[Question #2365] NSU Query

45 months ago

I asked a separate question yesterday regarding some NSU concerns which is currently active with Dr. Handsfield. My understanding is that I’m allowed 2 questions per 6 month period so would like to clarify my understanding on a separate incident, again NSU related.

I am now happily married but previous to this  in June last year I had an unprotected one night stand  outside of my relationship with my now wife with a work colleague . This was unprotected vaginal sex multiple times (10+ separate exposures over course of night).

A week or so later I felt wetness in my fitted swim shorts on two separate occasions on different days, I can’t remember if I looked at it or just put my hand down my shorts to feel it but it felt like what I would call slimy mucous, similar to pre-ejaculate completely covering the head of my penis. The abnormal element was that I hadn’t been aroused before noticing it.

I had swabs for NSU at 14 or 21 days post this exposure (can’t remember exactly as it's unclear on my calendar) and no white blood cells were found. I tested negative for chlamydia and ghonnoreah. I also had a home test for M. genitalium, trich, U. Urealytcum at 5 weeks post exposure via a supplier that uses the same lab as Freedom Health – again, all were negative.

-         Q1. I emailed (online consultation) Dr. Sean Cummings at Freedom Health to confirm whether I could trust the negative swab at 3.5 hours post urination (Freedom Health didn’t do the swab, it was done by an NHS nurse in a GUM Clinic) – he confirmed this was a reliable period of time. Do you agree?

-      Q2. I also asked that even if the swab had somehow missed an infection and I did have NSU the fact that I had tested negative for chlamydia, ghonnoreah and m. genitalium would mean that it could be ignored anyway with no fear of harm to my partner and again Dr. Sean agreed. Do you agree with this?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
You didn't need to start a new thread; I was about to respond to your last question in the other one when this arrived. There's no specific limit on no. of questions -- except that repetative, anxiety driven questions cannot go on indefinitely and some users get warnings to stop. But that doesn't apply here (at least not so far!).

I'm confused by the differences in your story vs the other thread. You said you were diagnosed (more than once, I recall) with NGU (same as NSU), but here you describe no such diagnosis. Based on the current description, I would not have been very suspicious of NGU based only a single episode of apparently clear discharge (implied by your liking it to pre-ejaculate fluid). I would wonder if you happened to have moved your bowels soon before it appeared, perhaps expressing prostate fluid (a fairly common occurrence in some men). In any case, a single episode of clear discharge that does not continue is not suggestive of urethritis. Absence of WBC by swab is also strong evidence against it. I'm not familar with any home self tests for trich, UU and M genitalium. You mention in the next line you apparently had negative tests for gonorrhea and chlamydia; I'm also unaware of home self testing for those. Also not sure what advice you hope to gain beyond ehat you heard from Sean Cummings and/or his staff at Freedom Health. They are equally expert as am I or Dr. Hook. For sure they must know more than I do about the reliability of home self tests for all these infections.

Q1) I agree with Sean. There was no clinical evidence you had NGU, and I would guess the lab tests for the various pathogens are reliable.

Q2) I think I agree here too. There are no guarantees that pathogen free NGU is harmless for female partners, but it's a good bet. But in any case, you didn't have NGU. Don't overthink it:  "what if" questions about unlikely scenarios really aren't helpful, in my opinion.

Best wishes--  HHH, MD

45 months ago

Apologies, this question, whilst NSU related, is completely distinct to my previous one yesterday. This relates to something from last year – the other one is related to partner notification from historic events. Given I’ve paid for 2 separate questions it would be really appreciated if you could re-open the other one as I have distinct questions relating to it. These aren't anxiety related but linked to concerns for partners health, including my wife's. Thanks for your understanding Dr. 

 With regard to this most recent question:

- As I stated, I noticed the discharge on TWO separate occasions (may have even been 3), not a single one, c. 1 week, on different days, following  my unprotected exposure .  There was a lot covering the whole end of my penis on at least one of these occasions. I also hadn’t been to the loo beforehand as you suggest might have been the cause.

-          I only noticed it on the couple of occasions I wore swim shorts as they were  tight fitting. I don’t wear tight boxers (so wouldn’t usually feel wetness), I am uncircumsized (so wouldn’t see any discharge) and simply wasn’t looking out for it – including in the shower or when urinating – as I had decided to just get swabbed when I returned to the UK from my business trip (my wife had come out to meet me and we were having sex over this period).

-          Would the swab test have been accurate at a couple of hours short of the full 14 days post exposure? I also read on the medhelp forum that symptoms can start at 15 days so concerned that given I assumed I was in the clear I would have missed an infection that started on day 15 as I wouldn’t have been actively looking and wouldn’t have noticed discharge for the reasons I mention above?

-          Likewise if the swab was done at three weeks I’m assuming any infection would still be there and not cleared on its own? 

I tested  negative for chlamydia and ghonnoreah with the NHS and again when I took the home urine sample test which also tests for M. Genitalium, Trich and UU via an online clinic that uses the same lab as many private London clinics including FreedomHealth.  


Given this clarified info do you see any need for my wife and the girl I had the one night stand with to be treated as a precaution?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
OK, understood. This additional information does not change my opinions or advice. 14-15 days are not a sharp deadline for onset of symptoms. Usually symptoms start sooner, typically 7-10 days.  I would consider a negative WBC exam conclusive well by 14 days. I continue to believe there is no need for your wife or for your other partner to be examined or treated.

But I do think your two questions are closely related to one another. And although you don't view them as anxiety related, I see both as displaying a lot more concern about NGU than usually is warranted. As best we know, in absence of defined pathogens (especially chlamydia and M genitalium), it should be viewed as a minor inconvenience, not an important health issue. There are no signficant long term effects known for either affected men or their partners. In absence of the well defined causes, NGU just isn't as big a deal as you seem to be making of it. Current theory is that many cases are due to adjustment of the urethra to a new mix of bacteria -- a term used by some researchers is "dysbiosis -- and not infection with a potentially harmful pathogen. In other words, that there is nothing wrong at all with the partner from whom someone acquires NGU; treatment may not be necessary, even though we usually do it; and as a corollary, no need for partners to be treated. (Understand this is all theory -- but it supports the notion of NGU as a benign condition. And any case, all the evidence is you do not have NGU, so no worries.)

45 months ago

Thanks Dr, the additional explanation is very helpful.  It would be appreciated if you could answer these final questions for my peace of mind:

-         1. Please confirm you read the fact that I noticed discharge on TWO separate occasions (maybe three), not the single occasion you initially thought you’d read, and the high chance I wouldn’t have noticed any other discharge for the reasons I mentioned (not being circumsized (so wouldn’t have seen it), wearing loose boxers (so wouldn’t have felt it) and fact i simply was never looking for it, including in the shower and when urinating, and this didn’t change your opinion as to it being urethritis?


-          2. I took my swab test 3.5 hours after last urinating. I’ve read on the medhelp forum a recommendation for 4 or even 6 hours. Would you say that 3.5 hours is enough time to wait for an accurate NSU result in any suspected case of NSU?


-         3.  Just an FYI - In the UK the nurse/doctor takes the swab and puts it on the slide and then a lab technician looks under the microscope for white blood cells – does the additional person involved in the process water down the chance of accuracy (the collection process may be different in the US)?


-          4. Based on what you know as a scientist and appreciating one can never say never would you say that IF the swab had missed NSU, given I’d tested negative for all known pathogens  the chance of an unknown pathogen causing harm to my wife is too small to be concerned about?


-          5Finally,  if findings are ever announced – in the short or long term- that unknown pathogens causing NSU can cause serious complications should I inform my wife and the one-night stand partner or is the negative swab at 3.5 hours enough to assume there was never any NSU anyway?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
1. I noted all that. Intermittency of discharge plus absence of WBC are more important.

2. This makes little difference -- certainly not beyond an hour or so. In my clinic we generally ignore time since last urination.

3. The same proccures are used in many clinics world wide; I don't think there is any consistent difference between countries. In any case, if the microscopist is well trained, it makes no difference in test reliability.

4. I agree with that analysis.

5. This won't happen in the foreseeable future. I anticipate that most if not all of the current unknown cause NGU cases will turn out to be due to dysbiosis, as noted above, i.e. nothing harmful to partners and probably not to affected men. Even if a new pathogen shows up, it will take many years to work it out. It took 20+ years from discovery of M. genitalium to confident results that it causes about 15% of NGU, and even now there is uncertainty about whether or how often it causes important problems in women.

Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about these exposures, testing, and concerns about NGU or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.