[Question #201] Ngu Oral sex.

107 months ago

Received oral sex 5th march 15. tested 2 weeks after for chlamydia, gon, syphilis and ngu. All neg. Had sex with wife as thought all clear. began to get slight irritation in urethra. Returned to clinic 30th march 15 for another swab. told have ngu as swab was 5-10 wbc. Didnt have usual symptoms for ngu. No discharge or painful uranation, just very slight irritation. Given doxy 7 days. Took all meds but still no better so took aizthrmycin 1g 3 days after doxy. Still no better so went back to clinic on 20th april 15. Swab taken was <5wbc, told all clear. doc said probably caused by me squeezing penis looking for discharge and obsessing about std. Over the weeks and months upto now i still have this irritation. Have had 4 neg swabs since. most recent was 20 sept 15. Seen urologist and rx cipro for a month but still have irritation. I am worried I have an std. Have tested negative for all of them inc mycoplasma genitalium twice, ureaplasma, trich. I do suffer from thrush occasionally. On one of my clinic visits, consultant said he would not have treated me for ngu as i didnt have a discharge. He said the nurses were following procedure. Do you think i am worrying unnecessarily.

H. Hunter Handsfield, MD

107 months ago

Welcome to the forum. Thanks for your question.

I am confident you have no urethral infection at this time and certainly no STD, and probably never did. For sure you need not worry about transmitting anything to your wife, and you should be continuing your normal (unprotected) sexual practices with her.

That's the bottom line. Here is my reasoning. First, too much is sometimes made about NGU and oral sex. Many (most? almost all?) such cases probably are not an STD in the usual sense, just the urethra's adjustment to a new mix of bacteria. There certainly is no evidence that it ever leads to complications or important health outcomes either in affected men or their sex partners. Second, it isn't by any means certain you had NGU at all. Entirely healthy men occsionally have a few WBC in their urethral swabs; your symptoms were not typical (usually dischrge, not just "slight irritation"). Third, there are no known potential causes of urethritis from oral sex that would not have responded to the various antibiotics you have had -- so even if despite all the above you nevertheless had NGU to start, you certainly do not have it now.

I would not have recommended most of the tests you mention. M. genitalium, Trichomonas, and Ureaplasma are not carried in the oral cavity and therefore are not known to be acquired by oral sex. I can understand how some urologists or others might test for them, but my guess is they were done more to reassure you than out of any serious suspicion you were infected with any of them.

For all those reasons, I agree exactly with the "consultant". I would not have recommended any of the treatments you had except possibly the first courses of doxycycline and azithromycin, and perhaps not even those.

So what IS the cause of your "irritation"? Hard to tell, without more information. But if you mean a sense of urinary discomfort and perhaps urgency but nothing else, I would suspect anxiety -- that you have been sensitized to trivial symptoms or normal body sensations that in a different circumstance would not be bothersome and that you might not even notice. Of course that's just a guess. But what I AM certain about is what I said above: at this time you have no infection of signifcance, nothing you need worry about either in terms of your own health or your wife's. I recommend strongly against any further testing or antibiotic treatment.

I hope these comments have been helpful. Best wishes-- HHH, MD

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107 months ago

Hello Doctor. Thank you for your reply. You have eased my concerns. I have read many of your posts from another forum and I anticipated your answer would be along the lines you said. Some more details about sympoms.

1. Irritation is not painful or itchy in any way. It is difficult to describe. Feels like it's on the tip of urethra or just on the bottom of glans. Hard to pinpoint. It feels like a tingle or something similar. Not there all the time. Can go days without feeling it. I did have a sense of needing to pee more often. That has now gone and I suspect it was due to very high anxiety levels. At the time my symptoms started, my glans seamed to be more sensitive. Not painful but a feeling of arousal. (Strange) I also had a bad case of thrush days before symptoms started. It never hurts to pee and there is no discharge except in the morning sometimes but this is always after an erection and is entirely clear. All swabs have been done at least 6hours after uranation or in the morning. I thought because the meatus looked wet and glossy it was a discharge but the consultant said its normal mucus/secretions and the skin of the meatus is supposed to look like that. (Forgot what my normal is)

2. My wife took 7 days doxycycline when I got dx with ngu Would this have protected her if it was ngu? As I said in original post. We did have sex before onset of symptoms as I was told nothing wrong and ngu test was neg. Of note, we did have anal sex a week before onset of symptoms. Could that have caused this?

3. Urologist rx cipro as he thought could be prostatitis due to anal sex. Never found anything in urine and prostate felt normal he said. (I have had 3 msu cultures that were clear) I do get pains in my anus and buttocks but I think that this is because I am constantly tensing them due to stress and anxiety. (When I am less stressed, it settles down) In fact, I get aches all around lower pelvis. This has diminished considerably over the last 2 months.

Would ngu from oral sex that is pathogen negative cause prostatitis and could I pass it on to wife?

I know that my symptoms are not typical for ngu and I am at war with my guilt and anxiety. I know intellectually that I am negative for all std but the Internet has put the fear of God into me after reading all the horror stories. I am having a hard time just carrying out day to day tasks. It is mentally exhausting.

Thank you for your time.

H. Hunter Handsfield, MD

107 months ago

1) The details of these symptoms don't chance my opinions or advice. They are by far most consistent with anxiety raising your sensitivity to trivial or normal sensations, as suggested above.

2) Most likely your wife did not need treatment, regardless of the timing of when you had sex with her, and there is nothing in your story that suggests she needs more treatment now or that your symptoms have anything to do with sexual exposure to her.

3) As for the urologist and possible prostatitis, I would recommend you look up "chronic pelvic pain syndrome", which causes symptoms similar to prostatitis. Lots of google hits, and I would suggest you start your reading with the very good wikipedia article and information you'll find from the Stanford University department of urology. You're going to see a whole lot of overlap with your symptoms and overall story, including the likelihood that the underlying problem is genitally focused anxiety. You'll also read that your self-diagnosis of muscle tension in the genital area is right on the money. It's really the equivalent of tension headaches, which also are due to increased muscle tone, just different muscles. And no, prostatitis is not known to result from oral sex; and prostatitis is not transmitted to sex partners.

A basic take-home message is that not all symptoms mean disease. Ankles ache long after the sprain has healed, and back, head, and muscle aching from time to time are part of being human and we typically don't think twice about them -- we just live with these things. For some people, the genitals have a special place in the psyche, but the principle is the same.

At this point I STRONGLY advise: no further diagnostic tests; no further antibiotic treatment; continued unprotected sex with your wife without worry; and aside from researching CPPS, no more internet searching about your symptoms. They appear to be improving now and I expect they will continue to fade away.

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107 months ago

Hi doc.

1. I find it strange that On initial ngu test 2 weeks after encounter that it was negative. I though that it was possible to test after only a couple of days. Do you think that my constant squeezing and obsessing over and std could have caused the second swab to be over 5wbc. Think the doctor I seen on one of my visits said it was about 7wbc observed.

2. When you said there was nothing in my story that suggested that my wife needed treatment. I forgot to mention that around the time on my symptoms she had a case of thrush or bv as she said she felt uncomfortable down there. Only lasted a day and she had no discharge. Then about 2 months later she had pains in her belly for a week or so.

When dx with ngu, we both took meds and didn't have sex of any kind for about 1 month and only after I had been retested and proven clear. Does this change your assessment in any way?

I thank you for your time and patience. This has been truly liberating to speak to a physician of your status and expertise.

107 months ago

I forgot to add. I have read many articles about ngu. On the bashh guidelines it states what you have said.

"There is no direct evidence of treatment benefit to partners of men with chlamydia-negative NGU"
Given the fact that I have tested negative for all std. Is your assessment and advice still the same.
Thank you

H. Hunter Handsfield, MD

107 months ago

1) Yes, persistent checking, squeezing, etc could have caused inflammation that would show up as urethral WBC. However, as noted above, entirely healthy men from time to time have a few WBC in their urethras. Either way, by itself it is not evidence you had NGU.

2) Neither bacterial vaginosis (BV) nor yeast (thrush) is related to NGU, and neither is an STD. Those problems in your wife were unrelated to your sexual exploits or your genital/urinary symptoms.

I am aware of the BASHH guidelines on NGU -- I didn't remember they had a specific statement about partners of me with nonchlamydial NGU, but glad to see it. My assessment of your situation is unchanged and I would suggest you carefully re-read all my comments above, then do your best to let this go. All is well!

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