[Question #3471] I can only think of Nongonococcal urethritis (NGU) - Follow-up to #3193

35 months ago
Adding from Question #3193, I have already gotten majority of viral tests. All taken exactly 6 weeks after encounter. Hep B antigen, Hep C, HIV duo. All non-reactive. Still no other symptoms except throbbing/radiating pain in urethra (around base of penis)

After blood extractions, I took a prescription medicine suggested by a urologist. It's called Monurol (Fosfomycin). After I ingested it by mixing with a glass of water on Jan. 29, the mild urethral discomfort disappeared completely for around 1 month (month of February). But it's back. It has been about 2-3 weeks since I started feeling that sensation again &is present everyday (mild enough to not cause disturbances in daily activities, but it's there). I have come to realize that perhaps bacteria (I assume) were not killed off. 

I never took syphilis , HSV IGG blood tests, urine test for gonorrhea & chlamydia. I asked my urologist for gonorrhea & chlamydia screening, he said clinic only had urine culture & it was not guaranteed to work. I'm from the Philippines.  Doctors here are clueless on STD's. Asked 2 urologists & they're not close to diagnosis of experts here. I don't want to take antibiotics unnecessarily & need treatment recommendation.

The girl I had unprotected sex with surely had bacterial vaginosis (BV) due to odor that gets worse during sex. Based on the 2 articles below, there's an association between BV and NGU for men.

http://sti.bmj.com/content/77/2/139
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195895/
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I'm sorry these symptoms continue to trouble you.  I have a small number of comments in addition to my earlier responses.  There is still little reason to be concerned about STI and clearly the health care providers you have seen feel the same way.  Fosfomycin is an antibiotic used two different ways- as a single dose treatment for urinary tract infection or, for prostatitis as multiple treatments given over two or more weeks.  The drug has not been used and is not recommended for treatment of STIs including NGU.  The fact that you improved but that your symptoms recurred may indicate that you have prostatitis and need a longer course of treatment.

As far as the BV-NGU treatment issue is concerned, I would pint out that both of the papers that you mention are over 15 years and research since that time has not confirmed the association that is described. 

No change in my earlier assessment this problem seems not to represent an STI.  EWH
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35 months ago
I'm not so concerned about viral STD's anymore after passing the tests and conclude i'm most likely free from lifelong STD's. But i'm concerned how to correct the very mild throbbing/radiating pain thinking it might cause problems in the future. It does not seem to pass behind my testicles and believe it is localized near the base of the penis. I have never felt such sensations until about 1 week after the sexual encounter so I just cannot help to think that some kind of garden variety bacteria entered my urethra in some way through that encounter.  After reading 2 more recent but still semi-outdated papers back in 2005 and in 2011, it's true like you said that the causal role of BV to NGU is unproved as mentioned by the authors. I also learned that most NGU cases are of unknown origin which was also stated across several sites while looking around. But both the same paper found that men with urethritis exposed to abnormal bacteria in women that has BV, specifically the bacteria, Gardnerella vaginalis and a few other bacteria, do contribute to having urethral symptoms similar to that of NGU. Because of my exposure, the timing, and the unexplained causes, I am at a lost given that a recent urinalysis as of yesterday had nothing. So the only cause I can think of is are due to some bacteria--especially since Fosfomycin relieved the symptoms for a month.

http://sti.bmj.com/content/sextrans/81/2/163.full.pdf
https://sci-hub.hk/https://link.springer.com/article/10.1007/s10156-010-0203-0


Anyway since it disappeared 2 months ago after taking Fosfomycin, should I try taking another sachet to treat the said prostatitis? Also, if it does relieve the sensation like last time, how much doses should I take over what time to cure the issue and prevent relapses and possibly make them Fosfomycin resistant? If you can give an approximation based on your experience that would be ideal. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
 The questions you are asking our beyond the information that we can provide from the site. I advise you to return to the healthcare provider who prescribed the fosfomycin for you and discuss the issue with him. Perhaps a urologist would be helpful. EWH---
35 months ago
Before closing the question, I just want to clarify i'm not exactly sure what the scope of the site is but the urologist will only have the same information as I have mentioned here and it is most likely of sexual origin by nature.  Maybe an opinion of treatment rather than a prescription so I can compare with the urologist? Or is this really beyond your field of treatment? I feel they'll just ping pong me around. Thank you.
35 months ago
One last thing  assumingif a girl was to perform oral sex or have unprotected sex with me, there would be no problem given my issue? 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I sense your frustration and am sorry you are experiencing it.  The purpose of this site is to offer advice and direction to persons who are concerned that they may have STIs, including HIV.  Based on your history, you are concerned that you may have acquired and STI.  In reply I have informed you that the nature of your exposure and the symptoms you report are not those that are typical, of for that matter, either of us has ever encountered in a cumulative more than 75 years of STI-focused practice.  Your negative tests and the interactions you have had with other health care providers who had the advantage of being able to examine you and order tests also support that your current symptoms are NOT an STI.  It is time for you to put your concerns that your current symptoms are due to an STI aside and move on to look for other reasons.  For that reason, I suggested you see a health care provider who specializes in genito-urinary problems beyond STIs- a urologist.  I noted that your temporary response to a single dose of fosfomycin as is recommended for non-STI UTIs suggests that a longer course, f the sort recommended for prostatitis (again NOT an STI) might be warranted but we do not prescribe treatment on this site (it would be unethical to do so without examining you are being able to order and interpret tests).  For that you must see someone who can examine you, order tests, and provide follow-up. 

As for your concerns about sex with others, nothing you had said on your posts here suggest any reason to be concerned about having unprotected sex with others. 

This is my 3rd reply.  thus as per Forum guidelines, this thread will be administratively closed in a few hours.  I wish you the best.  Take care.  EWH
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35 months ago
The fact that i'm here on this forum show how lacking our country is when it comes to medicine specialization. Time and time again I experience ignorance among the doctors here. Back when my intestines were having muscle spasms years ago, the doctors just kept doubling doses of antacids and proton pump inhibitors but what I needed was antispasmodic medicine. With my father a cardiologist allowed the use of 2 drugs simultaneously, namely amlodipine and carvedilol and caused severe hypotension with a BP of 70/40 while out of hospital care and she expected him to take the medicines for 3 weeks before going back without BP checking. If he did not stop the medication and asked for a second opinion who knows what could've happened.  All they do is talk, but rarely ask the details and determine the root cause of things--which is a trait of most skilled specialists. There is also no STD clinics here that I know of unlike in the United States so finding real specialists when it comes to sexual health is a challenge so it's really great this forum exists. We need STD clinics more than ever because after I did a non-linear regression analysis on HIV clinic statistics here back when I did not know what was going on with me and the growth of HIV cases went from flattish (10 cases in the 1990's to 300 cases in year 2006) to exponential in growth with 11,103 cases last year 2017 and 20,000 expected this year and will rise to a 15-20% prevalence by 2040 if not controlled. Anyway, thank you for all the help and patience Dr. Hook. I do feel I need an antibiotic. I just hope I get the right prescription.