[Question #1106] Need advice on NGU or prostatitis

50 months ago
Hello Dr.

I will be try and be brief on going over this past 3 months of misery.

5/23 unprotected oral(15 seconds max) protected sex(1 min)

Already felt buring/discomfort on my way home after the encounter.(maybe from condom)

Since then- frequent urination, lower back pain, groin pain, slight pain on ejacuation(meatus looks puffy)and gel clumps in sperm. Discharge(maybe?) I will occasionally during the day see some clear fluid at tip before I pee that is very watery, not thick or sticky. So I don't know if that's worrisome discharge or not.

Tests- 6 urine samples(all negative) no WBC or anything. 3 negative GC/CT test, 2 neg Syphillis, and negative HSV1/2.

Meds-doxy(3 different times) Cipro( twice)

Urologist throughly examined me and told me there was some "cells" in my prostate fluid. I get 2 months doxy and alpha blockers. I'm 26, I feel like this had to of stemmed from my oral and this is NGU. Does "cells" in my prostate fluid indicate NGU? Should I put this behind me or move on? Everybody I have seen has kind of waved off NGU but my symptoms seem to match.

Your input/guidance on this would be greatly appreciated. Thank you in advance
50 months ago
I will also add, since about a week after I look at and squeeze my penis around 10/15 maybe more times a day checking for discharge. Don't know if this could have any to do with my troubles.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome to the forum. Thanks for your question.

You had a virtually zero risk exposure for STDs, including NGU, from such a brief oral sex exposure. And no STD can start to cause any "burning/discomfort" (or any other symptoms) within a couple hours of exposure; 1-2 days is the minimum, and for NGU it's 7 days minimum. Further, your symptoms are not those of urethritis or any STD. NGU does not cuase frequent urination, back pain, groin pain, or painful ejaculation. And having several normal urinalyses also is against any infection. Despite what you apparently have found in online searching, your symptoms definitely do not those caused by NGU.

I also do not believe you have prostatitis. Your symptoms are most consistent with a psychological origin, i.e. anxiety over the exposure. Almost anybody has a some white blood cells in their prostate fluid, and NGU doesn't cause that. In the very small chance you in fact have prostatitis, it is not from this exposure and almost certainly would be non-infectious. Based on all you have said, I would have strongly advised against the inital treatments you had with doxycycline (3 times??? really???) and ciprofloxacin (twice??) -- good grief!!! What were your doctors thinking??? 

We don't provide medical care on this forum, so officially I cannot and do not advise you to stop the treatment prescribed by your urologist. But in all honesty, I cannot imagine that you need it or that it will make any difference. My other advice is, first:  for goodness' sake, stop squeezing your penis, which indeed might be contributing to your symptoms. Hands off entirely!!! If you don't see spontaneous discharge that stains your underwear, then you don't have abnormal discharge. (Unless the squeezing itself causes discharge, which eventually will happen.) Second, stop searching the internet about your symptoms.

I hope this has helped. Best wishes--  HHH, MD

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50 months ago
Dr. HHH

First off, thank you for the thoughtful reply. I appreciate it beyond words like many others that come here. If you wouldn't mind answering a quick follow up for me so I can't put this to bed.

As for the doctors and the meds, it's my fault. My anxiety about this has been through the roof. Can't sleep, work, or function. Nobody finds anything wrong on examination, I just felt they weren't up to date with NGU. I also read about M gen and that scared me as well.

I have skimmed a lot of your work on NGU, a lot!! And you answered most before I wrote in yesterday, but I couldn't figure out the discharge. So my quick questions are:

1. When you say mucous discharge, does my discharge fit the script? (Clear,same consistentcy as urine) I look in boxers to check for stains but even on closely looking I don't see anything different.

2. I never see the discharge in the AM. In fact in the morning I feel great until my mind starts thinking about it. When I push in on my groin region or sit on a hard chair the pressure it what triggers the discharge feeling. Still not hinting at NGU/urethritis? I have also had vague on and off right testicle pain, but comes and goes.

3. I'm happily married and this has been the worst mistake of my life. In your opinion, is unprotected sex a safe thing for me and should I drop Google and move on with my life?

Best Wishes to you as well Dr. HHH
50 months ago
Also to add to follow up. I took my first NAAT urine test 11 days post exposure. I peed a lot that night and in the morning so probably 30-45 mins before the test. I had no antibiotics in my system but a few days before the test I took Advil, any chance that would of voided a false negative for gono? I had sex with my wife after the hearing my negative result I just want to make sure we aren't passing an infection back in forth.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Many men have a little clear mucus visible in the urethra from time to time. The absence of WBCs in your many tests is proof that the discharge is not inflammatory or infectious, i.e. cannot be due to NGU.

I'm confident you have nothing you can transmit to your wife or that will ever harm either of you.

My final comment responds to your "worst mistake" comment. It seems clear that you are obsessed with a sexual decision you regret, which in turn is probably the main cause of all your symptoms -- the anxiety making you notice trivial symptoms or normal body sensations that otherwise wouldn't be bothersome or you might not even notice. Do your best to separate that sexual event from the medical consequences you fear so much. Deal with the former as you need to (counseling?), but forget the latter. It's not an issue.

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50 months ago
Thank you again Dr.

I do think it's anxiety driving me crazy, that's what I keep telling myself. I've been to urgent cares, my PCP, ER and urologist twice. The discharge was the most worrisome, if it wasn't for that I would of have moved on long ago. Thank you again for taking the time to respond to my anxiety drivin questions. Last question if I get one more follow up from you. I can also put gono out of my mind with the negative test from labcorp after 11 days even though I urinated 30-45 mins prior and may not of been first void? I did repeat 2 months later but I was on and off doxy/Cipro so I know that was a waste. I won't respond again if you take the time to answer and I thank you again for the replies.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Time since last voiding doesn't actually make any known difference in gonorrhea/chlamydia test performance. Your negative results still were reliable. If a manufacturer specifies say 2 hours since last voiding when they do the initial research, FDA will certify the test as being reliable after that time. It doesn't mean it isn't reliable earlier, only that formal research hasn't been done. But the day to day experience of STD experts and labs is that it makes little if any difference in test performance.

That completes the two follow-up comments and replies that come with each question, and so ends this thread. Do your best to move on without further worry. Even in the unlikely possibility you have prostatitis, that's not an STD and I would still be confident it's not an important health issue for either you or your partner.

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