[Question #1759] Oral sex NGU and Anxiety

43 months ago

Thank you for your expert help, I have been reading your information for 4 months now (including several studies and CDC/govt sites), and feel having you address my own concern will help put this event behind me (male 30, monogamous 5 years). Event, brief (1min) receipt of oral sex from female CSW, no ejaculation in month, hand finish (10/15/2016). 3 day later immediate panic/guilt/anxiety set in, symptoms of penis tip sensitivity and frequent urination. Gon/Ch/HIV/Syph testing 3, 14, 25, and 60 days post exposure at STI clinic (confident in results). Concern is NGU, already have cold sores since child. Went to STI clinic 25 days post exposure got physical exam and urethral swab, RN said no NGU. Went to STI clinic for second swab test 60 days post exposure, negative again, RN said no NGU, no sign discharge, not necessary to treat. I have never seen any discharge anytime, checking everyday, extra close in morning, and no dysuria, no sores, no redness, all normal. It is now 4 months still have sensitive/irriated/tingling penis, especially when sitting at work, mostly on the head, occasional warm scrotem. I feel this is anxiety fueled, as the symptoms are worse when I am more anxious, but still have doubt I am clean. I also had a urinalysis, digital prostate and physical exam 60 days post at my doctors, all clean.

1) Do I have NGU or any other STD, do I need to be treated or take anymore tests?

2) MOST important is my partner at risk of anything? I tried resuming regular sex.    
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to our Forum and thanks for your question.  The short answer, which I will then expand on, is that you are in the clear.  Here's a bit more detail:

1.  You do not have NGU.  I say this with confidence for several reasons which include: 1.  The you do not have symptoms of NGU (tingling does not count, see below), your tests for chlamydia are negative, and, most importantly, your swab test, taken at an STI Clinic did not show NGU and would have at the 25 day time point when you sought care there.  The tingling you are experiencing in clients who are focused on looking for abnormal genital sensations and are nervous about STIs. This leads to becoming aware of normal sensations which are always there and would normally not be noticed. 

2.  Your partner is not at risk, both because you do not have NGU but, also because, when persons have NGU which is not caused by chlamydia (so-called non-chlamydial NGU). there is little evidence that their partners are at risk for any infection-related problems.

Bottom line, I suggest you focus your attention at somewhere other than your genitals and not worry that you might have acquired an STI from the low risk exposure you have described.  EWH


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43 months ago
Thank you Dr. Hook, I was expecting that sort of reply, it will definitly help. When reading all the forums you and your colleague comment on I was surprised that so many people are treated immediately, whereas the STI clinic I went to told me they didn't find NGU and dont treat emprically. I felt like others had more reassurance becacuse of the treatment they recieved. 3 quick follow ups.

1) CDC states the urethral itch is a symptom of NGU (some other sites say urinary urgency too), is it safe to say that no WBC and lack of discharge outweigh tingling/irritation symtoms (cant really tell if its in the urethra tip, not really itchy though)

2) Now that 4 months has gone by can i stop checking for any symptoms; discharge ect.. and move on

3) Would you recommend not seeking treatment correct?

That should be all. Once again thank you very much.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

If I had seen you in my STD Clinic and had not found NGU, I would not have treated you either.  it is not good medicine to treat "just in case"!  The clinicians in the STD Clinic had a reliable test result which showed you were not infected.   With respect to your follow-up questions:

1.  No WBC far outweigh symptoms such as itch or tingling.  When itch and tingling are present in persons with NGU, they are accompanied by a discharge or burning on urination.

2.  Absolutely. it is more than time for you to stop checking and to  move forward without concern.

3. Nothing you have describe suggests a need for treatment in any way.

I hope this helps.  Take care.  EWH.



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43 months ago
Thank you very much, the time you spend to share your knowledge is greatly appreciated. I was hoping to use my last reply lean on your knowledge and experience to provide better details for myself (and others) regarding the symptoms of NGU; for knowledge, not an anxiety induced question.

1) Regarding discharge, the RN stated you would know if you had it. On your experience is this discharge very noticeable? Wet underwear when not having urinated for a while or dripping from the penis. Is it generally thick and mucus/pus like? Seems like morning would be the best time to check after not having urinated for a long time (guessing urine washes out the infection).

2) Regarding dysuria, RN stated it is really painful and really obvious, based on your experience is this the case?

Thank you again for your reply. You have truly helped me put this horrible mistake behind me and provide clairity on an infection that seems to have a lot more misinformation than good information online.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

1.  The urethral discharge of NGU can be mild and, as you know, some men with NGU have only dysuria.  In such instances the urethral gram stain (which you had) helps to discriminate NGU from normal sensations.  In men with NGU the discharge is typically more evident after having not voided for several hours, including on awakening from sleep.

.  I think the clinician you spoke with was trying to be reassuring.  The dysuria can be mild as well.  Once again, when there is a concern, a Gram stain provides the discrimination answer. 

I'm pleased my comments were helpful  Take care

EWH

p.s.  as you know, this thread will be administratively closed in a few hours.  EWH

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