[Question #487] NGU and Urethritis

36 months ago
Hello forum, was searching the Internet for an online source to ask this and thankfully ran into this site.  Alright NGU and Urethritis. I was the recipient of oral sex and stupidly it was unprotected.  It's been a couple months and I have two negative gonorrhea and chlamdiya tests.  Here is my worry, I am HOPING that the NAAT tests were run on these because I am pretty sure the urine sample I gave was not first void.  If they were supposed to be, no one ever mentioned that before I tested and that actually makes me a bit upset.  Secondly I also gave a urine sample for culture hoping to rule out NGU or a UTI.  That was also not first void. Now the Leukocyte levels were nil with no blood or protein seen and normal.  But again, not first void and if it was supposed to be... Why wouldn't someone tell me.  So, no blood in urine, no funky discharges, no pain in urination.  The meatus does seem a bit off now and then so I am concerned.  Do I need to retest for this stuff and make sure it's all first void?  I was never given any antibiotics, just gave my samples and was going to go from there.  Could I have NGU? Gonorrhea? Chlamydia?  I would sure hope my tests were accurate.  And if they aren't, why wouldn't someone tell me the proper way of giving a sample.

-Thanks-
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Welcome to our Forum.  I can understand your confusion.  For better or worse (probably worse) many clinicians still refer to NAATs tests as "cultures".  In some instances this reflects a lack of understanding of the tests in others, it is an effort to keep their messages as simple as possible for their patients.  The problem with his approach however is that for persons such as your yourself, this causes confusion and concern.  The entire problem is compounded by confusion about the term "first void".  The recommended specimen for urine NAAT testing is the initial portion of a urine specimen, not the first urine specimen of the day.   More recent research has shown however that while studies of urine NAATs for gonorrhea were done with an initial fraction of voided urine, collected after at least an hour since the last void, the timing of collection is not an important variable in test performance. The results are reliable whether the specimen was collected at the beginning of urination or later and irrespective of the time interval since the previous urination.  These tests are the most accurate tests for gonorrhea and chlamydia that we have ever had and give accurate results virtually irrespective of how the urine was collected in terms of timing and quantity.   From what you have said, after two tests, I see no reason for you to need to re-test or mistrust the result you have.  My advice is to move forward with confidence that you did not acquire gonorrhea or chlamydia from the exposure you report.  No need for further testing or concern,  EWH
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36 months ago
Dr. Hook, thank you for your quick and reassuring response.  I believe I have two follow ups so I will definitely like to take advantage of your wealth of knowledge.  So with your response my mid afternoon (due to work schedule), more than likely mid-urine stream samples were still solid enough to show I did not acquire Gonorrhea and/or Chlamydia from this encounter.  That is definitely reassuring and does clear some of my doubt.  My next question(s) are in regards to non-chlamydia NGU.  Besides the two Gonorrhea and Chlamydia tests that were ran, there was a seperate sample used for a urinalysis for potential UTI.  This was also more than likely midstream urine.  As stated before with Leukocyte levels being nil and everything looking normal and healthy according to lab reports.  With that, even though that was midstream as well, would that  have caught any potential issues that would have been considered non-chlamydia NGU?  I know that oral sex is low risk, but I do know that NGU can be received from this.  I am wondering if there is anything specifically I need to do to attempt to rule that out?  Is that urine culture enough?  I am afraid I have developed some hyper-viligance when it comes to my penis/meatus.  I seem to start urination more frequently with two streams.  I know all men occasionally get this, seems more frequent for me now.  Any thoughts on this would be greatly appreciated.

-Thanks again-
36 months ago
A urine dip test was done midstream as well.  That also came back normal.  Not sure how relevant that is. Thought I'd add that in too.

-Thabk you-
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Unfortunately, the tests for leukocytes in urine are not as sensitive for detection of non-chlamydial NGU as a swab specimen taken from directly inside the urethra at least an hour after last urination so this test does not rule out non-chlamydial NGU.  On the other hand, I would point out that there is considerable debate about the pathologic significance of non-chlamydial NGU. 

The topic of the health importance of non-chlamydial NGU is debated among experts in the field.  In the United Kingdom, when a man is known to have non-chlamydial NGU, clinicians do not recommend treatment of partners and there are no data to suggest health complications or problems related to non-chlamydial NGU.  Most patients with NGU are treated because chlamydia test results are typically not available at the time the NGU is diagnosed and because it COULD be chlamydia. 

My advice, (sometimes hard to accept) is to do your best to not worry, to cease your intensive self-inspection and try to relax.  You have clearly and reliably ruled out the major health consequence of sex with a new partner- chlamydia and gonorrhea.  If you cannot do that, I suggest you see if there is a local STD Clinic nearby where you can get a urethral gram stain to completely rule out non-chlamydial NGU.  Personally however, I do not believe this is medically necessary.  EWH

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36 months ago
Dr. Hook, thanks again for all of the information. This will be my final follow up question per forum policies and it changes gears just a bit.  I am now going to switch to Herpes.  There seems to be a lot of different information about this disease.  Specifically when it comes to testing and testing reliability.  It sounds like the IgG test is the way to go here, but it sounds like this test is not as good at catching HSV1 infections.  Can you help me to understand what my true, honest risk of HSV1 was from my encounter.  I have not had a cold sore my entire life.  I already have negative IgG tests.  From posts I have read from Ms. Warren, the IgG test misses one out if every four infections.  That seems to be a bit nerve racking.  I would really like to know my true Herpes 1 status.  Statistically, if I tested once a month for like four months. And they were all negative... I'd be inclined to believe that I did not have HSV1.  But that is a lot of needles.  If someone truly wants to know their HSV status, and have the utmost confidence in the testing... What should they do?  Granted if i suddenly tested positive for it, due to previous testing, I would assume that I contracted the virus from my fairly recent exposure.  Thank you for your input and time Dr. Hook.  I eagerly wait your response, and I appreciate everything you do.

-Thanks-
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

We hear from many clients who are worried that they may have acquired HSV from a misstep of the sort you describe.  Our general stance is to not look.  This recommendation comes not from a single study or fact but from a cumulative synthesis of a number of studies and observations.  These include:

1.  Most exposures to partners with herpes do not lead to transmission of infection.  A back of the envelope estimate suggests that in the absence of an obvious lesion exposure, transmission occurs less and possibly far less than once in every 1000 exposures- so, the odds of infection after a single exposure are quite low.

2.  While not everyone who acquires HSV develops and outbreak, many and perhaps most people do. 

3.  As you point out, currently the HerpeSelect IgG appears to miss about 1 in 4 existing HSV-1 infections (taken conversely, it detects 3 out of 4) so the test is not a sure thing and, complicating things further, even in persons with prior negative tests, false positive results DO occur from time to time.

For these reasons, my advice is to not worry about the unlikely possibility that you acquired HSV-1 from the oral exposure you described.  If your anxiety cannot be controlled and you want the current "gold standard" test, this would be the Western Blot assay performed at the University of Washington's virology laboratory.  Of course if you do this and have a positive test for HSV-1, there is no way to know if your antibodies reflect a longstanding prior infection that was missed by your earlier tests or a more recently acquired infection.  Statistically the former possibility is more likely than the latter. 

Thus. my recommendation is to stop worrying an move forward.  After all, what would you do if the test were positive?  EWH

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