[Question #2851] Possible NGU, when can I have sex again?

41 months ago
Details:
  • Male 31 yrs
  • Unprotected oral and vaginal sex with 28 year old, don't know sexual history
  • Very drunk couldn't keep erection, accidentally cheated on my wife of 10 years. No other sexual partners in over 10 years. I feel awful and anxious, can't stop thinking about it.   

  • Seeking treatment for alcoholism

Symptoms developed 2 days after exposure:
  • Stinging sensation in urethra after urinating (not during), tip or near end of penis

  • Urge to urinate more often, feeling like I cannot empty bladder completely and some leaking urine after

  • Mild discomfort when sitting for long periods

  • Pain when masturbating and during ejaculation in tip of penis

  • Sensation at the end of penis like there is fluid  sitting in my urethra

  • Sometimes when I bend over or press my bladder against something I feel a sharp pain in urethra

  • No noticeable discharge

  • No rash or bumps (I have oral HSV-1 and understand the appearance of herpes)

Testing Timeline:

2 days after exposure:
  • Full STD panel including Chlamydia, Gonorrhea, Herpes, Syphilis, HIV (ALL NEGATIVE)

3 days after exposure:
  • First Void and Mid-Stream Void Urinalysis at GP Office, Negative for Chlamydia, Gonorrhea , WBC =  0 - 2, RBC  = 0 
  • GP said all lab results were clean including blood work
  • Precautionary 1g azithromycin and ceftriazoxe shot administered on-site

10 days after exposure:
  • Symptoms persisted, some days better than others but not subsiding

  • Submitted first void urine samples to LabCorp and Quest Diagnostics for testing of M. genitalium and Trichomonas vaginalis using NAAT (BOTH NEGATIVE)

17 days after exposure:
  • Symptoms are not as pronounced but still noticeable
  • Approximately 75% relief of symptoms
  • Submitted another first void urine sample of M. genitalium, Trichomonas, Chlamydia, Gonorrhea. Should have results in 2 - 3 days. 

I am trying to repair my marriage, when do you think it will be safe to have unprotected sex with my wife again? 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your message.

Based on all that information, I'm quite confident you have no STD, including NGU, from the sexual exposure described. NGU generally does not cause genital area discomfort, urgent urination, or other genital symptoms. Further, you have been adequately treated in the event you had any STD that conceivably could cause such symptoms, and all the tests you had are highly reliable, and I would not have recommended the additonal tests currently in the works. I'm pretty confident that your symptoms are the physical manifestations of your obvious anxiety over a sexual decision you regret. 

In addition, in case you in fact had an atypical case of NGU, it probably doesn't matter in regard to sexual safety with your wife. The only causes of urethritis known to cause potential health problems in sex partners are gonorrhea, chlamydia, and M. genitalium. NGU without those organisms often may be the urethra's adjustment to entirely normal bacteria, and such NGU has never been reported to cause important problems either in affected men (no urethral stricture, epididymitis, infertility, etc) or their partners. You can safely have sex with her now.

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

HHH, MD

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41 months ago
Thank you Doctor. I appreciate your quick response. 

I have read too many peer-reviewed articles about M. genitalium with macrolide and tetracycline resistance. Then you throw in Ureaplasma urealyticum and my mind starts going down the rabbit hole of anxiety and guilt. It's reassuring to hear this from someone who is an expert in this field. My GP didn't know what M. genitalium was or how to test for it. 

Last two questions and this can be closed:

  • Is it safe to assume that the azithromycin and ceftriazoxe would have treated any potential syphilis infection so there is really no need to retest at 6 weeks unless I develop symptoms?

  • If I were your patient, would you recommend a prostate exam or PSA test based on some of my symptoms? 
    • The symptom "Urge to urinate more often, feeling like I cannot empty bladder completely and some leaking urine after" I have had on and off for a few years. It just seems to be more exaggerated right now.  

Thanks again


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
The chance of M. genitalium from any single sexual exposure probably is quite low (although not much research on it), and it is not known to cause symptoms like yours. The main symptom of NGU is discharge; if there is urinary discomfort at all, it is generally mild and limited to the penis, not bladder discomfort, urgency, etc. It's not surprising your GP isn't familiar with M gen, since routine testing is not widely done or recommended. The large majority of U. urealyticum strains are non-pathogenic, i.e. cause no disease; usually it's just a normal bacteria in the genital tract. (At any point in time, 50% of all sexually active people are carrying UU.

Yes, ceftriaxone for sure and probably azithromycin as well would have eliminated syphiliis if you had been exposed, and for sure no need to test for it at 6 weeks or any other time.

That you have had your current symptoms for years, and now merely "more exaggerated", goes along with no association with your recent sexual indiscretion, other than stress/anxiety resulting from that event. I definitely would not recommend a PSA test at your age. However, evaluation by a urologist would be a good idea. Your symptoms are suggestive of overactive bladder, and prostate exam often is done in this situation. OTOH, you're quite young for prostate enlargement or obstruction. So I would advise seeing a urologist, and then follow his or her advice about what evaluation is indicated.

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