Hi

Following our exchange yesterday under the subject ‘Escort Incident’ , given the unexplained stains in my shorts and periodic tingling urethral sensations, I decided to test this morning at an NHS GUM Clinic. The results, have left me completely confused.

The Doctor said she could only see a small amount of discharge in my urethra, on inspection, and so took two swabs (same swab inserted twice) to ensure she got the best sample. The result came back as <5 white cells found and so was negative. I asked exactly how many cells had been found and she said it would be very difficult to find out (no idea why if they need to count anyway!) but 'some puss cells' are completely normal.

My confusion is that whilst the NHS cut off for cells indicating infection is >5, I know that the CDC guidelines now have been revised down to >2. This has obviously left me feeling very confused and concerned I may have NSU.

1)      1. What would your advice be if I had come to your clinic and got this result?

2)      2. If I test tomorrow at a different clinic for a second opinion to find out exactly how many cells are there  is there a risk that the swab today would have caused trauma thus leading to a false positive or should I wait until Thursday?

Thanks Doctor, hopefully you can understand my concerns. 

Welcome back to the forum.  As you probably know, because we always agree with one another, Dr. Handsfield and I answer questions interchangeabley, depending on who picks up the question.  I'll be answering this question and have reviewed your earlier exchange withDr. Handsfield and agree with all that he said, including his repeated suggestions that you may be overthinking your risk for STIs.  Given your concerns however, I would endorse your decision to be seen at a GUM clinic and be screened for STIs.  I anticipate that your tests will be negative and would not recommend further testing until your formal test results for Gonorrhea mand chlamydia are available.  If your tests are negative, I see no reason for further concern or testing.---

Thanks for your advice Doctor. This has left me confused as it would seem that the NHS are telling people they’re infection free that would actually be treated in the US. This leads me to the following concern.

One year ago, before I was married, I had a one night stand with multiple separate unprotected vaginal intercourse exposures over the course of the night (ie. 10 +) with the same girl. A week or so later I felt some abnormal secretions – I didn’t look but felt with my finger that the whole head of my penis was covered in what felt like semen or pre-ejaculate (I hadn’t been aroused or  passed faeces previously that day) - I had this on three separate occasions. I also felt some urethral irritation on various separate occasions. 

 I didn’t keep checking myself or my underwear as I made the decision to be tested when I returned from this business trip, and please note I’m  uncircumsized so wouldn’t  notice any discharge coming from my penis and don't look at my penis head in the shower or toilet. 

I tested on the NHS 14 days post exposure  and was told the swabs showed a negative <5 result. I tested negative also for chlamydia and ghonnoreah. I also tested privately (urine sample at home via a private clinic with the sample sent direct to the lab – same lab as Freedom Health use) and was negative for M. Genitalium, UU, and Trich.

My concern is that there may well have been NSU and if I’d have been in the US my now wife, one night stand partner and I would have been treated.

Question

If there had indeed been NSU (ie.  2-4 white cells which the CDC would say indicated an infection) given the fact that I’d tested negative for all known pathogens (chalmydia, Ghon, MG, UU, Trich, Gardnerella)  would you agree that the risk to my partner and now wife would have been miniscule and thus can be ignored anyway? 

I understand your confusion.  Perhaps I can explain it in a way that will help.  NSU is not an infection but is a syndrome.  Syndromes are used to indicate a group who MAY be infected but many people with the NSU syndrome do not have STIs and their partners are not at risk.  The fact that you have been tested for gonorrhea, chlamydia, trich and Mycoplasma genitalium is more important and a more useful indicatior of the fact that you do not have an STI and that your regular partner in not at risk from your infidelity than that you might have had 2, 3, or 4 WBCs on a stained urethral swab specimen......much more important.  Again, I say emphatically, based on your results, you do not need treatment, you do not need further testing and your partner is not at risk because of your behavior.  I hope you will believe his explanation.  It is meant to explain and agree with what was said to you in previous posts and at the GUM clinic.  EWH---

Thanks for this additional information Dr, much appreciated.  Your  response reads as if you’re still speaking about the most recent exposure with the escort, which after Dr. Handsfield’s and your first response in this thread, I appreciate there is no need to be concerned about.

1.     1, Can you confirm you understood that my concern yesterday is in relation to a different and unprotected exposure one year ago: 10+ unprotected vaginal intercourse exposures with a girl (not a CSW) over the course of the night?

2.      2.  That you understood my concerns with regard to possible symptoms after this event  – clearly abnormal secretions on 3 occasions and urethral irritation on separate occasions (and the fact I wasn’t actively looking and I am uncircumsized so wouldn’t have noticed any discharge that didn’t cause obvious wetness in my underwear) and that any ongoing symptoms after my test would have been ignored as I’d assumed I was negative given the  <5 while cell result?

3.       3. Most importantly, that despite these symptoms,  the ‘<5 ‘ ‘Negative’ NSU swab result,  EVEN IF THERE HAD BEEN 4 WHITE CELLS FOUND,  the fact that I’d tested 4 weeks after this one night stand for Chlam, Ghon, MG and Trich means that the girl from last year and my current wife don’t need to be treated as a precaution and I can put it behind me without fear of risk to their health?

4.       4. Finally. I have always waited just over 2 hours to 3.5 hours post urination for swabs to be taken for NSU. Can you confirm that this is fine for an accurate and conclusive swab and 4+ hours isn’t required? 

---