[Question #472] NGU?

92 months ago

Thank you for taking my question.

I am a 48 yr old male and received unprotected oral sex outside my normal relationship from a female friend.

5 days – felt pain in left testicle, urgency to urinate, and dribbling after urination

10 days – Got 10-panel std test (hiv,hsv,hep,gon,chlamydia,syphilis) all neg

12 days- went to GP and concluded Epididymitis and prescribed Sulfamethoxozole-trimethoprim (800-600) for 10 days.  No growth in urine culture, neg WBC

25 days – Got another 10 –panel std test and all back neg

28 days – Got a urine test for Trichomoniais came back neg (wasn’t sure if I touch myself after fingering partner)

Symptoms continued and added a mild burning sensation during urination, itchyness, and discomfort in perineum

41 days – Returned to GP and put me on Ciprofloxacin 500mg 2x per day for 15 days

50 days - Got another 10 –panel std test and all came back  neg

Symptoms continued

78 days Returned to GP and put me on Doxycycline 100 mg 2x per day for 20 days

162 days (6 mos) Got another 10 –panel std test and all came neg

As of today symptoms still exist but are not as pronounce but keep me wondering if I contracted something?

Question 1: Do I need to worry about a NGU infection (ureaplasma urealyticum or mycoplasma genitalium) and can I resume unprotected sex with significant other without worrying that I am transmitting an infection to her?

H. Hunter Handsfield, MD
92 months ago
Welcome to the forum. Thanks for your question.

I don't think you have NGU or any other STD at this point. Most likely you never had any STD at all. Oral sex can transmit some STDs (but not all), but always with low frequency -- i.e. any single exposure always is low risk for everything -- and you describe no symptom at any time that are typical for any STD. Despite the initial physician's diagnosis, I doubt epididymitis -- assuming you didn't have overt enlargement and marked tenderness of a single testicle. All your symptoms are much more consistent with the physical manifestations of genitally focused anxiety. That explains why the various antibiotics have had minimal if any effect on your symptoms -- there was no infection. Trichomonas was never feasible -- not acquired by oral sex (not carried in the mouth) and I've never heard of a case tranmsitted by fingering, hand-genital contact, etc. By the same token, most if not all the "10 panel" tests were unneeded. I'm sure several of them were impossible simply on the basis of the kind of exposure, and no STD would have been predicted from your symptoms.

My guess at genitally focused anxiety doesn't imply the symptoms were "in your head". It was real physical discomfort, in the same way that tension headaches are real pain but nonetheless orginate from stress, anxiety, etc. In that case, the affected muscles are in the head and neck; for the other, the pain originates from tension in pelvic muscles, which results in referred pain in the lower abdomen, testicles, anal area, etc. Long-term problems along these lines are typically considered "chronic pelvic pain syndrome", which used to be considered a form of prostatitis, but probalby has little to do with the prostate gland. Google it for more information, and start your reading with the very good Wikipedia article and also look for information from the Stanford University dept of Urology. I think you'll see parallels with your own symptoms.

Finally, NGU doesn't cause symptoms like yours. The only proved symptoms of NGU are penile discharge (which almost always is present) plus various combinations of painful urination (usually mild), itching at the penile tip, and sometimes redness or swelling of the meatus. NGU is not known to cause pelvic or testicular pain. Neither U. urealyticum nor M. genitalium are known to be carried orally and hence not transmitted by oral sex. And UU would have been eradicated by the treatments you received.

Had you seen me at the outset, I would have examined you to determine there was no visible urethral discharge; tested you for gonorrhea and chlamydia (and maybe 6 weeks later for HIV and syphilis); and would have stopped there. I would have advised against any other testing, would not have prescribed any treatment, and would have advised you to continue unprotected sex with your regular partner. You certainly can follow that path now. My bet is that once it sinks in (emotionally as well as intellectually) that nothing important is wrong, your remaining symptoms will fade away.

I hope this has been helpful. Best wishes--  HHH, MD

92 months ago
You have been very helpful - I appreciate your expertise!! Thanks Doc.

H. Hunter Handsfield, MD
92 months ago
You're welcome. Thanks for the thanks.