[Question #416] very worried ngu

34 months ago

happy new year Dr! ,39 yr married old male here, I made an dumb mistake and had an encounter with a woman I don't know 9 months ago. unprotected oral and quick anal, we stopped as it was unpleasant. one week later I had sex with my wife twice unprotected. a week or so after that I noticed very clear discharge from my penis, burning when urinating, blood in urine and red tip urethra.  went to walk in, they gave me 1 g z pack and a needle in buttocks forget the name for gonorrhea and chalymdia in tested me for both.  days later results came back both neg. my symptoms cleared up and my dr said it must have been a uti or prostatitis - I took cipro for a week and symptoms have not returned - I waited 10 days after the z pack to have sex with my wife again after being told I was sti free and have not had any symptoms since.  two weeks ago I was researching prostatitis symptoms as I sometimes have a dull pain in testes, lower back pain, frequency to urinate especially at night (more so the past two weeks which I think is stress/anxiety/prostatitis related) and discovered ngu which I had never heard of and am now worried that maybe I was infected and in turn infected my wife and put her at risk.  we have had sex about 70 times the past 8.5 months always unprotected. I am very worried  after reading that forum and learning about ngu and have the following questions for you please:

1. do you think I was infected 9 months ago with ngu?

2. if so do you think my wife was infected and I could be re infected? she has not had any symptoms nor have I other than the ones noted above the past two weeks (stress/prostatitis?) .

3. are there fertility or health issues for her or me if you think we were infected?

4. Is ngu easily passed from male to female?

5. I am in Canada and can't find any tests for ngu for men or women...do they exist?

6. is it safe to say that after 8.5 months and me presumably not being re in infected after 70 times having sex that she was not infected and is in the clear I do not need to mention this encounter. I love her very much and don’t want to lose my marriage but I also don’t want her health at risk due to my stupidity.

7. my wife has had BV for years, are NGU and BV connected and if so could I have got ngu from her and not the encounter?

8. can monogamous couples get NGU?

Please help – thanks so much


Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to the Forum.  I will try to help,  NGU is the most common form of urethritis in men and can be caused by a variety of organisms including chlamydia, mycoplasma genitalium, trichamonas and a variety of less common organisms.  Further in about 30-40% of men it is unclear what causes NGU.  Most NGU is treated based on clinical presentation without a lot of testing using either azithromycin (in a single 1 gram dose rather than with a Z-pak as you were given) or doxycycline, 100 mg daily for 7 days.  Other than for NGU caused by chlamydia, mycoplasma genitalium, trichamonas it is debatable whether or not treatment is needed.   

1. do you think I was infected 9 months ago with ngu?

Yes, this was probably NGU.  It is doubtful that you had prostatitis.  Few men under 40 get prostatitis.


2. if so do you think my wife was infected and I could be re infected? she has not had any symptoms nor have I other than the ones noted above the past two weeks (stress/prostatitis?) .

It would depend on what organism was present.  Further, if your wife has regular GYN evaluations, it is recommended that she be tested at that time although many doctors, unfortunately do not do the recommended testing.

 

3. are there fertility or health issues for her or me if you think we were infected?

There is concern that some of the organisms that cause NGU in men can cause pelvic inflammatory disease in women after getting into the upper genital tract,  This is turn can lead to infertility, increased risk for ectopic pregnancy or chronic pelvic pain.  If your wife has remained asymptomatic for 9 months, it is unlikely that this occurred.


4. Is ngu easily passed from male to female?

When present, the organisms present in men can be transmitted to women at a rate estimated to be 20-40% per act of intercourse.


5. I am in Canada and can't find any tests for ngu for men or women...do they exist?

Yes, a sexual health or STD clinic present in most Canadian cities can provide you with further evaluation and, if need be treatment


6. is it safe to say that after 8.5 months and me presumably not being re in infected after 70 times having sex that she was not infected and is in the clear I do not need to mention this encounter. I love her very much and don’t want to lose my marriage but I also don’t want her health at risk due to my stupidity.

It is more likely than not that you got lucky and had non-chlamydia NGU which did not infect her.  I would recommend you seek further evaluation at an STD or sexual health clinic to guide your decision making however.


7. my wife has had BV for years, are NGU and BV connected and if so could I have got ngu from her and not the encounter?

It appears that BV and NGU are different processes.


8. can monogamous couples get NGU?

Yes

Your situation is complex.  My advice is to start by seeking a thorough evaluation at a local STD or sexual health clinic. These are typically provided by public health services.  EWH


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34 months ago
Thanks Dr Hook for your response. A few follow ups please...

1. Would it be very rare for me to not be reinfected after having sex with my wife 70 times since this exposure?

2. Do you reccomend that I get a swab test even though I have been symptom free for 9 months and have tested negative for chalymdia and gno and hiv several times since the exposure and if so what do I ask them to test for and how long do the results take to get back.

3. It seems as though your fellow Dr on this site (sorry I forget his name and can't to close this link to check from my phone) thinks that gnu is usually not a health concern to partners of infected males and in most cases cause no fertility issues...do you agree with this?

4.  Do you feel as though my recent need to urinate at night and slight testes pain is a result of anxiety due to this situation.

5. Considering the fact I have been treated, I have retested every few months all negative, 9 months have passed, no symptoms, my wife no symptoms, do I need to disclose this exposure do you feel?

Thanks for you time and this great service.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
1.  If you had infected your wife, I would have expected you to have become re-infected in the interval since then.
2.  In your original post you did not mention that you had been retested.  Since you have been retested multiple times since your treatment I see no need for a swab test at this time.
3.  Dr. Handsfield and I agree that if you're NGU was not caused by chlamydia, there is little risk of subsequent fertility  problems for your wife, or other health problems for you.
4.  I suspect your recent symptoms are more likely to be due to anxiety then an infection that you caught nine months ago.
5.  I think you got lucky, were successfully treated, and do not have a compelling reason to disclose your dalliance to your wife at this time.   EWH
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34 months ago
Thanks for the good news Dr Hook. My last follow up and I will leave you alone.

1. Just to clarify  so since I am symptom free after 70 unprotected times having sex with my wife and we are both symptom free 9 months after my exposure it is safe to say neither of us are infected at this time?

2. Because I have been treated 9 months ago and have re tested for ghonnerea/chalymdia/hiv 3 times since then all negative results there is no to do a swab test or any further testing at this time.

Many thanks for your great service. I am looking forward to putting my mind at ease and getting on with my life.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Correct, this will be my last reply, as per Forum policy.

Your questions are repetitive and have already been answered.  To repeat:
1.  It is unlikely that either of you are infected.
2.  I see no need for further testing at this time.

Take care.  EWH
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