    * burning on passing urine (dysuria)

    * frequent need to pass urine (frequency)

    * excessive need to urinate at night (nocturia)

    * rash in the genital area, which can be painful or itchy

    * swollen lymph nodes (glands) in the groin.

    What are the causes of penile discharge?

    Common causes are:

    * gonococcal urethritis

    * non-gonococcal or non-specific urethritis (NSU).

    Gonococcal urethritis (gonorrhoea)

    This sexually transmitted disease is caused by Neisseria gonorrhoeae.

    * Incubation period: it usually takes two to five days from infection to symptoms. Without treatment, symptoms of urethritis (inflammation of the urethra) and purulent (pus-containing) discharge peak within two weeks.

    * Symptoms: discharge occurs in 95 per cent of men and is purulent in 75 per cent, white or cloudy in 10 per cent and clear in 5 per cent. Recent urination can make the discharge appear less purulent. When the infection begins to resolve, the discharge changes from purulent to mucoid (mucus-like).

    * Transmission: transmitted by sexual intercourse, including oral sex. Without treatment, the infection can continue for many months.

    * Complications: spread up the urethra to the epididymis (sperm-storing tube connected to the testicles) is rare and infertility can be a rare late complication. Anal infection is common especially, but not only, when the infection is transmitted by anal intercourse. Bloodstream infection occurs in less than 1 per cent of patients, causing arthritis of the knees, wrists and hands plus fever, chills and skin lesions, usually papules or pustules (red or pus-containing raised spots or bumps) on the hands or feet.


    Non-gonococcal or non-specific urethritis (NSU)

    NSU is the most common form of penile discharge accounting for over 60,000 new cases per year in England alone. The number of cases has fallen slightly over the past three years. Men aged between 20 and 35 years are most commonly affected. Several different organisms ('bugs') can cause the syndrome:

    * Chlamydia trachomatis (25-60 per cent).

    * Mycoplasma genitalium (up to 25 per cent).

    * Ureaplasma urealyticum (15-25 per cent).

    * Trichomonas vaginalis (17 per cent).

    * Herpes simplex (rarely).


    Routine tests are not available to detect all of these infections, so the cause of the NSU might not be found. In some patients, no sexual contact has occurred and the symptoms are blamed on irritants, soaps or detergents, but no firm evidence exists to support this theory.

    How is the diagnosis made?

    Penile discharge or urethritis is diagnosed by finding white blood cells (neutrophils or pus cells) on a urethral swab or 'first catch' urine sample (ie urine taken from when you first begin to pass water). The infecting organism might be identified from these samples. Ideally, the patient should be seen in an STD clinic for prompt examination of specimens because transfer of specimens to a hospital laboratory can lead to a missed diagnosis. The colour and consistency of the discharge does not help to distinguish NSU from gonococcal urethritis.

    Gonococcal urethritis is diagnosed in 98 per cent of men by microscopic examination of the discharge obtained from a urethral swab. Other infections are less easily diagnosed. Between 6 and 11 per cent of sexually active UK men carry chlamydia in their urethra with minimal or no symptoms. The development of more sensitive tests such as polymerase chain reaction and ligase chain reaction might allow for more precise diagnosis, particularly in patients with no symptoms, especially if they are sexual contacts of proven infected women - but this is not used routinely in STD clinics.

    How is penile discharge treated?

    Gonococcal urethritis

    One of several antibiotics can be given as a single dose:

    * ceftriaxone 250mg by intramuscular injection

    * cefixime 400mg orally

    * ciprofloxacin 500mg orally

    * ofloxacin 400mg orally.


    In addition, doxycycline 100mg twice daily for seven days is often given to treat chlamydia in case it is present. Sexual partners are given similar treatment.

    NSU

    Usual antibiotic treatment includes doxycycline 100mg twice daily for seven days or a single dose of azithromycin 1g if the infection is due to Chlamydia trachomatis. Sexual partners should be given similar treatment. Patients should be followed up after two weeks with repeat swabs (known as 'test of cure') because of the high risk of re-infection often due to failure of all sexual partners to comply with therapy.

    Contact tracing

    It is essential that sexual contacts of men with gonococcal urethritis and NSU are traced and treated, preferably in an STD clinic. Without treatment of sexual contacts, recurrence is likely and treatment will probably fail. Pregnant or potentially pregnant sexual partners should not be given erythromycin or tetracycline antibiotics (including doxycycline).

    Conventional therapy for NSU fails in 25 per cent of cases. Longer courses of antibiotics have not been shown to be of benefit and re-infection from a new or untreated partner is the usual cause. It is important to realise that recurrence of NSU can cause considerable psychological strain on individuals and relationships and it is important that both partners in a relationship have a full explanation and understanding of the nature of the condition.
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  3. #3
    Cardio bunny Alex.V's Avatar
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    Urinary tract infection. Yes, they can be caused by having sex, nothing to do with STD's, but fairly common. Good hygiene by both parties can minimize the occurrence, but it comes with the territory I guess. No worries. DcK, why did you give him a whole long post on STD's when the STD panel came up negative?
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    Nice post DcK. Props for including NSU's. Just to add a bit on to this...UTI's go hand in hand with STD's...and are often considered genital-Urinary tract infections. Additionally the tests for NSU's or non-gonoccal UTI's are not very good. The antibiotic cleared it up so it was probably some kind of bacterial infection. The intense color could be because of the antibiotic. It could also be because of dehydration or incomplete clearing of the infection. Also make sure you keep on taking that antibiotic for full term. If it's a UPEC or Mycoplasma infection, you may want to ask your doc if it would be wise to continue meds for an additional round.

    Belial, I think DcK included the post on STD's because most STD panels only include Neisseria, Chlamydia, and T. pallidum. The non-gon. STD's (T.vag. Mycoplasma, Ureaplasma) are usually not tested for. UPEC is usually not tested for either, because it's more of a UTI. Anyway, my $.02.

    Frank, keep on the meds and I'm sure you'll be fine.

  5. #5
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    perhaps a yeast infection? (altho antibiotics aren't what i'd treat yeast with. that makes no sense). altho itchiness isn't a symptom for UTI, is it b? (it's not in chicks anyway). Also did you use a condom with her? perhaps one with nonoxynol 9? then again perhaps you are allergic to her cooter.


    and perhaps your pee is yellow either because you are not drinking enough water and/or you are taking a vitamin that causes the color?
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    I just doubted the STD, given that the two have been in a monogamous relationship for some time, and this was hardly their first time having unprotected sex.
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    oh i musta missed the long-term monogamous unprotected sex part. i think?
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    argh.

    i hate when doctors do that.
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    T- other thread. The saga of frank's sex life has been well documented (though perhaps not intentionally) if you follow a few recent threads.
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  10. #10
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    hmmm...i think i've missed those.

    odd.
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    el imposible ectx's Avatar
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    *smacks frank on head for taking antibiotics without prescription, and then secretly smiles because it means ectx will never run out of a job* :evillaugh

    If it cleared up then don't worry about it. She's okay, you're okay, and you ain't oozing anymore. You're asymptomatic so be happy. I wouldn't worry about knowing exactly what it was. If it were important the initial screens would have picked it up. again, good luck.

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    Originally posted by Belial
    DcK, why did you give him a whole long post on STD's when the STD panel came up negative?
    Just wanted him to be safe! Plus, I don't trust most these MD's (personal bias), they'll say they tested you for STD's and they may only do a test for one or two, and that's in fact what happened: "I was tested for chlamydia and gonorrea." Plus, I guess I too missed the long-term monogamous, yet that doesn't mean too much these days either. Another thing I noticed that's a bit disturbing is that this doctor actually prescribed the medication Before the test results came back? What's up w/that, Prophylactic antibiotics? That's not too cool IMO.
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  13. #13
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    Originally posted by DcK


    Just wanted him to be safe! Plus, I don't trust most these MD's (personal bias), they'll say they tested you for STD's and they may only do a test for one or two, and that's in fact what happened: "I was tested for chlamydia and gonorrea." Plus, I guess I too missed the long-term monogamous, yet that doesn't mean too much these days either. Another thing I noticed that's a bit disturbing is that this doctor actually prescribed the medication Before the test results came back? What's up w/that, Prophylactic antibiotics? That's not too cool IMO.
    There's no reason to test for anything other than Neisseria and Chlamydia. The other tests are expensive and would not change the need for antibiotic treatment. There are no causes for penile discharge that I am aware of that do not merit antibiotics. An antibiotic can be chosen that hits all the most common pathogens, so waiting for results to come back is not necessary. A doctor that lets a sexually active young adult out of her office without antibiotics for what is almost assuredly an STD is asking for trouble from the local health department and state board. Two things a doctor must keep in mind at all times: 1) You may not be getting the whole story from the patient. 2) You may not be able to get in touch with the patient at a later time. And in this situation, the patient may be having intercourse with other people before test results come back (Not saying this about Frank, just in general). You obviously don't like MD's but make some sense when you bash them, please.

  14. #14
    el imposible ectx's Avatar
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    Originally posted by Delphi

    You obviously don't like MD's but make some sense when you bash them, please.
    Must be one of those graduate students. Arrogant bast***s!
    hehehehe
    Last edited by ectx; 08-25-2002 at 03:08 PM.

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    Originally posted by Delphi


    There's no reason to test for anything other than Neisseria and Chlamydia. The other tests are expensive and would not change the need for antibiotic treatment. There are no causes for penile discharge that I am aware of that do not merit antibiotics. An antibiotic can be chosen that hits all the most common pathogens, so waiting for results to come back is not necessary. A doctor that lets a sexually active young adult out of her office without antibiotics for what is almost assuredly an STD is asking for trouble from the local health department and state board. Two things a doctor must keep in mind at all times: 1) You may not be getting the whole story from the patient. 2) You may not be able to get in touch with the patient at a later time. And in this situation, the patient may be having intercourse with other people before test results come back (Not saying this about Frank, just in general). You obviously don't like MD's but make some sense when you bash them, please.
    Well, I disagree. I'm not here to debate you on medical procedures and proper diagnosis. I'm simply stating that the prescription of antibiotics and any treatment procedure should never occur without a proper diagnosis. Given broad spectrum antibiotics without proper diagnosis is leading to "super viruses" that are becoming an epidemic in this country, the WHO and even the AMA are urging the MD's to not prophylacticly prescribe antibiotics w/out proper diagnosis. The fact that he probably had NO STD is validation to me that the antibiotics should have never been prescribed.

    My opinion, and I have no further desire to comment on this matter.
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    This will be my lost post on this thread, I promise. I disagree with several items in your last post:

    There was as diagnosis- penile discharge. As I stated earlier, there are no causes for penile discharge that do not require antibiotics. The greater error would be in losing a patient with a possible/probable STD than in prescribing an antibiotic before knowing the exact name of the pathogen involved. Even if the tests came back negative, there's still the discharge. Tests, especially cultures, aren't perfect. 50% of patients who die of sepsis have negative cultures, for instance.

    Antibiotic overusage results in resistant bacteria, not viruses.

    In this situation, the antibiotics weren't prophylactic, they were empiric. Empiric antibiotics are given when you know a patient needs antibiotic coverage, but before any culture reports are back. If an elderly woman showed up in the ER with pneumonia, are you saying she shouldn't get any antibiotics until the sputum culture is back? What if it comes back negative? If you wait too long, you're going to have a dead patient.

    By definition, he had a urethral infection- he had discharge. If he didn't need antibiotics, then what non-infective condition caused the discharge? Why did it go away after he took the antibiotics?
    Last edited by Delphi; 08-25-2002 at 06:12 PM.

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    You are giving chiropractos a bad name, mate.
    Last edited by Paul Stagg; 08-26-2002 at 06:24 AM.
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    Now boys, keep it civil.
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    Frank, go back to your doctor. Dck's post (directly lifted from netdoctor.co.uk) states that NGU is refractory to antibiotics 25% of the time. Cultures are notorious for being false-positive. You might need repeat treatment. I know this is a touchy subject, and it's getting out of hand in this thread, but again, I'm not aware of any cause of penile discharge that doesn't need treatment with antibiotics.


    I take that back, I searched on noninfectious penile discharge. I found a page that mentioned chemical irritation, crystallized urine, and some connective-tissue diseases as potential causes. Never heard of these in Microbiology in med school or on the Internal Medicine rotation, though.

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    Player Hater PowerManDL's Avatar
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    I'm just wondering how over-prescription of antibiotics is causing *virii* to mutate out of control.
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    Originally posted by PowerManDL
    I'm just wondering how over-prescription of antibiotics is causing *virii* to mutate out of control.
    There's report of Both Bacterial resistance and Viral resistance.

    Quote: "Fifty-two percent said that antibiotics are the best medicine for infections caused by viruses, when in fact, antibiotics should only be used for bacterial infections. Viral infections, such as colds and the flu, must run their course in the body. Research in recent years has shown that many physicians appear to be confused as well, and frequently prescribe antibiotics for viral infections."

    Source: http://www.wcanews.com/archives/1999/Jan/jan99b.htm

    There's hundred of other sources, look them up yourself if you care too.
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  22. #22
    Player Hater PowerManDL's Avatar
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    That was my question. Antibiotics don't have any effect on virii, so I don't see how they'd be responsible for any Darwinian mutations in them.
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    Originally posted by PowerManDL
    That was my question. Antibiotics don't have any effect on virii, so I don't see how they'd be responsible for any Darwinian mutations in them.
    There are only a handful of medications that have any effects on viral infections. Why do you think they are recommending NOT TO PRESCRIBE antibiotics when it's VIRAL infection? It's not because "they don't work," it's because the experts, WHO, AMA, etc., are concerned these virii will indeed develop into superbugs with an increased resistance. Do you think bacteria is the only thing that has the intelligience to become resistant? I don't think so, the fact that we have a very difficult time treating virii is proof that virii are extremely adaptative. Here's another article that talks about STD (Gonorrhea) and resistance, plus is goes to the overall idea I was trying to get across earlier, and yes, I took this from a web-site, just in case I'm later report as "ripping" by Delphi.

    -----------
    Antibiotics: The Dark Side of Wonder Drugs
    by Charles W. Moore

    How often have you left the doctor's office clutching a prescription for antibiotics? If this sounds familiar, it should ? 75 percent to 100 percent (depending on the physician) of medical office visits conclude with a prescription. Between 50 and 80 percent of adult North Americans take a prescription medication within every 24 to 36 hour period.

    Antibiotics don't affect the progress of uncomplicated viral infections like colds or flu at all ? any apparent benefit is coincidental. On the other hand, antibiotics have many harmful side-effects. Allergic reactions are common. Antibiotics kill the ?good bacteria? in your body as well as the ?bad? ones ? throwing your system's synergistic balance out of kilter. It is also suspected that antibiotic medications may be partly responsible for the emergence of strange auto-immune disorders afflicting more and more people.

    Another alarming consequence of antibiotic use is evolutionary development of antibiotic-resistant disease strains ? ?superbugs?. There are antibiotic resistant variants of all major bacterial diseases, and the race is on to develop new, ever more powerful antibiotics faster than bugs can evolve resistance to existing drugs. Lately we've been falling behind. Bacteria can reproduce every 20 minutes, and can share information about resistance.

    Medical science is already near-helpless against new bacterial strains, such as the so-called flesh-eating streptococcus A agent that took then Canadian Opposition Leader Lucien Bouchard's leg, and killed Muppets creator Jim Henson in 1990. In the winter of 1991-92 an unexpectedly aggressive strain of meningococcus C killed several young people and terrorized parents across Canada.

    Some strains of tuberculosis and gonorrhea have mutated to become resistant to virtually all known antibiotics. Tuberculosis W, a new variant endemic to New York, but expected to spread, now means almost certain death.

    According to the U.S. Centers for Disease Control, by early 1991 fully 14 percent (and growing) of reported tuberculosis cases were drug resistant, and these can easily spread through the air. Various bacterial and viral pneumonias officially cause 6,000 deaths in Canada each year.

    The National Foundation for Infectious Diseases in Bethesda, Maryland, reports that a new group of antibiotic-resistant pneumonia bacteria already causes half a million cases in the U.S. annually ? 20,000 of them fatal. The foundation also notes antibiotic resistance in bacteria that cause toxic shock, urinary-tract, blood, and vaginal infections.

    Hospitals and day care centres are especially fertile breeding grounds for ?superbugs?. One report claims that 70 percent of hospital-acquired infections in the U.S. are now antibiotic-resistant. Dr. Reuben Grunberg of University College in London, England, says that hospital plagues like antibiotic resistant pneumonia and staphylococcus infections in surgical wounds are becoming ?almost uncontrollable?.

    Antibiotic abuse is partly a cultural phenomenon, exacerbated by factors like working parents who don't want to stay home with sick kids, and therefore demand that the doctor ?give them something? ? usually an antibiotic. However, in Holland only six percent of children treated for uncomplicated ear infections are given antibiotics, compared with a whopping 97 percent in North America. Interestingly, the frequency of complications is about the same. Even proponents of indiscriminate antibiotic treatment for juvenile ear infections admit that the drugs are really necessary in only about two percent of cases. Dr. Grunberg says that because of antibiotic resistance, such prescribing decisions are now too important to be left up to individual doctors.

    Recognizing the grave threat antibiotic-resistant disease presents, the German government decreed that only patients admitted to hospitals may receive antibiotic medication. In May 1993 I asked then federal Health Minister Benoit Bouchard whether similar measures would be considered for Canada. Mr. Bouchard acknowledged that antibiotic overuse is accelerating development of resistant bacterial strains, and that this phenomenon occurs within ?the normal and recommended therapeutic usage of antibiotics?. However he would not comment on restricting the use of antibiotics in Canada to hospitals.

    Mr. Bouchard's Liberal successor, Diane Marleau, told me recently that the matter is being ?monitored and studied?, but did not indicate that her department had taken or would take any pro-active measures to prevent antibiotic abuse.

    I don't think that's good enough. Unfortunately, the pharmaceutical industry is very powerful in North America, and may be counted on to vigorously oppose any restriction on medical or agricultural (another scandalous horror story) use of antibiotics. Drug manufacturers advertise in medical journals, fund medical research, endow medical schools, create jobs, and contribute to political parties. Both the medical profession and politicians are therefore beholden, and in a serious conflict of interest on the antibiotic issue. Also, acknowledging the dangers inherent in antibiotics would make both the profession and government regulators look incompetent or negligent in respect of the way these drugs have been prescribed over the past 30 years.

    Antibiotics have made bacterial disease much less dreadful (at least temporarily), and sometimes they mean the difference between life and death. But in our arrogantly misplaced belief that we can control such things, we took what might have been an unalloyed blessing and turned it into a scourge. If antibiotics had remained an ?ultimate weapon?, used only in extreme cases, their dark side might have remained dormant indefinitely. Instead, doctors handed out these powerful drugs like candy ? as a placebo in cases of routine viral infections like colds and flu.

    Patients are partly to blame for demanding immediate relief of discomfort, rather than letting minor ailments take their natural course. Also, writing prescriptions tidily concludes the office visit's social transaction for doctors, and helps speed up traffic flow through waiting rooms.

    Greed plays a role too. For example, a couple of years ago a large drug manufacturer reportedly paid doctors $1,200 if they would prescribe a new antibiotic to 20 hospital patients as part of a ?study?. At the same time a consortium of 10 drug companies was providing doctors with free $35,000 computer systems if they agreed to spend 20 minutes a week watching drug promotion videos and complete four continuing ?medical education? programs a year.

    Personally, based on what I've learned in researching this issue, I would not take any antibiotic unless I was truly convinced that the alternative would be permanent physical damage or death.
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  24. #24
    Player Hater PowerManDL's Avatar
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    Do you understand what a virus is, and how it reproduces?

    If you did you wouldn't be telling me how an antibiotic can cause increased resistance in virii. At least not in virii that don't reproduce in microbiotic life.

    Edit: That article deals with bacterial resistance, not viral.
    Last edited by PowerManDL; 08-25-2002 at 08:51 PM.
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    Aug 2002
    Location
    Texas
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    130
    Originally posted by PowerManDL
    Do you understand what a virus is, and how it reproduces?

    If you did you wouldn't be telling me how an antibiotic can cause increased resistance in virii. At least not in virii that don't reproduce in microbiotic life.

    Edit: That article deals with bacterial resistance, not viral.
    Duh? I posted the article?? I guess you don't get my point. But, who care if you do or not, I'm done with the pointless debate.
    "You can take the red pill and stay in Wonderland and I'll show you how deep the rabbit hole goes. Remember that all I'm offering is the truth, nothing more."

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