[Question #1438] ngu

48 months ago

I have some questions about NGU. I have gone to my Doctor and had an STD 8 panel test. Everything comes back negative. It seems that Doctors don't know much about NGU and its hard to get answers.

1. I have urethral itching with clear discharge. The clear discharge stains dark underwear but not white underwear  The Doctor  did a 3 minute examination and said discharge is never clear and that its not NGU. I have read that up to half of people with NGU that the discharge can be clear.

2. The Doctor based the negative NGU diagnosis on a clean microscopic urine sample. Is this accurate.

3. I still have symptoms and went back and he said urine was clean again. Am I missing something. Should I seek a different opinion.

4. How easy is NGU to detect based on a Doctors evaluation with out testing?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome to the forum. Thanks for your question.

My first thoughts and advice are to not worry much about NGU. When not caused by chlamydia, it is generally harmless both for infected men and their sex partners; and probably clears up on its own, probably over a few weeks. In other words, failing to diagnose NGU rarely has any important consequences. That said, I agree many (most?) practicing physicians don't understand NGU very well. (But one reason for that is the very fact of its usually non-serious nature. There's not a lot of scientific or social pressure to understand a trivial condition that's usually harmless.) This isn't to say it never causes harm, but that's definitely the exception, not the rule.

As for your discharge, it would be helpful to know more about it. How often? What time of day? Does anything trigger it, especaily a bowel movement or recent sexual arousal/erection? Also, say something about the sexual exposure(s) that made you seek STD testing in the first place.

To your specific questions:

1) The visual clarity of urethral fluid isn't the most important issue by a long shot. If there is no evidence of inflammation -- i.e. white blood cells in the urethra, or in the initial 1-2 tablespoons of voided urine -- then urethritis is absent. Your doctor's advice that abnormal discharge is "never" clear in appearance is an exaggeration, but it's not far off. Also, what patients report in clarity is often not confirmed by expert examination. In any case, absence of colored staining of white underwear is pretty good evidence there is no significant inflammation and therefore no NGU.

2) This is accurate on the initial 1-2 tbsp of urine. It has lesser value if you collected a midstream specimen. However, the best approach is to collect a swab specimen of the discharge, or even better the inside of the urethra, for microscopy.

3) Second opinion? Maybe, but from all you have said, my bet is that this also won't find anything abnormal. But you could see an infectious diseases or STD expert. Alternatively, perhaps make a new appointment with your docctor, take a printout of this thread, and use it as a framework for further discussion.

4) There is no lab test for NGU. The diagnosis is based on a combination of symptoms, examination (ideally when the patient hasn't urinated for several hours, e.g. first thing in the morning before first urination), and microscopy looking for urethral/urine WBC.

By far the most important facts here are that your STD lab tests were negative. I doubt you have NGU. In any case, I look forward to perhaps helping a bit more if you can answer the questions I asked above.

Best wishes--  HHH, MD

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48 months ago
Thanks for the info. The discharge is when I wake up in the morning, There are some white staining in dark underwear. rarely if I don't pee for awhile during the day, a stain might appear but this is rare. My urine test was done on first void urine first thing in the  morning but it was more then a couple tablespoons. How do I find a STD expert or infectious disease expert? The whole thing started from receipt of oral. Noticed this discharge 10 days later but thought it was normal because I had it clear discharge before. Then about a month after the incident, sharp pain in urethra for about a minute and ever since then , I have had aggravation and itching
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Thanks for the additonal information.

NGU from oral sex is believed to often result from the urethra's reaction to normal oral bacteria. It probably cannot be transmitted to partners and is believed to be harmless. Also, clear discharge only in the morning usually isn't anything abnormal. Most likely you're just noticing pre-ejaculate fluid that was produced during normal nocturnal erections. And itching of the penis isn't a symptom of NGU. It's more likely just anxiety making you more sensitive to minor symptoms or to normal body sensations that otherwise you would ignore or not even notice. I also would encourage resuming sex with your regular partner, if you have one. No harm will result.

So I don't think you need any further evaluation, by an ID/STD specialist or anyone else. Just live with it -- I'm confident the symptoms will clear up over time. But if you want to pursue it, ask your doctor for a referral; or contact the local or state medical society to learn of specialists in your area.

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48 months ago
The std panel did not include Mycoplasma genitalium . I read that MG is most comon bacteria in NGU. Is this true. Should I be concerned or tested for MG
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
No routine STD panel includes M. genitalium testing. It is nowhere near the most common cause of NGU. Further, it is not carried in the oral cavity, and therefore does not cause NGU acquired from oral sex. So you definitely should not be concerned about or tested for it.

Each new question includes two follow-ups and replies, so that concludes this thread. You can move on with no further concerns. All is well.

Best wishes and stay safe.

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