Q. I got urethritis and conjunctivitis after unprotected oral sex. Please help.

Hello doctor,

I got urethritis and conjunctivitis, at the same time a few months back. I had thick transparent penile discharge with burning and itching sensation. I got this after a week of having unprotected oral sex. I have had urethral swab and urine test done, and the reports showed ureaplasma urealyticum. I have been treated with Ceftriaxone and Azithromycin for urethritis. And with Azithromycin, Tobrex, and Aureomycin for conjunctivitis. 

Most of the symptoms disappeared after a week, but since then, I still have the penile discharge throughout the day, the discharge leaves black stains in my underwear. I have a strange sensation of pressure in my prostate, and it burns when I pee. Sometimes, it burns slightly after ejaculation also. In the eye, I still have inflammation of both my eyelids and discomfort in one eye.

In the past month, I saw a urologist again, and I have been treated with Azithromycin and Ciflox for two weeks, Doxycycline for eight weeks, and Flagyl for two weeks, but with no improvement. I also had several swabs, urine tests, and a sperm culture, which all came back negative. I got an MRI of the prostate that showed an inflamed prostate. For the eyes, I have been prescribed Ciclosporin and Ketotifen for six months. I have never had urethral swab after a prostate massage because my urologist said it is useless.

Now, my urologist thinks of putting me on Cortisone for two months. Do you think it is a good idea? Do you have any explanation for the remaining symptoms? Do you think there is a link between eyes and genital symptoms? Thank you for your help.

Hello doctor,

Thank you for replying. What do you mean by the treatment is tricky? Are you talking about the treatment with Doxycycline? The penile discharge is very thin and transparent, so it does not look like a gonococcal infection. At the very beginning of the infection, I had Azithromycin and Ceftriaxone injection, so how could it be possible that I still have eyes issues? 

You say that I have symptoms of chronic non-bacterial prostatitis, do you mean that I have no remaining bacteria in my body? If so, why should I have Ciflox again? I already had Tamsulosin along with Ciflox, but I stopped it after a few days because it made me have ejaculation troubles and dysuria.

Hello doctor,

Thank you for replying. If we assume that I had a gonococcal infection along with the detected ureaplasma urealyticum, the only treatment I had against gonorrhea is the one-time Ceftriaxone injection. Now my eyes look fine and there is no external sign of conjunctivitis, but I still have inflammation under my eyelids, sticky eyes in the morning, and feel discomfort. The ophthalmologist confirmed I still have inflammation of the cornea. He put me on Cyclosporine to reduce the inflammation and Ketotifen for six months. It has been two and a half months since I begun the treatment, and I do not feel any improvement. Do you think the treatment is right? The ophthalmologist says he does not see any signs of infection but just inflammation. Is there really any chance that the bacteria is still in the eyes? Is there no need to get antibiotics against gonorrhea in the eyes? What should I do to get an improvement?

Concerning the use of steroids, is it not a good solution to reduce the inflammation of the prostate? If taken along with Ciflox, can it be effective? For how long should I have Ciflox? Why do I still have penile discharge? Is it because the prostate is inflamed, or is it due to remaining bacteria? Do you advise me to consult a dermatologist instead of a urologist? Thank you.

Hi doctor,

Thank you for your answers. Last time I saw my urologist, he already wanted to give me steroids because he is convinced that I had enough antibiotics and that there is no infection remaining and that my prostatitis is just due to an inflammatory response of my body. Is it a possibility? In that case, getting steroids for two months should definitely cure me, right? I convinced him to put me on Doxycycline for a long course so he agreed to an eight weeks course. I will finish this treatment in the middle of next month. If at the end of the treatment I have the same symptoms, your advice is to go back to the urologist and discuss with him about getting Ciflox again for 12 to 14 weeks, right?

Are you optimistic about the fact that I well get rid of my symptoms with one of the options? It has been five months since the beginning of my symptoms, and after so many treatments I must admit that I am beginning to lose faith.