[Question #11486] Follow up clarification NGU oral treatment success

14 months ago

Hi Doc,

I have some follow-up questions about NGU, confused by other posts . See previous question 5 days ago, I had unprotected oral sex, no vag sex, and a whitish cloudy discharge. I started treatment on 6/7 and finished on 6/13. The discharge cleared on 6/8, and it's been 10 days since treatment started. no discharge, mild urination pain is i think is Gen focus anxiety.

How often can NGU, contracted through oral sex, return after treatment without re-exposure? Is it as common as with vaginally contracted NGU ?
Is Mycoplasma genitalium (M. genitalium) a concern? can i get that via oral? is a test needed?
I want to test for M. genitalium, chlamydia, and gonorrhea this week for reassurance. Since it's been 10 days since treatment and 4 days post-doxy, will the tests be accurate, or should I wait longer?
What are the chances of NGU returning if it's been 10 days since my last discharge? Does it typically return even after symptoms resolve? or just if its doesn't fully resolve? Dr H said could return 2-3 weeks. be on look out.
Is NGU with sex always Clam NGU?

I'm concerned about having sex with my wife and whether the discharge might return after and wanted to test to get confim

Thanks for your help.

H. Hunter Handsfield, MD

14 months ago

Welcome back but sorry you found it necessary. As discussed last time, NGU from oral sex is generally believed to be harmless and infection is rarely due to traditional STDs, except sometimes gonorrhea -- which almost certainly you did not have. To your questions:

1,4. Any case of NGU can recur after treatment, on average maybe around 10% of the time, but probably even less frequently when acquired by oral exposure. In any case, if it happens, it will be easily re-treated. Even if untreated, probably the infection is harmless for female partners. (And I agree any minor urinary discomfort indeed is most likely anxiety related.)

2. M. genitalium rarely infects the oral cavity and therefore rarely if ever a cause of orally acquired NGU.

3. There is no need or point in testing for any of these at this point in time.

5. Chlamydia also rarely is in the throat and many studies show it never causes NGU from oral sex.

Putting this in personal terms, if somehow I were in your situation I would resume sex with my wife without worry about putting her at risk of anything.

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

HHH, MD

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14 months ago

Hi Doc,

Thank you for your guidance. I’m trying to move forward and not dwell too much on my symptoms. Overall, there's no discharge, but I still have some pain during ejaculation. I have a few questions:

Is pain during ejaculation a sign of not being fully healed and still recovering? I masturbated last night, and it was painful leading up to and during ejaculation. It felt different from normal.
Can you masturbate while healing from NGU or other STDs? I wasn’t sure if it slows down healing. The pain during ejaculation was different and unpleasant. I'll monitor it over the next few days.
Could this pain indicate a recurrence of the infection or not healed? I’ve had no discharge for six days since finishing doxycycline, and any pain during urination is minimal.
Could there be issues resuming sexual activity with my wife/constant partner after being treated for NGU? Specifically, is there a need to get reacquainted with my Wifes bacteria again after seeing the person i got NGU from, or is that a non-issue?
If NGU was contracted from oral sex, does that mean it will always happen in the future with that same person, or does the body get accustomed to it over time? I won’t see that person again but I’m curious if this implies incompatibility.

Thank you, and I hope this pain during ejaculation subsides soon. I’ll update you in a week or two if these symptoms subside.

H. Hunter Handsfield, MD

14 months ago

1) I have never heard reports or symptoms from patients about ejaculatory pain as a symptom of NGU but it might be expected in the several days after treatment, before internal healing is complete. I would expect this to stop after a few more days.

2. For those reasons, it's a good idea to avoid sex and ejaculation for a week or so.

3. I doubt it means the infection wasn't cured.

4. Nothing like this has ever been known or, to my knowledge, subjected to research. I doubt this would make any difference.

5. I've never heard of anyone who had more than one episode of NGU following oral sex.

We won't be able to help significantly if this symptom continues. IN that event, I would advise seeing a urologist. That's the referral we would make if one of our patients had these symptoms.

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14 months ago

Doc,

I know this goes against your advice, but I went ahead and purchased the tests directly through Quest and took three different tests today for my peace of mind: Chlamydia and gonorrhea, urinalysis, and Mycoplasma genitalium. I hope you can keep this open so I can share my results when they come back in a few days.

You mentioned that testing might be too late, but if I had caught gonorrhea, considering I'm one week out from finishing the doxycycline antibiotic and two weeks out from getting the shot and my first doxycycline dose, should my test be negative if it was cured, or would I still show positive if I did, in fact, catch it? Could DNA linger? My main concern is gonorrhea-related NGU versus non-gonorrhea NGU. I understand three weeks is preferred for a cure test after treatment ends.
Regarding M. genitalium, since the test was available, I wanted peace of mind just in case I picked that up. Could it have been dormant for a while from a prior event year ago? My concern is about persistent NGU or resistance, especially considering it was an oral event, though I know that's a slim chance.
Lastly, for the urinalysis, post-antibiotic and shots, would blood cells still be detectable if NGU wasn't cured? is that the best sign its still there?

My anxiety is high, and while I know I'm probably cured, I wanted to check all the boxes for reassurance since I had discharge and this wasn't just in my head. I understand non-gonorrhea NGU isn't a major concern, but I need to know since I didn't get tested initially. I will share my results when they come in soon. Thanks, and sorry for the repetitive questions.

H. Hunter Handsfield, MD

14 months ago

1. Even if you had gonorrhea, your test result now would be negative. You're wasting good money on tests that will be negative and meaningless.

2. M. genitalium can be dormant and carried for long periods; should your test result be positive, it will not be from the recent oral sex event. Instead, as you suggest yourself, it would be from some previous exposure. Almost certainly your test will be negative.

3. The best sign of persistent NGU is continuing discharge, but sometimes it might be detected by evidence of increased white blood cells in the urethra.

The "boxes for reassurance" you are hoping to check will be meaningless. I'm sorry you're spending the energy, time and money on them. Butyou do raise a valid point with "I didn't get tested initially". That should have been done, and any knowledgeable STI expert would have tested you before treatment. But that's water under the bridge now, and testing at this point isn't going to help anything.

Threads are closed after two follow-up exchanges and we're there, and there would be no need or point in letting me know your negative test results. But I'll make a deal for you: if any result in fact is positive, feel free to start a new thread and we'll reimburse the posting fee.

I hope the discussions have been helpful. If you remain concerned about any of this, my advice is to go back and read this entire thread carefully. With a little thought and refection, you should find the discussion very reassuring. Best wishes and stay safe.

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