[Question #3757] NGU Closure

35 months ago

Docs, I ask for compassion and forgiveness for posting one more question. I assure you, it will be my last. But my circumstances are causing great prospective harm to my family and I've turned to local providers with no avail. Please accept this last inquiry without judgement or disappointment.  
I received brief oral sex from a massage provider, no completion, as well as analingus. I have tested negative for all other STD's at the proper testing periods. I have visited my GP who only provided a dipstick test, which was negative. He was not knowledgeable. I visited a urologist, same result. I asked for a swab and he said there was no fluid to swab. What I wanted was a WBC urethra swab for closure and I didn't get it. I am now lost, seeking closure and can't find it with local professionals.  
Symptoms: It's been over 2 months since exposure and no dysuria. I have not seen discharge, although I can't tell if stains in underwear urine dribble or discharge. I have experienced, what feels like, urethra pain, sometimes stinging-like, sometimes aching. I have also felt pain and irritation in my perineum, but not always together. I have experienced penis tip irritation and redness. It is not constant, but there a majority of the time, even after my celebratory negative tests for everything else when I hoped to put it in the past.  

1) Could the irritation symptoms noted above, which started about 2.5 weeks, be indicative of infection, although it doesn't burn when urinating? 

2) I found an old 2009 Medhelp thread with Dr hook where a fellow started experienced NGU symptoms after 3 months. Is that possible? I'm afraid this risk of time is what is haunting me, as we are about to purchase a house and this would destroy everything if so. 

3) If it was NGU from oral, and I had to treat, does my partner need treatment as well? Again, devastating to my family and child.

4) Is there an opportunity for a blog-like response to close this for me and others? I’m seeking psychotherapy too. 

Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Its unfortunate to see you back again.  Your questions are repetitive and quite similar to the questions you asked both me and Dr. Handsfield.  Repeating your questions is not going to change my answers or my assessment that you have NO EVIDENCE of having an STI and that your problem is not one of an infection but related to your unconrtolled anxiety, presumably related to guilt over the brief encounter you described.  Further, as part of response to your last set of questions, Dr. Handsfield warned you that further questions could be deleted without comment.  For reasons that escape me, I will try, once again try to convince you that your concerns are not warranted.

On to your questions:
1) Could the irritation symptoms noted above, which started about 2.5 weeks, be indicative of infection, although it doesn't burn when urinating? 
As Dr. Handsfield and I have both explained, the symptoms you describe in no way suggest an STI.  This answer will not change!

2) I found an old 2009 Medhelp thread with Dr hook where a fellow started experienced NGU symptoms after 3 months. Is that possible? I'm afraid this risk of time is what is haunting me, as we are about to purchase a house and this would destroy everything if so. 

I do not recall that response from 9 years ago, nor the circumstances.  Rather I would point to your current test results, the assessments you have received from both Dr. Handsfield and I and the assessments from your own doctors who found no evidence of infection.  Put another way, no trained professionals agree that there is a reason for you to be continuing to worry.

3) If it was NGU from oral, and I had to treat, does my partner need treatment as well? Again, devastating to my family and child.

No, even if you had NGU (again, there is no evidence you do), there is no need for treatment of your partner.  None!!!

4) Is there an opportunity for a blog-like response to close this for me and others? I’m seeking psychotherapy too.

You've had multiple responses.  It is now time for you to believe them

EWH

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35 months ago
Thank you Doctor. It's the definitive tone and directness that works best for my communicating style, and I greatly appreciate the tough love. I'll try not to be repetitive and very quick for this final question: 

1) Although there is no evidence of infection today, how far out would one expect symptoms to be nearly impossible from this event? Is this something that could still take another month or two, or could we say that 8.5 weeks is enough already, not a chance it will ever come to that, absolutely no need to think about it further? 

2) Simply put: Urethra burning, discomfort, and penis tip irritation WITHOUT burning urination or clearly seen discharge is unequivocally NOT caused by NGU, even if the burning/irritation started a while back and persists? 

You're right about my anxiety of course, but the problem with NGU is, I can't get a definitive test result like other STI's. Without clear negative results frmo a test, I'm clearly hard to convince that this discomfort is just anxiety. 

Thank you both for your patience and professionalism. I am sorry to have been overly dramatic. 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
1.  The further you go from the exposure, the progressively less likely it is that symptoms will begin.  I would say that a month is the outside limit for symptoms related to a specific exposure. If you are 8 weeks out, you should be confident that you are not going to develop symptoms related to the event.
2.  Correct.

EWH
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35 months ago
Thank you. I will officially move on from NGU being a concern. 

Lastly, during this event I received a few minutes of  having my anus and perenium licked, much longer than my penis was. Through these difficult past 8 weeks,, I have experienced burning of the perenium area as well as entire pelvic region which is what brought me here. Nerves are extremely likely, but to just close the loop permanently:

1. Should there be a concern over anal infections of some sort, gonorrhea? Bowel movements do not hurt and I have no evidence of discharge or blood. The area appears red, but I usually don’t analyze it like I am now. (If you look back at my older posts, I was clearly complaining about perenium burning) 

2. Would you recommend seeking out some sort of exam and testing? If I presented to you with this concern would you bother looking?

3. Even if it somehow was gonorrhea, would my system clear it without treatment? 

4. Are anal infections from licking common enough to be a concern? Are they more rare? And if I didn’t get it on the penis, there’s a solid chance there’s no way it would be acquired anally and causing my discomfort? 

Thanks again. I struggle when things aren’t black and white. I just want to move on today and be done. I will not post again. 


Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
Having again dismissed your concerns about NGU and penile pain I now find your shift to questions about your anus to be indicative that the problem is not infection but your psychological distress regarding an encounter which you now profoundly regret.  I will briefly address your new, shifted concerns and then the thread will be closed.  No further questions of any sort on this encounter will be accepted.  Instead of continuing this unwarranted effort to "find" an STI, I urge you to seek professional counseling to address your anxieties and guilt.

For your questions:
1. Should there be a concern over anal infections of some sort, gonorrhea? Bowel movements do not hurt and I have no evidence of discharge or blood. The area appears red, but I usually don’t analyze it like I am now. (If you look back at my older posts, I was clearly complaining about perenium burning) 
No, anal licking does not put you at meaningful risk for ANY STI.

2. Would you recommend seeking out some sort of exam and testing? If I presented to you with this concern would you bother looking?
If I saw you initially I would evaluate your complaints.  I would not re-examine you or test you for repetitive complaints or implausible infections of the sort you suggest

3. Even if it somehow was gonorrhea, would my system clear it without treatment? 
Yes another "what if" question.  Over time, many gonorrhea infections do indeed clear themselves, irrespective of the location.

4. Are anal infections from licking common enough to be a concern? Are they more rare? And if I didn’t get it on the penis, there’s a solid chance there’s no way it would be acquired anally and causing my discomfort.
No, anal infections from analingus are not a concern.

You really need to move on.  End of thread.  EWH
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35 months ago
Thank you sir. Your comments are very helpful. My anus is very red, and like I’ve said, I have experienced perenium, and pelvic pain that has been radiating throughout my entire genital region. While it may seem like I am just bouncing around, I really didn’t think much about the risk of minutes worth of tongue massaging there. Although I seem crazy, is it far off to think that a longer exposure of tongue to tissue would not put me at risk of infection, and more importantly, explain the pain sensations I began feeling after week 2, previously documented? Would I have pus dripping out of the anus? Would it be unmistakable? Thanks again, I’ll promptly leave he forum now....