[Question #4732] NGU or prostatitis

26 months ago
Dear Doctors,
I am really anxious.
I had an encounter with a CSW who first gave me a handjob (unprotected) and later protected oral and vaginal. This lasted very short. There was only a few seconds when my penis touched her bullocks.
1 week later I had unprotected sex with my partner.
2 weeks after encounter I started having vague symptoms such as: awareness of urethra, maybe some irritation, frequent urination (due to some urge from the tip of the penis), pain/dull feeling between anus and scrotum (prostate?). 
Symptoms always disappeared during the night and came gradually during the day.There was no discharge, no pain at urination
I went to the doc and he did an urineanalysis (labo) of FVU (only 1 hour after last urination, due to the urge) but he couldn't find any wbc or bacteria and he did a std test for Chlamydia which was negative.  I also did a test for Chlamydia, Trich and Gon, which was also negative.
Anyway he prescribed me 1g of Azithromycine as he suspected something, even before knowing the results.
Symptoms slowly faded away and were gone after 8 days.
I had again unprotected sex with my partner and 10 days later the symptoms reappeared again, this time starting as a kind of candida. (Redness around top penis) and later again all the same symptoms.
I did again a std test which was negative for Chlamydia, Trich, Gon and even mycoplasma genitalium.
Went to a doc who did a labo urine analysis FVU (4 hours after urination),could not find any infection, anyway he suspected a urethritis and gave me again azithromycine 1g.
This was yesterday, and now a notice the symptoms are getting less.

- Do you think I might have ureaplasma or something else? Is this a NGU?
- Did I pass something something to my wife and get it back? Should she be treated?
- My wife is pregnant, can this cause a risk?

thanks
26 months ago
An extra question:
- Will an ureaplasma infection being noticed during an urineanalysis in the lab, where they check growth etc.
Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
Welcome to our Forum  I'll do my best to help but sense that my comments will be most helpful to you if my comments will provide you to move forward without the apparent anxiety and perhaps guilt which you are experiencing since the encounter over two weeks ago that you have described.  The exposure that you describe are not the least bit suggestive of any STI and your test results likewise do not suggest any STI or genitourinary infection whatsoever.  I should add the that symptoms of urinary frequency is most typical of either a UTI (which was ruled out by your urinalysis) or genitally focused anxiety.  Further, I would add that your laboratory tests and non-response to azithromycin tend to confirm the fact that the exposure you describe (receipt of masturbation, condom-protected sex, and incidental touching of your partner's buttock with your penis) all fall into the category of no risk events.  Thus:

1.  See above.  Nothing you have reported suggests an infection of any sort- STI or otherwise.  I specifically recommend against testing for ureaplasma since ureaplasmas are NORMALLY PRESENT in the genitourinary tract.

2.  Nothing you've indicated suggest that you have anything to pass on to your wife or that she passed anything to you.

3.  No, pregnancy would not change my assessment.

I hope these comments are helpful.  Try to put your fears and anxiety aside and make every effort to shift your focus from repeated self-examination and checking for STI symptoms.  EWH
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26 months ago
Dr doctor,

Thank you for your answer.

Just to make clear that I do respond to Azithromycine, the first time it did, and now it is also clearing some symptoms already. So that means something was there?
So then probably my wife is infected with something (by me) and gave it back? So something is ping-ponging?

Even with my anxiety, the symptoms will not clear by itself, I asume, especially the prostatis like symptoms. (dull feeling between scrotum and anus), feeling some urine is left in my urethra. (These symptoms were there for 2 weeks and 24h after the azithromycine, they are gone)

So let's assume I don't tell my wife, and have sex with her, and then 2 weeks later I have mild Urethritis again, then I for sure something must be going on?

thanks


Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
I'm not sure that there is cause and effect with respect to your azithromycin response.  It sounds as though your symptoms were already responding at the time your doctor provided the azithromycin.  Irrespective however, given the nature of your exposures and negative tests, you have ruled out the possibility of STI (if your symptoms had been due to an STI, the tests for gonorrhea, chlamydia or trich would have been positive).  I am quite skeptical of your supposition that you infected your wife and an infection is "ping ponging".  If it were, another STI test taken at this time would be positive.

As for prostatitis, this is a doctor's diagnosis and again, I would expect a positive urinalysis for inflammation and a positive physical examination which would infolve palpation of your prostate in the course of a rectal examination.  Further, prostatitis is virtually never an STI, nor is it transmissible to others. EWH
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26 months ago
Hi doc,

4 days after azithromycine some symptoms became less or are gone, but my lower urethra and testicles feel a bit tender.
The day before taking this, I had another STD test, which was again al negative. (chlam, gon, mycoplas, trich)  PCR FVU.

I'm still thinking I have NGU (and I infected my partner).
The symptoms: freq ur, discomfort penis, testicles,  urethra a bit tender by time,..  (all come and go) match this case? (only will this symptoms disappear at night and come back a few hours after waking up)

1. Does the bacteria involved always travels down from the infection place? So do you feel the symptoms changing?
In the beginning I had some red patches and irritation on the glans, later it was the red meatus (+freq urination), feeling of some urine in urethra, afterwards a bit a sore (2/10) upper urethra  (penis head) and after 4/5 days the testicles + prostate. The initial symptoms disappeared, but it changed all the time.

2. I noticed that my meatus became again skin colored after the azithromcine, and before I had sometimes a bit the glued shut feeling, although it was not really noticeable. Also my upper urethra (penis head) feels not tender anymore (but this was also slight) Maybe I am just focussing too much on the symptoms.

3. After taking the azithromycine i had all night long prostate pain, (which I had't before at night), is this normal? now this is gone.

4. Would you do partner treatment in my case? (negative for all std's (chlam, gon, mycoplas, trich) 

5. Would you do partner treatment if above + positive for NGU?

5. 2x times the docs did a first void urine analysis (they sent it to a lab), so they were checking WBC's in the urine sediment, is this a reliable method, because I read that they usually they do a urethral smear? Can this explain the negative results? 

6. The only (common) bacteria I wasn't tested for was Ureaplasma U., I know a lot of people have this bacteria, but couldn't it be that I was infected with the 'bad' ureaplasma which causes Urethritis? Is this the same 'bad' ureaplasma which causes al the trouble during pregnancy? Is it he amount (colonies) of ureaplasma which causes infection or is the kind of bacteria you have?



Thanks




Edward W. Hook M.D.
Edward W. Hook M.D.
26 months ago
You and I are going to disagree.  With all due respect, you have been examined by health care providers and tested for STIs repeatedly and have no evidence of infection following a virtually no risk exposure.  .  Further, STI symptoms do not come and go, nor do they go away at night and return later in the morning following awakening.  This does not suggest NGU to me, it suggests genitally focused anxiety.  In answer to your final follow-up questions (as you know we provide up the three responses to each client.  This is the 3rd and final reply.) :

1. Does the bacteria involved always travels down from the infection place? So do you feel the symptoms changing?
In the beginning I had some red patches and irritation on the glans, later it was the red meatus (+freq urination), feeling of some urine in urethra, afterwards a bit a sore (2/10) upper urethra  (penis head) and after 4/5 days the testicles + prostate. The initial symptoms disappeared, but it changed all the time.
This sort of migratory symptoms does not suggest an STI.

2. I noticed that my meatus became again skin colored after the azithromcine, and before I had sometimes a bit the glued shut feeling, although it was not really noticeable. Also my upper urethra (penis head) feels not tender anymore (but this was also slight) Maybe I am just focussing too much on the symptoms.
I agree.  I DO think you are focusing entirely too much on looking for genital symptoms.  When people do this they tend to normal sensations that are normally overlooked.

3. After taking the azithromycine i had all night long prostate pain, (which I had't before at night), is this normal? now this is gone.
No this is not what would be expected from an infection.

4. Would you do partner treatment in my case? (negative for all std's (chlam, gon, mycoplas, trich) 
Absolutely not, nor would I have provided the azithromycin that you were given despite the absence of any tests suggesting infection.

5. Would you do partner treatment if above + positive for NGU?
We do treat sex partners of persons with NGU.  You however have NO evidence of having NGU.

5. 2x times the docs did a first void urine analysis (they sent it to a lab), so they were checking WBC's in the urine sediment, is this a reliable method, because I read that they usually they do a urethral smear? Can this explain the negative results? 
A urethral smear is somewhat more sensitive than a urinalysis for detection of WBCs but after two urinalyses, it is VERY unlikely that a smear would show abnormal concentrations of WBCs

6. The only (common) bacteria I wasn't tested for was Ureaplasma U., I know a lot of people have this bacteria, but couldn't it be that I was infected with the 'bad' ureaplasma which causes Urethritis? Is this the same 'bad' ureaplasma which causes al the trouble during pregnancy? Is it he amount (colonies) of ureaplasma which causes infection or is the kind of bacteria you have?
Ureaplasma are normally present in the genital tract.  I recommend against testing for Ureaplasma.  Further, there are no solid data to suggest that ureaplasma in the genital tract cause problems during pregnancy.  

This will complete my responses.  I am sorry you have not found my assessment helpful.    I wish you the best.  My continuing advice is to stop worrying about STIs from the exposure you have provided. This thread will be closed in a few hours. EWH

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