[Question #2528] NGU

45 months ago
Hello,

1)  I am curious why you say that non-chlymidial NGU self resolves on its own or even chlymidia for that matter.  Everything I read on the internet says it does not self resolve.  Is there some data or studies that show this?  Doesn't it cause epididymitis, orchitis, etc?  Can the other agents like mycoplasma genitalium, hominis, and ureaplasma cause epididymitis, orchitis, or anything else?  Are there other NGU besides the mycoplasma genitalium, hominis, ureaplasma, adenovirus, and herpes?

2)  I seem to have some clear liquid in my penis (not all the time) and really worried.  Is it not NGU since it is not continuous?  What can it be?  Is there any test confirm that it's not an infection?  I've had a first pass UA, testing for GC, Trich, mycoplasma genitalium, hominis, and ureaplasma, and all negative.  Can it be any other infection that I don't know?   I occasionally get a burning when I pee at the tip or rarely the whole length of the penis.  Had this for 5 months now, but symptoms not always constant.

3)  This seems to have happened soon after I got penile eczema.  Can the ezcema go inside the urethra a little and cause oozing?  The liquid seems to be minimal and distal.  I sometimes have a split stream when pee.  

Thank you


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

1) Most infections are cleared eventually by the immune system, sooner for some infections and longer for others. There are plenty of exceptions, like tuberculosis, syphilis, herpes, and others. However, immune system clearance is the rule for the large majority. In the pre-antibiotic era, most people (90% or more) with pneumonia, diphtheria, bacterial dystentery, scarlet fever, and other infections eventually got better. Of course some people died or suffered severe complicaitons -- but most did not. Gonorrhea clears up, usually in a few weeks in men, a few months in women. For chlamydia, 90% of infected women who do not receive antibiotics are free of infection after about a year, and the longest infection ever documented was 4 years.

In people with first episode (non-recurrent) NGU, chlamydia causes about 30%, M. genitalium 10-15%, and trichomonas, HSV, and adenovirus 1-5% each. M. hominis is not a cause. Ureaplasma is controversial -- it probably causes some NGU cases (under 5%), but the large majority of Ureaplasma is harmless and is recognized as an entirely normal bacteria in the genital tract. All together, these things cause roughly half of all NGU cases, i.e. the cause(s) are unknown in almost half. When speaking about recurrent NGU after previous treatment, the cause is unknown in 90% or more. Some cases may not be an infection at all, but some sort of non-infectiious inflammation, or perhaps just the urethra's adjustment to exposure to a new partner's normal genital or oral bacteria. Chlamydia is the only cause of NGU known to cause epididymitis, orchitis, etc. Equally important, only chlamydia and perhaps M. genitalium are known to cause health problems in men's female partners.

2) Inconsistent symptoms like yours usually are not due to NGU. Have you been examined for evidence of urethral inflammation (i.e. white blood cells) when symptoms are present? If so and that was negative, then you don't have NGU. Perhaps more important, your negative tests for all those infections are reassuring. I would be much more suspicious you might have prostatitis (which is not an STD).

3) I've never heard of eczema extending inside the urethra and I'm inclined to doubt it happens. But I can't say for sure -- a dermatologist might have more information about it.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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45 months ago
Thanks for the response.  I forgot to mention that I also get a stabbing kind of pain in the urethra occasionally.  Sometimes more evident after ejaculated the next day, but not always.

To ask for clarification on your response to my question #2,  

1)  Can prostatitis cause that kind of clear liquid in the penis?  Also, prostastitis is not caused by any ngu bugs?

2)  Does NGU usually have constant symptoms like burning every time when pee, always liquid in penis, etc?

3)  How do I get a test for urethral inflammation?   Is this a gram stain or what is this test called that I can request from a doctor?   Do I get it done only when liquid present in the penis or anytime?   If it's NGU, wouldn't the WBC be there anytime, regardless of symptoms? 

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
1) Completely clear urethral discharge (not cloudy at all), usually small in amount, usually is normal. It might occur in prostatitis, but usually does not. Prostatitis is not known to be due to any of the bacteria etc that cause NGU. (There have been theories and beliefs about NGU being related to prostatitis, but nothing has ever been scientifically documented.)

2) Yes, NGU symptoms typically woudl be constant, not on and off.

3) A gram stain of a urethral swab is the main way to documented WBCs/inflammation in the urethra. A leukocyte esterase test on the first ounce of voided urine is sometimes used, but is less accurate. Any doctor's office can do either of these, but to my knowledge no labs do them independently or offer them through online testing services. And yes, just like symptoms, WBC in the urethra would be there more or less continuously, except that such testing may be negative if the patient has recently urinated, washing out the urethra. These tests are best done when the patient hasn't urinated for a couple of hours or more.

It seems you are more worried than necessary about all this. Having had negative tests for all those bacteria, you can be confident you don't have NGU; or if you do, it will never harm you or any future or current sex partners. It sounds like you have symptoms without disease. I doubt you have anything to worry about.

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45 months ago
I had my doctor about a gram stain before, but he had said they only do that on the secretions/discharge, but I had none at my visit.  They can also do urethral swab gram stain of the urethra it seems I should be asking for?  Can a walk in clinic do that? 

Also, don't they look for WBC on the UA if it's with microscopy?   Is that accurate or it's like the leukocyte esterase in the sense that it may not be accurate? 

On a related and unrelated note, I sometimes feel like my underwear is wet when walking,  mostly in pants, but it's not.   Any ideas why I am experiencing this?

Concerned about the liquid as little and infrequent as it may be among with the on and off symptoms.   I have heard that abacterial chronic prostatitis is a lifelong thing and you just have to deal with the symptoms which is the troubling part.

Thank you 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Yes, a small swab can be inserted into the urethra to look for WBC by gram stain. However, I don't recommend it in situations like yours. Yes, urine is examined for WBC but it's a poor test for urethritis. Your sensation of underwear wetness sounds like a perception problem, perhaps psychological in origin. Indeed non-infectious prostatitis can persist a long time, and some men just have to live with the symptoms. But most have no problem doing so once they understand they have nothing harmful. People live with minor symptoms all the time, whether genital or low back pain or the now healed ankle aprain that still hurts. If you're not under the care of a urologist, that would make sense. But I'm confident you don't have NGU, probably not prostatitis, and almost certainly nothing that will ever cause harm. Many if not most or all your symptoms sound psychological.

That completes the two follow-up comments and replies included with each forum question and so concludes this thread. I hope the discussion has been helpful.
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