Persistent Clear Discharge from Glans: Possible Causes and Solutions

Q: Persistent Clear Discharge from Glans: Possible Causes and Solutions

Hello： 1) Herpes does not produce secretions. <br>2) Secretions are not caused by herpes. <br>3) It is possible that there was a previous infection, but the duration cannot be determined. <br>4) Testing midstream urine is correct. <br>There is no need to test the initial stream;

Six months ago, I engaged in high-risk sexual behavior, and I still have clear discharge?

Hello Doctor, about six months ago, I had a risky sexual encounter, and afterward, I noticed yellow-green thick discharge from my urethral opening.
When I went to the hospital, the doctor suggested it might be gonorrhea.
After a urine test indicated an infection, I received an injection of what was described as a gonorrhea treatment, and the doctor told me it would be effective for both gonorrhea and urethritis.
I was also prescribed a week’s worth of medication and was scheduled to return the following week for results to confirm if it was gonorrhea.

Upon my follow-up visit, the doctor stated that the gonorrhea bacteria did not culture successfully, and it was uncertain whether it was due to the absence of bacteria or if the bacterial count was too low to culture.
That day, my urine test results were normal, and I had minimal discharge, so the case was closed.
However, I continued to experience clear discharge from my glans, occasionally with a whitish tint, which was persistent.
Upon waking, my glans was noticeably moist, and even after ensuring I was dry post-urination, clear discharge would reappear immediately.
I had no other significant symptoms, such as difficulty urinating, nocturia, or redness and pain.
I returned for another check-up and had my urine tested again, but the doctor indicated that the results were normal.
He explained that having discharge was normal and advised me to drink more water without prescribing any medication, so I went home.
Since then, I have been drinking plenty of water and urinating frequently, and I have not engaged in sexual activity, but the situation has not improved; the clear discharge continues without any other noticeable symptoms.
In February, I sought medical attention again, and the doctor decided to test for the herpes virus in my blood.
The results from the blood and midstream urine tests indicated that I have herpes simplex virus type 1, likely contracted through oral sex, which has affected my reproductive system.
This virus currently cannot be cured, and the doctor advised against medication due to significant side effects, leaving me without any solutions.
I would like to ask, can infection with herpes simplex virus type 1 cause persistent discharge from the glans? I have researched extensively and found that my genitalia (penis and testicles) do not exhibit herpes lesions or sores like other patients.
Can it be confirmed that the discharge from the glans is solely caused by herpes simplex? If I had previously been infected with herpes simplex type 1 (I am currently unsure if I had an infection in the past), wouldn’t the blood test show antibodies? How can this situation be definitively attributed to herpes?
Additionally, if urine tests only examine midstream urine, could this overlook other potential causes? For example, chronic non-bacterial prostatitis or non-gonococcal urethritis caused by chlamydia, as these conditions can be difficult to culture from urine.
I have seen other medical information suggesting that some STDs require testing with first-void urine or special culturing methods to detect specific pathogens.
Some doctors also perform prostate massage to examine secretions and urine or semen for a more accurate diagnosis.
Given that I still have not resolved the issue of persistent discharge from my glans, how should I communicate my current situation to a new doctor when I switch hospitals? What more precise tests should I request to address the ongoing issue of discharge? Thank you.

Xiao Shi, 20~29 year old female. Ask Date: 2021/03/01

Dr. Du Shixi reply Urology

Hello: 1) Herpes does not produce secretions.
2) Secretions are not caused by herpes.
3) It is possible that there was a previous infection, but the duration cannot be determined.
4) Testing midstream urine is correct.
There is no need to test the initial stream; the doctor will massage the prostate to check for secretions and urine or semen—this can be referenced, but it may not always be detectable.
It can be quite uncomfortable.
5) Consult a urologist at a major hospital for examination.
If the initial tests are normal, further testing is not recommended, as the likelihood of finding anything is very low.
Wishing you good health.

Reply Date: 2021/03/01

More Info

Persistent clear discharge from the glans can be concerning, especially after experiencing a previous infection and treatment. Based on your description, it seems you have undergone a thorough evaluation for sexually transmitted infections (STIs) and other potential causes of your symptoms. However, it’s understandable that you are still seeking clarity and resolution regarding the ongoing discharge.

Firstly, it’s important to note that clear or slightly cloudy discharge from the glans can occur for various reasons. In some cases, it may be a normal physiological response, especially if there is no accompanying pain, redness, or other symptoms. The male urethra can produce mucus, which may appear as a clear discharge, particularly after periods of sexual arousal or activity. However, given your history of potential infections, it’s wise to consider other possibilities.

You mentioned that you were diagnosed with herpes simplex virus type 1 (HSV-1), which is typically associated with oral herpes but can also affect the genital area through oral-genital contact. While HSV-1 can cause lesions and discomfort, it does not typically cause persistent clear discharge. The absence of visible sores or lesions is also a good sign, as it suggests that there may not be an active outbreak. However, the virus can remain dormant in the body and may reactivate under certain conditions, leading to symptoms.

Regarding your concerns about the testing methods used, it is true that different types of urine samples can yield different results. Midstream urine tests are standard for many infections, but they may not capture all potential pathogens, especially if the infection is localized in the urethra or prostate. Conditions such as chronic non-bacterial prostatitis or non-gonococcal urethritis can be challenging to diagnose, as they may not always show up in standard urine cultures.
If you are considering seeking a second opinion or further evaluation, here are some steps you can take:
1. Document Your Symptoms: Keep a detailed record of your symptoms, including the frequency and characteristics of the discharge, any changes in urination, and any other associated symptoms. This information can help the new physician understand your situation better.

2. Request Comprehensive Testing: When you visit a new healthcare provider, express your concerns about the ongoing discharge and ask for a comprehensive evaluation. This may include:
- A full STI panel, including tests for chlamydia, gonorrhea, and other pathogens.

- Testing for prostatitis, which may involve a prostate exam and analysis of prostatic secretions.

- Consideration of a urethral swab if appropriate, as this can sometimes identify infections that are not detected in urine tests.

3. Discuss Your Medical History: Make sure to inform the new doctor about your previous infections, treatments, and the results of your past tests. This context is crucial for making an accurate diagnosis.

4. Explore Other Causes: If infections are ruled out, discuss other potential causes of your symptoms, such as allergies, irritants, or even anatomical variations that could lead to increased discharge.

5. Consider Referral to a Specialist: If your symptoms persist despite initial evaluations, you may benefit from seeing a urologist or an infectious disease specialist who can provide more targeted assessments and treatment options.

In conclusion, while it is possible that the clear discharge could be related to HSV-1, it is essential to rule out other potential causes, especially given your history. A thorough evaluation by a knowledgeable healthcare provider can help you find the answers and relief you are seeking. Don’t hesitate to advocate for yourself and seek the care you need to address your ongoing symptoms.

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