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Suggest Treatment For Tonsilitis, Fatigue, Postnasal Drip And Dry Mouth

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Posted on Mon, 16 Nov 2015
Question: I recently met a girl, and we had sex (we used a condom and there was no oral sex, but obviously we did make out). we have now been dating for around 3 months. Around 3 weeks after we had sex i went on a holiday to the usa (all up i went to USA, cancun mexico, and cuba, however the ifnection developed whilst in the USA), where i came down with what seemed like a chest infeciton (felt sick, coughing up yellow flem, had a bit of puss on tonsils). I was given a ten day course of augmentin duo forte in Las Vegas and sent on my way. I finished this course just as i got back to my home country, yet still did not feel well. I was given another ten day course of augmentin duo forte. During this course (around the 3-4day) I develoepd tonsilitis (very red throat and a lot of puss on tonsils). this is really weird considering i was already on strong antibiotics. I continued the course and was given an additional 5 day course which i took. The infection went down, however did not completely go away (still felt unwell, had red throat, and a bit of white puss on tonsils). Since then i have taken a course of erythomycin, 2 weeks of abocillin (500mg 4x day), another course of erythromycin (800mg 2x day), and a five day course of clarithromycin 250mg, however the infection has not gone away. I still feel very fatigued, have a red throat, and there is still a bit of puss on my tonsils. (my tonsils are not and never were swollen). Im starting to freak out and do not know what is wrong with me. I am starting to think that i may have oral chlamydia, as the symptoms all started around 3 weeks after I made out with this girl. My swab, urine and blood tests have all come back clear, however my white blood cell count was up, which indicated i still had an infeciton (i had two tests, one showed an infection, then the second done a week later showed regular white blood cell count, indicating no infection, but i still feel the same). Im worried that the swab test did not pick up chlamydia, as i was on antibiotics everytime i did the test (i have done two swab tests and a urine test along with several blood tests and blood cultures all of which have detected nothing)
at the present moment my symptoms include the following:
* Fatigue, its not that im not sleeping right, as i feel awake, i just feel as though the infection is draining all my energy.
*occasionally i get inflamed cheeks, and develop white marks on my cheeks.
*can not concentrate. feel hazy and lost.
* tight sinuses, (no infection in the sinuses, as i was examined by an ENT)
* i get very sweaty in the early afternoon. before the sweats start i tend to feel as though i am going to break out into a fever, but never do. instead i sweat for about half an hour or so, and then go back to normal.
* my throat is red, but not sore.
*dry mouth
*my tonsils still have white puss on them, but are not inflamed (i get tonsilitis quite a bit, but they never get inflamed)
* have post nasal drip. even though i am using avamys nasal spray.
* due to the fatigue (and maybe the infection) my libido is low and have trouble getting and maintaining an erection, however am still able to have sex sometimes.

I have seen an ENT regarding this, and he put me on 250mg of Azithromycin daily for 6 days and then 3 tablets a week for 4 weeks. he said this is more for the anti inflammatory action of azithromycin rather than killing bacteria. I have taken it for 6 days now, however do not feel any better. the above symptoms are still present. He is not treating me for an infection, as he said my white blood cell count indicated no bacterial infection. (note: my tests also indicated no viral infection either)
What are my chances of having contracted oral chlamydia (or any other oral STD) from this girl just by kissing? She is the only girl i have had contact with since i broke up with my last girlfriend (we weer together for five years)
If this is NOT chlamydia or any other STD, what ELSE could it possibly be?
note: I do not have any other symptoms that would indicate an STD. ie no discharge from penis, or soreness in testicles etc, I have since received oral sex fro mthe girl multiple times.
All up this has been going on for 3 months now.
Please help
Thanks
doctor
Answered by Dr. Sumit Bhatti (48 minutes later)
Brief Answer:
IV medication. Throat swab for PCR. Blood culture.

Detailed Answer:
Hi,

Thank you for your query.

1. I recommend that you seek indoor admission for intravenous antibiotics and supportive medication.

2. Throat swabs should be sent for PCR (Polymerase Chain Reaction) tests.

3. A blood culture should be sent. The initial differential white blood cell counts will give an indication as to the type of infection.

4. Viral infections will not respond to antibiotics and will run their course. Antibiotics will only help prevent secondary bacterial infections.

5. The possibility remains between endemic infections along your travel route and STDs.

6. IV ceftriaxone and oral doxycycline should be started.

7. Comprehensive blood investigation including liver function tests and serology should be done.

8. Testing of your partner is advised. STDS tend to remain silent in many people, especially in thd female partner.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sumit Bhatti (1 hour later)
Just a few questions:

1. So i should start treatment for chlamydia and gonorrhea even though i haven't been diagnosed with it?

2.do you suggest i do ALL of these 8 things,. or are they various options i have available to me?

3. If i was to take a one of 1g dose of Azithromycin to possibly treat the chalmydia (IF it even is chlamydia), how long would it take for me to no longer be infectious?

4. if i was to take the 1g dose of Azithromycin, and had contact with an infected person again, would i remain ill, or would the whole process start again. ie the bacteria would take 3 or so week to incubate, meaning i would think that i am okay.. but then in 3 weeks would get sick again? or would i just feel as though the antibiotics did nothing ?

thanks



doctor
Answered by Dr. Sumit Bhatti (8 hours later)
Brief Answer:
Detailed answers below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Yes, you can start dual treatment.

2. Follow all the steps listed in my previous answer.

3. It usually takes a week for the single dose Azithromycin to cure chlamydia.

4. Reinfection is possible, hence the need to 8n vestige and treat your partner.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti (37 hours later)
I have a few more questions if you dont mind.

When i took an oral swab test, i was taking augmentin duo forte at the time. If i had chlamydia or gonorrhea, is it possible that it was NOT detected because i was on antibiotics?

how common is it that bacteria would not be detected if taking antibiotics?

can you get chlamydia or gonnorhea through kissing? example. a girl who has chlamydia/gonnorhea in the mouth, kisses (with tongue etc) a man. would the infection spread?

can penicillin based drugs (amoxicillin etc) cure the infections? if not, does it make it seem as though you are getting better, however dont?
for example, could I have had these infections for two months, however they have not been full blown, because i have been taking penicillin? the reason i ask is because i have been on antibiotics for 3 months now, and have been kissing/having unprotected oral sex with this girl over the last three months. is it possible, that i have been infected, however, the infection is small and maintained, rather than full blown due to the penicillin?
doctor
Answered by Dr. Sumit Bhatti (8 hours later)
Brief Answer:
Details discussed below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Throat swabs should be repeated if negative with more emphasis on PCR tests which will settle the issue.

2. These infections can be spread by intimate contact. Most partners are asymptomatic carriers, hence indolent infections exist.

3. Concurrent antibiotics will modify the results.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti (3 days later)
Thank you for the reply!

I had another swab test done along with a Chlamydia PCR. They both turned up negative. I also had another blood test which also came up clear. white blood cell count was normal, along with everything else being normal. Can I safely assume that i do NOT have an STI?
I had also been taking 250mg of azithromycin per day for the week before the tests, which was given to my by an ENT for anti-inflammatory purposes, i had taken one the day before, but not on the day of the blood/swab tests.
Seeing as my white blood cell count came up normal, can I safely assume that i do NOT have an infection? or could I still have one?

also I have stopped taking all antibiotics for about a week now, and my symptoms are still there, however, have slightly improved. I presume that if I did have an infection, over the course of the week my symptoms would have become worse?

Also, the doctor that gave me my test results suggested that this could just be acid reflux, and gave me a script for Nexium. I have had acid reflux maybe twice in my life, and have felt it. Is it possible that I am having it in my sleep without realizing? If so, could the acid reflux be a result of taking antibitoics every day for the last two months?

Thanks
doctor
Answered by Dr. Sumit Bhatti (16 minutes later)
Brief Answer:
Yes, no STI.

Detailed Answer:
Hi,

Thank you for writing back.

1. Yes, you can safely assume there is no STI involved here.

2. Your symptoms should improve in a week.

3. Even normal people have a few episodes of reflux in a day (24 hours). Antibiotics can increase reflux even in short term use.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Wishing you good health.

Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2686 Questions

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Suggest Treatment For Tonsilitis, Fatigue, Postnasal Drip And Dry Mouth

Brief Answer: IV medication. Throat swab for PCR. Blood culture. Detailed Answer: Hi, Thank you for your query. 1. I recommend that you seek indoor admission for intravenous antibiotics and supportive medication. 2. Throat swabs should be sent for PCR (Polymerase Chain Reaction) tests. 3. A blood culture should be sent. The initial differential white blood cell counts will give an indication as to the type of infection. 4. Viral infections will not respond to antibiotics and will run their course. Antibiotics will only help prevent secondary bacterial infections. 5. The possibility remains between endemic infections along your travel route and STDs. 6. IV ceftriaxone and oral doxycycline should be started. 7. Comprehensive blood investigation including liver function tests and serology should be done. 8. Testing of your partner is advised. STDS tend to remain silent in many people, especially in thd female partner. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.