[Question #2982] Does this sound like NGU?

42 months ago
so i have a dull pain in my urethra, that goes in and out, throughout the day. Started in april, went away. Came back in july, then went away, now its came back in October. i also believe i have redness at the tip of my penis, but this goes in and out as well. more pronounced after ejac.  I have no pain during urination, but do urinate frequently sometimes. I have no pain ejaculating, but a couple minutes after ejaculation the pain starts. again its a very faint pain, but causes discomfort with my underwear. i haven't masturbated for two days, now i have no pain. the symptoms commonly are more pronounced at night. Also urine seems to be stuck in my urethra , commonly at night as well. I'm not sure if its a discharge, but i have clear liquid, that comes to the surface of my penis head after ejaculation and urination only. its sticky, kind of looks like semen, it doesn't ooze out of penis. it just sits there in my penis head, and i dab it with toilet paper, then commonly i feel slight dripping in my underwear after. i was tested for herpes 1 and 2, gonn, chlaym, trich, hiv, hepb, hep c by blood and urine negative for everything. Also i been too two urologists both gave me physical exams and stated nothing looks wrong. the only things i can think off are over anxiety, too much masturbation with edging, ngu, or prostatis? does this seem like ngu though? i just want to be safe. was also given a urinanalysis, nothing abnormal was found.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome back to the forum. I scanned your recent discussion with Terri; FYI I agree with her reassurance about herpes.

In addition to herpes, we can be confident you don't have any of the other STDs for which you were tested (but more below about trichomonas). However, if I correclty understand your description, you may have an abnormal urethral discharge and I have to wonder if you indeed have NGU or prostatitis. It is unlikely these would be missed by two urologists, but it's possible, depending on their expertise and details of their evaluations. (Not all urologists are highly familiar with STDs or NGU, believe it or not.) If you a patient in my clinic, we would carefully examine for discharge, ideally when you haven't urinated for at least 6-8 hours, preferably overnight. If abnormal discharge is present and contains increased white blood cells by microscopy -- or if no discharge but a swab passed into the urethra shows WBC -- the diagnosis of NGU would be confirmed.

If that evaluation is unrevealing, other evaluations should include a "three glass" urinalysis for WBC and culture (for non STD bacteria), i.e. the initial 10-15 ml of urine (the first tablespoon), midstream, and following prostate massage. If the previous trichomonas test was microscopic or a culture, that's not adequate -- it should include a nucleic acid amplification test (NAAT, i.e. DNA test). Beyond all this, a prostate ultrasound might also be useful, depending in part on the results of these other tests.  

Masturbation, no matter how frequent, shouldn't cause any of the symptoms you describe -- except if especially frequent and vigorous, maybe pain (but not discharge). Anxiety is always a good bet for unexplained lower genital symptoms, and when someone suspects his or her own symptoms have a psychological origin, usually s/he is correct. However, you and your own doctors are in a much better position to judge this than I am.

A physician or clinic experienced in STD diagnosis and management would be the best choice for this sort of evaluation. If your local or state health department operates an STD clinic, that's probably the best bet (or an equivalent clinic, if you're not in the US).

Don't over-interpret all this advice. Not all your symptoms fit well with NGU or prostatitis, so don't get your hopes up too much for quick answers. In the meantime, don't be overly worried. These symptoms may be uncomfortable (and disconcerting even if mild, until you have a clear diagnosis), but they don't sound serious. This is not likely to be caused by anything dangerous for you or your current or future sex partner(s).

I hope this information is helpful and gets you started on a track to the answers you seek. Let me know if anything isn't clear.

HHH, MD

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42 months ago
Thank you doctor. I read a lot of your blogs about stds when I was going through molluscum, In which has cleared. Your advice and diagnoses are always very helpful. Thank you for that. Yeah I just know something's not right. My one urologist gave me a urine ngu test today, but wouldn't give me a swab. My other urologist didn't test me, said there's no other tests to run. He prescribed me doxy and some other antibiotic, that you take 4 pills at once, only once. My urologists have dismissed prostatis due to my age, I wasn't even given a prostate exam, I don't know if the urinanalysis giving to me, checks if you have an enlarged prostrate or not, or if white blood cells come up on it, to envoke an ngu diagnosis. I'm worried about mycoplasm genitalum. The other ngu diseases I don't care about because I read they go away fairly quickly. The one I was scared of was herpes urethritis, but that was confirmed with a blood test. My only fear iis that this issue comes uncorrectable, like spreading To my prostate. because I have had I it on and off since April and my doctors aren't being too proactive. If it's 100 percent curable I wouldn't worry, but everything has its parallels. So I'm not sure what to think or what to do 
42 months ago
And my masturbation tendencies were 3 times a day,. with intercourse the same day as these 3 sessions once or twice a week. Sometimes I would masturbate 5 times in one day, but sex wouldn't be included. All my unprotected exposures in the past 2 years is from oral sex giving and receiving. I had one unprotected vaginal intercourse exposure almost a year ago. And yes I am in the US. In New Jersey 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
There is no such thing as a "urine NGU test". One can look for WBC, but this isn't helpful if not done right (and often not then). Prostatitis is more common with rising age, but not rare in younger men.

I'm sorry I didn't know previously about the doxycycline and azithromycin (the 4 pills, single dose). Continued NGU after such treatment, if confirmed, indeed elevates the possibility of Mycoplasma genitalium, but also trichomonas, which is a lot more common. OTOH, neither of these is possible from oral sex -- neither is carried in the oral cavity -- and although it's possible this all goes back to the vaginal sex a year ago, it seems unlikely. Reliable testing for M gen isn't widely available, but trich testing is (as discussed above). If objective evidence of urethritis is found by a competent examiner who will not blow off your complaints, as one or both your urologists might have done, and if NAAT (DNA) for Trichomonas vaginalis is negative, it would be reasonable for you to be treated with moxifloxacin, the drug of choice for M gen. (Alternatively, you could be treated for both trich with metronidazole or tinidazole, and M gen with moxifloxacin. But the preferred approach would be testing and basing treatment on those results.

In any case, I reiterate my comment above about all this probably not being serious, and that includes most M genitalium infections. Nothing bad is likely to result from all this; in my 40+ years in the STD business, I have never once seen a serious outcome in a male patient with unexplained NGU or prostatits, or his sex partners. As for "I'm not sure what to think or do", I would suggest again you follow my advice above:  find an infectious diseases or STD specialist and take it from there. Just do it. You could print out this thread as a framework for discussion.

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42 months ago
Thanks doc. One last thing what does this sound like most to you? Trich, m gen or prostatis. Also how long do these typically take to cure after antibiotic use? Just opened my urinanalysis. No wbc in urine, no bacteria just a little mucous was present 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
With normal urinalysis, all three are unlikely. The symptoms of all three often are identical. As I said above, I suspect nothing is wrong at all; in the unlikely chance you have trich, MG, or prostatitis, I would judge them equally likely. 

That will have to conclude this thread. I'm afraid the forum can't help you further -- I have given all the advice possible from this distance. Best wishes.

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