[Question #2679] NGU Fear

41 months ago
In a previous a post of mine, the doctor said the only definitive test to rule out NGU was a gram stain of urethra.  Is there anything else that can cause WBC in the urethra?  I have been tested for GC, Mycoplasmas, Ureaplasma, Herpes, etc and all negative.  I ask since all test negative and have also been given Doxycycline x10 days, Zithromax 1gm, Zithromax 500mg x14 days, Flagyl 500mg x10 days, Ofloxacin x7 days, and Cipro x10 days.  After all these test and antibiotics, I still occasionally have some clear liquid in the urethra.  I plan to get the urethral gram stain this week, but nervous because I am wondering if it comes up positive for WBC, what is the next step since I have taken so many antibiotics already that would treat NGU.

1)  Is there anything else that can cause WBC in the urethral gram stain? 

2)  If NGU is the only cause of WBC in urethral gram stain, what is the next step?

2)  Could the fluid just be some discharge from the seminal vesicle or something along those line that is normal aging?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome back to the forum, but sorry to see you found it necessary.

You have nothing wrong -- no NGU, no abnormality at all that I can see. And even if you had some version of NGU, it would not matter. NGU with no known cause (chlamydia and all the others you were tested for) is believed to be harmless. There are no known complications of any kind, either for affected men or their partners. But that's really beside the point, since you almost certainly don't have it. A bit of clear fluid in the urethra from time to time is entirely normal -- more common in some men than others, but not in itself a sign of disease or infection of any kind. I recommend strongly that you not see further exam or testing, and for sure that you not have an exam for urethral WBC.

To your specific questions:

1) Urethral WBC has never been a subject of careful research study. We know that presence of WBC supports a diagnosis of urethritis, but in itself is not abnormal and doesn't make the diagnosis. WBC without symptoms and with negative tests for no know pathogens is probably entirely normal in some men -- perhaps more frequent in uncircumcised men, but probably meaningless in anyone. If you were to have a Gram stain that shows WBC at this time, it would not indicate anything important and would not be a cause for further diagnosis or treatment. So don't do it!

2) The next step, as implied above, is to do nothing.

3) Probably such clear fluid is urethral mucus, not from the seminal vesicles. I am unaware of any evidence that it is more common in older vs younger men, and doubt it has anything to do with aging.

So from all I can tell, nothing is wrong and you have nothing to worry about. But if you remain concerned, continue to work with a physician knowledgeable about STDs and genital physiology, such as an STD specialist or urologist with particular interest in infectious diseases. But really, after all you have been through, the tests you have had, and the treatments you have received, I see no need even for that.

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

HHH, MD

---
41 months ago
Hello, so I guess that I'm a little confused.

1) I thought that a urethral gram stain was like the gold standard to prove no NGU and if there were WBC's in the urethral stain then it meant you have NGU and no WBC meant no NGU?  But you said some men have WBC's in the urethral stain but no NGU.  So aren't a bunch of men getting treated upon testing who have WBC in the stain, then retested, to just continue showing WBC?

2)  What is a test to prove that the liquid I'm having is not from some infectious cause?

3)  Can prostatitis cause WBC on a urethral stain?

Thank you 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
These are important questions without clear answers. You've given me an opportunity for one of my occasional blog-like responses that can be used to answer similar future questions in addition to yours. Please bear with me.

1) You misunderstand NGU. It is not a single entitiy -- almost certainly a collection of various disorders with several causes. Fortunately, most cases appear to be harmless, with no known serious outcomes for either effected men or their partners. Some cases may not be due to any infection at all, but result from transient responses to an unfamiliar mix of bacteria (such as oral bacteria or even entirely normal genital bacteria in a new partner), and clear up without treatment or harm. Others may be due to other non-infectious inflammation. The only causes of NGU known or reasonably suspected to be harmful are Chlamydia trachomatis and Mycoplasma genitalium, plus uncommon cases due to herpes and maybe trichomonas. More than half of all NGU cases are due to none of these.

Partly to this etiologic variability,  as well as lack of understanding of the causes of more than half the cases, there is no gold standard for the diagnosis of NGU, certainly not urethral WBCs. Studies back in the 1970s showed that when urethral WBCs are found in asymptomatic men's urethras -- i.e. in the absence of visible discharge, painful urination, or other evidence of urethritis -- half the time the WBC are gone when the men are reexamined a week later. In other words, WBC may be present transiently from time to time in entirely healthy men. Many such men indeed are treated for possible NGU; at the time of the clinic visit, the results of testing (especially for gonorrhea or chlamdya) aren't yet known, and it's less time consuming and much less expensive to prescribe azithromycin or doxycycline than to wait for those tests, perhaps do additional testing, and to have repeated follow-up visits to work out what probably isn't anything important or serious to begin with. I'm sure many (most?) such men are told they had NGU, but that's probably not actually true for many (most?) such persons.

2) There is no single lab test to determine if a particular case or urethral discharge is infectious or not. The appearance of the discharge, WBC, other symptoms (e.g. painful urination), and sometimes tests for various microorganisms all can play roles depending on the clinical situation.

3) The relationship between some cases of prostatitis and NGU isn't clear. However, for the most part they are believed to be entirely separate entitites, and prostatitis rarely causes urethral discharge. Most prostatitis, like most NGU, probably is not due to any infection (at least we know that most prostatitis does not respond to antibiotic treatment). It's also usually harmless, as far as we know.

---
41 months ago
1)  So to ask a similar question, does no WBC on urethral gram stain indicate no NGU?  Or the presence or lack of WBC by itself mean nothing either way?  You had stated that some men have WBC and that could be normal.

2)  If I have some form of NGU,  how long does it take to resolve on its own?  I've been testing for all the known stuff.

3)  My only real symptoms are occasional (once a week maybe) burning after or during urination, usually the length of the whole penis, and I see this fluid inside the penis sometimes.  I've never seen this fluid prior to these symptoms.  The penis also seems to have a glued shut appearance.  Any other ideas or still thinking prostatitis? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
1) Urethral WBC increases the likelihood NGU is present. If obvious symptoms are present (visible discharge, staining underwear, urethral pin or irritation when urinating, a diagnosis of NGU usually is made. If only elevagted WBC are found, that alone does not confirm NGU, even though many such men are treated for the possibility they have it. We are more inclined to ignore a few WBC in uncircumcised men. See my initial reply above.

2) Unknown:  no research has ever followed men over the next few weeks to see what happens to untreated NGU. But since the large majority of infections, including urethral gonorrhea and chlamydia, are self cured by the immune system within a few weeks or months, that's a pretty good guess for the time frame for NGU. Your sympotms are not suggestive of NGU and you should stop testing for anything.

3) This pattern of discharge is far more suggestive of originating from the prostate or seminal vesicles than the urethra. Some men go their whole lives with occasional discharge fom the seminal vesicles, often triggered by defecation. It's not an abnormality, just part of normal human physiology, more common in some men than others. As I have already said at least once (twice?) I remain confident you have nothing that will ever harm you or a sex partner or that requires further medical care or attempts at diagnosis.

That completes this thread. Since it's your second on this topic, and 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 this exposure, testing, and your fears about HIV 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.


---