[Question #13424] history of problems, negative tests, but symptoms

1 months ago

Thank you for the service. I am male, 10 years ago I received unprotected oral sex and got NGU. I did not know that at the time but had typical discharge. Got tested for gonno/chlym/trich several times, all negative. Had sex with regular partner. She developed some discharge but she said was normal and it went away. Only reading this forum that i figured out it was NGU. I have had periodic irritation off and on for 10 years at the penis tip. No discharge. Various urine NAAT for same STIs, all negative. Regular urine test, no WBC or RBC.

Fast forward 2 months ago, I had protected anal sex with a new partner. Developed same nagging symptoms at the tip. No discharge. Feel like my groin is bruised, no lympnodes noticable. I have had 6 different urine NAAT tests for gonno/chlymida/trich from two different labs. Also tested for HIV and Hep., just one time. All negative. I do have HSV 1 on lips by history and have not tested for HSV 2 but I doubt this issue is from HSV. My PCP says overkill and did a regular urine test that showed no bacteria and mixed flora that he says is normal. My questions:

1. Could my assumed non-sti bacteria NGU from 10 years ago still be causing symptoms? If so, do me and normal partner need treatment. My doctor says no given the testing.

2. Could this latest partner have given me an STI that is not picked up on 6 urine naat tests from 2 labs? I hear urine misses some infections?.

3. Is mixed flora something that is normal or do i need an antibiotic given the symptoms of no discharge but irritation that is admittedly periodic. It normally is irritating the urethra tip after (not during) i pee or defecate.?

thank you

Edward W. Hook M.D.

1 months ago

Welcome back to the Forum. Thanks for your continuing confidence in our service. On this occasion I happened to pick up your new question and in preparing to respond I reviewed your earlier interaction with Dr. Handsfield. I agree with all that he said including “NGU from oral sex is believed to usually be caused by normal oral bacteria. The urethra sees them as strange and unexpected, and reacts with mild urethritis. However, it probably always clears up even without treatment, and probably there are no traditional STD germs present to cause infection in partners. It is unlikely that your urethritis had anything to do with your partner's vaginal discharge. So many women get vaginal discharge from time to time that It's basically normal,” This remains the current understanding of nearly all non-chlamydial NGU. If anything, non-chlamydial NGU is more common following unprotected insertive anal intercourse than from oral sex. In your case however, if the condom was worn throughout the encounter and did not break (breaks are obvious) this would be unusual. The other possibility here is that you may be looking too hard for signs or symptoms of infection. We regularly find that when clients are concerned about STI risk there is a tendency to look carefully for symptoms and, as result, tend to notice normal sensations in a way that they would normally overlook. I wonder if this may be what is going on here.

In response to your specific questions:

1. Could my assumed non-sti bacteria NGU from 10 years ago still be causing symptoms? If so, do me and normal partner need treatment. My doctor says no given the testing. Mo. Non-chlamydia NGU would have resolved, even without therapy years ago. I agree with your doctor that neither you or your partner need treatment.

2. Could this latest partner have given me an STI that is not picked up on 6 urine naat tests from 2 labs? I hear urine misses some infections?.

No! you are correct that rarely urine NAATs miss infection but this is statistically virtually impossible after multiple tests. NAATS are among the most reliable tests in all of medicine and if you were infected, your test would have been positive

That your symptoms are intermittent is suggestive that you may be looking too hard for symptoms as I suggested above. I really see no need for further testing or for treatment.

I hope this perspective and information is helpful Please don’t worry. EWH

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1 months ago

Dr. Hook,

Thank you for the response. It does put my mind at ease. The only reason I had doubt was symptoms, history and what I had read on line about NAAT urine test reliability in males. Just a few more questions.

1. One of my concerns was LGV. Why? Because I had the groin area pain, and still do. I assume that a regular urine NAAT test for chlamydia would pick up Chlamydia LGV?

2. I assume LGV would not be subtle and my groin issue would be pronounced as well as other discharge/penis symptoms?

3. My groin pain comes and goes, but mainly feels heavy and annoying. Some minor tingle, sting occasionally at the tip of penis after urination, not during. No fever. No noticable lymp node or hernia. Some itching, which makes me think it could be a lympnode but not all the time. Urine STI testing as described multiple times, from two different labs all negative. Also, two urine cultures showing no grorth other than flora mentined. Two urinalysis only showing a trace of glucose, I am diabetic. No other WBC, RBC, or any other bacteria. All this said, I am assuming whatever nagging issue this is cannot be related to an STI?

4. I realize this is an STI forum but assuming you agree that there is no reason to worry about LGV or other STI, any guess about my problem is appreciated. My GP is looking at another sonogram (or something like that) to make sure they havent missed a hernia. He doesnt see any need for additional STI testing or worry. While I agree with him, after reading this forum, I also know this is not his speciality.

Thank you

Edward W. Hook M.D.

1 months ago

As I've already said, your intermittent symptoms really are not characteristic of an STI. I suspect you have been mislead by the internet, a relatively common experience among our clients.

1. One of my concerns was LGV. Why? Because I had the groin area pain, and still do. I assume that a regular urine NAAT test for chlamydia would pick up Chlamydia LGV?

LGV is a severe disease which is reliably detected by all currently available NAATs.

2. I assume LGV would not be subtle and my groin issue would be pronounced as well as other discharge/penis symptoms?

Correct

I agree that there is no reason to worry about an STI at this time. It's time to look elsewhere as it sounds like your doctor is doing.

I find myself wondering about a problem called CPPS which is not an STI or possibly a prostate problem although the normal urinalysis makes prostate problems rather unlikely.

Hope this helps. EWH

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