I had unprotected sex with a new partner last Saturday and three days later began experiencing irritation in my urethra and some slight burning after urinating but no discharge. I decided to go get tested yesterday and my results came back today negative for Chlamydia and Gonorrhea. I also tested for HIV, HEP, and Syphilis. My doc did treat me before testing with cefuxime and doxy for 7 days. I made sure not to take any of the meds prior to being tested. I did also ask my doc for MGEN testing as well as I did catch it in the past but still waiting on the results. I’m concerned I may have it again altho the last time I had it, I had significant discharge at 3 days post encounter with the irritated urethra. I’m now at 6 and still nothing but the irritated urethra still that’s not that bad when peeing but more so after. I’m wondering if I should also test for trichomoniasis as well? Are my symptoms classic MGEN or could it be something else? I had complications with the MGEN treatment mainly the Moxifloxacin so I’m praying I don’t have it again because I know my treatment options will be limited. Any help is appreciated. Thanks!

I reviewed your previous threads and your M. genitalium saga three years ago. It's certainly understandable that you're concerned once again. However, you probably do not have a new episode of NGU, let alone another M genitalium infection. First, NGU generally does not cause urinary burning without discharge -- as you experienced last time. (As it happens, Dr. Hook was the senior investigator on one of the main studies showing this, i.e. absence of NGU in men with only dysuria [uncomfortable or painful urination].) Second, 3 days is too soon:  NGU symptoms typically start 7-10 days after exposure.

Had you been in my clinic, I would not have treated you based only on your symptoms, but only if I could observe abnormal discharge and/or evidence of increased WBC in your urethra. However, even if that treatment wasn't necessary, in this case there's actually an advantage:  that your symptoms have not cleared up is additional evidence you do not have (and did not have) NGU. What could be the cause? Sorry, but there are no clear answers. Trichomonas rarely causes symptoms in men; I think that is very unlikely. Often we see this sort of thing in men who are worried and anxious about a sexual exposure -- and you have an especially valid reason to be worried, based on your past experience. Very understandable. Anxiety probably doesn't create symptoms, but it certainly can magnify minor ones or even normal body sensations that otherwise would not be bothersome and perhaps not even noticed. However, you're in a better position than I am to judge whether this might be the best explanation.

At this point, I would not recommend additional treatment at this time. However, given your past experience, I would agree that testing for M. genitalium is a good idea, if only for reassurance. And as long that's being done, perhaps Trichomonas vaginalis as well. PCR tests on urine for both are readily available in most clinical labs. However, I definitely would not recommend treating you for either of these until and unless you test positive. You should discuss these options with your doctor -- and perhaps print out this thread as a framework for that discussion. My prediction is that you will test negative for both; and that your now apparently minor urinary discomfort will fade over the next week or two.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thanks for your reply. I still see no discharge and it is day 7. I thought I saw a small amount but again it isn’t near anything like I had last time which started a few days post encounter.  I did take the cefixime already and started day 2 of doxy. Should I continue the meds? I did take the MGEN test 5 days post exposure so I’m wondering how reliable the results will be once they return and if I will need to retest later if negative?

Your M gen test will be valid. As noted above, I expect it to be negative.