Hello, 

I am married and 14 days ago had unprotected vaginal and oral sex (both ways) multiple times over the night with a girl I know to be primiscuous (3 other partners in last 3 months that I know of and one of these was an unprotected one night stand). I have an appnt tomorrow morning to be tested for Chlamydia, Ghonnoreah and M. Genitalium (some NHS GUM clinics now offer MG testing.) 

I am concerned about NSU and the need to be swabbed as I don't want WBC to be found and sets hares running unnecessarily when there may not be an infection. I have checked my under shorts every day from day 9 post exposure until today (so for the past 5 days with th exception of 1st Jan when I didn't check at all) and there hasn't been any staining in my underwear over night or at the end of the day. I have also had no burning pain on urination. 

The only exceptions to this were a very small stain on 29th Dec (9 days post exposure) a couple of hours after initially checking my shorts which looked like a very small pre-ejac stain but I hadn't been aroused before hand. Then on 30th Dec there was nothing over night, i put new shorts on and then a couple of hours later three white  stains on my shorts. A couple of times later that day I noticed a very small amount of sticky clear secretion, not puss like, more akin to pre -ejac. I had been aroused shortly before each time but not erect. There were no stains at all yesterday and none this morning. 

Question 

Am I correct that if my Chlamydia, Ghonnoreah and MG tests come back negative, even if I have had NSU with mild symptoms, there is no need for concern and no need for my wife or the one night stand partner to be treated? Clearly I appreciate there are no guarantees but just what you would do in my situation ? 

Thanks 

My wife and I have sorted out the issues we have been going through and over the Xmas break agreed a way forward which Will get us back on track. I am seeking professional help for why I fall into heavy drinking and do things I know I’d regret as part of this.

Thanks for your partial explanation.  That still does not explain why these three very different histories which supposedly took place over the past 4-6 weeks.  Irrespective, as I have reviewed all of your earlier interactions with Dr. Handsfield and me, I suggest you do the same as each of your questions related to urethritis, urethritis risk and testing.  The testing you outline for gonorrhea, chlamydia and M. genitalium is appropriate.  Testing for NGU can be done at the same time at the GUM Clinic.  As Dr. Handsfield and I have both told you, if you had NGU, the symptoms would not take a lot of searching to find- they are typically obvious when present.  Further, treatment for NSU, M. genitalium and chlamydia are often the same.  

In answer to your question, if your tests are negative following examination at the GUM Clinic, there is no reason for continuing concern or additional testing of any sort.  EWH

I’m confused regarding your response below as you suggest a swab for NSU can be done at the same time as Ghonnoreah, Chlamydia and MG. 

My concern about having a swab test is that WBC May be found as I understand that they often are even when there is no infection which would then lead to unnecessarily treatment and difficult / unnecessary conversations. 

From various posts I’ve read on this and the medhelp site, I understand that NSU May be mild and ‘may’ be missed. 

I also ‘think’ I understand that in the absence of Chalmyadia and MG, NSU is nothing to worry about and isn’t harmful to partners.

So my question was that if I DON’T choose to have a swab test tomorrow for NSU but have the urine tests for chlamydia and MG - if these come back negative would you agree that no swab test is necessary for NSU is necessary. 

And secondly, from what I’ve described below you agree that these don’t wouldn’t be in the ‘obvious’ symptom category and are more likely ‘normal’ secretions. 

We may be on the same page but I just wanted to confirm my understanding. 

Thanks Doctor and I hope I have clarIfied things!

Good questions and sorry if I've been confusing.  If your tests for gonorrhea, chlamydia and M. genitalium are negative, the only possible pathogen which might be present and require treatment would be trichomonas.  FYI, your urine can be tested for this as well.  If those tests are negative and an abnormal number of WBCs are detected, then you would have non-chlamydial, non-mycoplasmal NSU which is currently thought to be an inflammatory response to other, non-pathogenic bacteria.  Many clinicians in this situation would not treat this form of NSU as there are no data to suggest that there are complications for persons with this syndrome, nor for sexual partners.  

As for the "mild" symptoms of NSU- this refers to pesrons who are not looking for symptoms or whom are dismissive of mild symptoms, something that is not the case for you.  In your case, you are aware of your exposures and looking for symptoms- you would notice them.  In fact, if anything, in your case, looking for symptoms might call attention to normal genital sensations which you would not have looked for otherwise.  Do you follow this?

I think we are on the same page regarding this.  If there are further questions, please use your final follow-up question to seek clarification.  EWH

Sorry Doctor, I’m still slightly confused. Simply down to text rather than verbal communication unfortunately I think. 

You mention about if an abnormal number of WBCs are found on a swab and my Urine tests are negative it would indicate non chlamydial, non-MG NSU. 

However, as mentioned, in absence of ‘obvious’ symptoms, my concern in having a swab is if elevated WBCs are found which could be completely normal. 

For final clarification:

1. I am uncurcumsIzed and haven’t been checking my penis tip, I have only been checking my underwear for staining. Do you agree that in absence of continuous staining it is extremely likely to mean NO NSU is present?

2. Do you recommend I have a swab for NSU or will the chalmydia, Ghonnoreah and MG tests be enough to ensure the risk to my wife (assuming negative results ) is minuscule? 

3. I don’t think trich is tested for routinely in men on the NHS (I have never been offered this in the past) and my understanding is that it is not an important pathogen anyway and so not particularly risky for partners? 

My understanding is that there is some controversy around whether it can lead to premature labour but trich would then be picked up due to the normal tests carried out in pregnancy anyhow so surely not a concern on this occasion?

4. If you think I should have a test for NSU, would the fact I’ve masterbated today (only once) heighten the risk of elevated cells due to friction? 

5. If any less than 5 WBC are found on a swab, and all the  pathogens mentioned above are negative, would you still treat for NSU or would you assume the WBC are normal and no treatment necessary. 

Thanks for this final clarificatIon Doctor, it’s much appreciated. 

Straight to your questions:

1.  Correct

2.  I would leave that up to the advice of the person who sees you at the GUM clinic but, in general, if the tests for gonorrhea, chlamydia and Mg are negative, I would not worry further.

3.  Trich is an STI which is typically asymptomatic in men and can be transmitted to men.  In my clinic we do it routinely although admittedly, in most clinics this is not the case.  Again, (and this is not a dodge), I would discuss with whomever sees you at the GUM Clinic.

4. Masturbation should not lead to increased numbers of cells

5.  Here in the U.S. if you had negative tests and >5 WBCs, most clinicians would provide treatment with azithromycin or doxycycline. In the UK not all clinicians would do this and that works out just fine for most patients.

As you know we provide up to three responses to each question.  This is my 3rd or 4th response, depending on ow you are counting. Thus this thread will be closed shortly without further replies.  If you tests are negative, and I suspect they will be, I would not worry.  Take care. EWH