[Question #585] Mycoplasma genitalium or nsu

90 months ago
Hi doctor,  I had two encounters with escorts. One of them I received unprotected  fallatiao for a very short time and then she preceded with giving me a handjob by using saliva as lubrication. 10 days later I had unprotected sex with my gf. A day later my second encounter with an escort happened. This time longer unprotected fallatiao(I know Im an idiot). 

The next day after my second enounter with the escort I kept feeling a frequent urge to urinate, tingle in my testicles, and the tip of my penis would be watery when i pull the skin back. Went to get an sti check everything came back negative. Going for cystoscopy tomorrow. Now my girlfriend hasn't been showing symptoms. My questions are 1) could this be mycoplasma genitalium or an NSU from the oral? 

2) how likely is my gf infected and is asymptomatic? 
H. Hunter Handsfield, MD
90 months ago
Greetings and welcome to the forum. Thanks for your question.

There is little chance you have any STD, either from the recent escort encounters or anywhere else, and even less likely you have M. genitalium. I'm not sure why that particular bacteria is on your mind -- my guess is you have been delving into the internet, without sufficient context to help you understand what you have found. That's not a criticism -- just a reality about the interet and how anxious people interact with it. Anyway, here are my thoughts:

As far as known, M. genitalium is not carried in the oral cavity and therefore never known to be acquired by oral sex. And no STD is transmitted by hand-genital contact, even if saliva (or even genital fluids) are used for lubrication.

Second, you have no symptoms that suggest STD. There are no urethral or genital STDs, including NGU (same thing as NSU) that regularly cause urinary urgency, or tingling in the testicles or penis. A little clear moisture suggests urine or scant natural mucus, nothing else; my guess is your anxieties are leading you to look too closely and over-interpret something that's always been there. Both this and your urinary/tingling symptoms are much more consistent with genitally focused anxiety than anything else. If the urologist (or whoever is doing the planned cystoscopy) found increased white blood cells in your urine or urethra, or if a urine culture was done and positive for a UTI bacteria, perhaps the cystoscopy will come up with something. But my guess is that it will be normal; and if not, it will have nothing to do with the sexual encounters described. To be completely safe, it would be reasonable to have a urine or urethral gonorrhea test (in fact, I would strongly recommend against urethroscopy (or refuse it) until and unless that were done and negative). (Chlamydia testing might also be done, since it's pretty much automatic at the same time as a gonorrhea test. However, chlamydia is almost never acquired by oral sex.)

Those comments pretty well answer both your questions, but to be specific to assure no understanding:  1) I am confident you do not have NGU, whether caused by M. genitalium or anything else. For sure not M gen.  2) Even if somehow you had NGU, when acquired by oral sex NGU has never been known to cause health problems in affected men's female sex partners. So your partner isn't at risk for anything at all. (Putting it at a personal level, if somehow I had been in your circumstances, I would not be tested, would not have seen a doctor, and would be continuing unprotected intercourse with my wife without the least concern for her health.)

So all is well. I recommend having a discussion with the urologist, and perhaps printing out this thread as framework, before proceding with cystoscopy. Unless there is other information you aren't providing (see above about urine WBC etc), I would judge the risk of an infection or other complication from the urethroscopy to be much higher than the chance you have an STD or that it will show anything abnormal.

I hope these comments have been helpful. Let me know if anything isn't clear. Best wishes--   HHH, MD

90 months ago
Doctor I understand your knowledge in the field of stis is far greater then mine, but I have seen people personally comment on medhelp (a site you are familiar with) that they did catch mycoplasma genitalium from unprotected oral and protected vaginal sex.
Ive done two urine tests for chlamydia and gonorrhea both have come back negative. The reason I'm so worried about MG is the increased infection rate and the little dialogue to go along with it. 

If not an nsu and MG then what?  I understand it could be anxiety, but I doubt anxiety feels like the urine is about to come out every 5 seconds. 

It's been a month and a half and my girlfriend doesn't have any symptoms. But im still considdrinh asking her to gettested. My worst fear in the world is her developing PID, and me being responsible. From what I hear MG is growing resistance to z pack and some to moxi which makes the situation scarier.
H. Hunter Handsfield, MD
90 months ago
Thanks for the follow-up information. However, it doesn't change even one word of my previous opinion and advice.

Judging the causes of medical problems from online online testimonials by individual persons is absolutely the worst kind of medical information and evidence that exists. Anyone who claims they caught M genitalium by oral sex is mistaken about the diagnosis, or simply doesn't know what s/he is talking about.

"The reason I'm so worried about MG is the increased infection rate":  You are misinformed. (Once again, undoubtedly misinterpreting information you have found online.) There is no evidence that the frequency of M genitalium infections has changed in recent years. We know better how to diagnose it, so more positive tests are being observed. But the infection undoubtedly has been there all along. And it remains a relatively uncommon cause of NGU, most studies showing 10-15% of cases. And as already discussed, you provide no evidence you have NGU anyway.

I stand by my judgment that anxiety explains your symptoms. And it absolutely can cause marked increase in bladder muscle tension, which is the source of symptoms like urinary urgency, frequency, and bladder area discomfort.

Your girlfriend will not develop PID or any other problem. You have no STD; and as noted above, neither PID nor any other serious problem has ever been reported in the female partners of men with NGU from oral sex. Which you don't have anyway.

90 months ago
Thank you doctor for your advice. A couple more comments before I'm off to my misery again.

1) some users who did get the infection by oral got a PCR test to confirm the result, so how could they be misinformed? (I wish I could easily access this test but no one seems to know what mg is.)

2) Reading online urinary urgency is a symptom for mg or an nsu, but it's not the only symptom I have. My urethra feels bothered through out the day but I don't know if it's due to inflammation. I also get pain on my testicles but it goes away pretty quickly. 

3) What medication should I be taking yo get rid of these symptoms. Besides the depression I'm going through for thinking what I could've passed my girlfriend these symptoms are affecting my day to day life. Would z pack work?

4) Why is it difficult to believe an nsu or mg in specific can be passed by oral?

Thank you for your time doc I believe my questions are up. 
H. Hunter Handsfield, MD
90 months ago
1) If someone had a positive PCR for M genitalium, probably it was valid. But that doesn't mean they caught it by oral exposure. If positive after an oral exposure, I'm confident it would have been positive before then. 

2) You simply can't believe everything you read online. I have done research on NGU and seen a few thousand patients with it. Few if any had urinary urgency. And urethra feeling "bothered" also is not suggestive. Your symptoms are typical of elevated pelvic muscle and bladder tension, which are not part of the NGU syndrome but are often due to genitally focused anxiety.

3) Sorry, but I won't help you treat something that I believe you do not have.

4) It'a not a question of belief, but scientific evidence.

You came here for expert reassurance, presumably. I can assure you there are no more than 10 people in the world more expert on NGU than I and Dr. Hook are. Accept my opinions and advice or not, I don't care -- but this isn't a debate. In any case, that completes the two follow-up comments and replies included with each new question, and so ends this thread. Best wishes to you.