[Question #6116] Ngu/mgen
70 months ago
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Hello Drs,
5 weeks ago I stupidly had unprotected sex (oral, vaginal, anal) while extremely intoxicated with a 40 year old female whom I did not know well. She didn’t seem overly promiscuous. She has a stable career, 2 kids, and is a divorced her husband of 12 years 3 years ago. We live in western Canada. We began with a condom, but it broke and we continued. I had asked her ahead of time if she was clean and she said she had just been tested a week ago.
On October 2nd (4.5 weeks since the incident), I noticed some burning with urination in the evening. The next morning and a couple times throughout the following days there was slight viscous cloudy discharge when I squeezed my penis. I went to see my GP on October 4, and he gave me 1g azithromycin and 800mg cefixime, all taken at once, as well as testing for the standard sti’s (awaiting those results). My symptoms had drastically improved by the next day, and now 36 hours since beginning treatment they are basically completely gone.
My concerns lie in that I suspect that the female in this incident was likely screened for the standard sti’s, and likely not for those such as mgen, which is the one I’m most concerned about.
I am married and had unprotected sex with my wife once on September 13, and once on September 14 (2 weeks after the incident, but without any noticeable symptoms).
Questions: 1. What are the chances that the antibiotics I took would treat mgen?
2. If the symptoms don’t reappear during the 7 day waiting period can I consider myself clear and can resume sex with my wife?
3. Do you recommend getting the mgen testing done?
4. Providing the tests come back negative for chlamydia and gonorrhea, how concerned should I be that I passed a non chlamydial ngu to my wife?
The last thing I want is to pass a disease to my wife, but I’m terrified to tell her also because I really don’t want to lose her because on a terrible mistake. I’m freaking out and would very much appreciate your advice. Thank you
70 months ago
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Sorry, just a bit more info. My symptoms are not completely gone. Still a little bit of clear discharge when I squeeze my penis, and maybe occasionally a tiny bit of burning/discomfort at the tip. Also, my dr did send away a urinalysis to look for uti.
5. Does my wife need tested?
6. Is it normal for ngu symptoms to take over 30 days to present?
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Edward W. Hook M.D.
70 months ago
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Welcome to the Forum. Thanks for your question. I'll do my best to help. My sense is that your guilt is getting the best of you. A few general comments before I answer your specific questions.
The risk of your dalliance is low. Most people do not have STIs and the likelihood of infection goes down with increasing age. STIs are uncommon in 40 YO women and your partner told you she had been recently tested. Further most unprotected exposures do not lead to infection. My advice to you, particularly since you have been tested and treated is to stop scrutinizing your genitals so much and move forward.
Regarding M. genitalium. Don't believe everything that you hear on the internet. My genitalium is a source of considerable controversy. Experts agree that men with persistent urethritis unresponsive to azithromycin should be TESTED (not treated). If M. genitalium is present, the infection should be treated. Beyond that, testing for MG is controversial and of unproven benefit. Burring on urination is NOT a symptom of ATI, including for MG.
In answer to your questions:
1. The azithromycin would cure about half of MG, if present.
2. Yes. I recommend you try to focus on something other than your genitalia. If you have real symptoms, you will know it.
3. No!
4. No, there is no evidence that non-chlamydial NGU causes symptoms or complications in sex partners.
5. No
6. No
I hope tis information is helpful to you. EWH
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70 months ago
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Hi Dr. Hook, thank you for replying to my situation. Having spent A LOT of time reading submissions on this forum, I am aware that most people don’t have sti’s and even less frequently with age. But having read that mgen is the 2nd most common cause of ngu after chlamydia, and that it isn’t part of standard testing makes me very concerned. The white discharge and burning that I had/kind of still have is certainly something irregular.
Can mgen clear up from azithromycin and then return, or would it just not clear up at all? Again, just afraid of resuming sex with my wife and then it returns.
If it is mgen, what are the chances I passed it to my wife 2 weeks before symptoms presented?
If non chlamydial ngu with discharge and burning is not caused by any of the known/standard pathogens, then what is it?
Does mgen eventually clear on its own?
If you were in my situation, what would you do?
Thanks for your time and patience with my questions.
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Edward W. Hook M.D.
70 months ago
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Let me start by pointing out that on the Internet find just about anything needed to reinforce whatever apprehension or concern you have. The role of MG initial episodes of NGU remains unclear. As I said above it becomes a consideration in persons with persistent NGU. Your symptoms have resolved.
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1. In persons with persistent NGU the signs and symptoms remain present. The small amount of discharge you find when you squeeze your penis does not count.
2. There are no precise estimates of the efficiency of MG transmission. With a single act of intercourse the risk is relatively low and goes up with each successive sex act.
3. Non--chlamydial NGU is thought to reflect the introduction of another persons bacteria into the urethra. It is somewhat more common following receipt of oral sex or rectal sex.
4. Yes
5. If I were you I would not seek testing since my signs and symptoms have resolved. I would move on and put my concerns behind me. I would also stay off the Internet.
EWK
70 months ago
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Dr. Hook, thank you for your thorough replies. They are truly appreciated and have significantly helped reduce my anxieties.
Today, 2.5 days since being treated, my symptoms appear to have completely resolved.
My final question is, how often do you see non chlamydial ngu or MG return after treatment has resolved all symptoms, provided that there has not been another exposure during that time of course? If that does happen, how long of a symptom free period until I can be confident that I am clean and clear?
Again thank you for your time and expertise. This truly is a very valuable resource for people. All the best.
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Edward W. Hook M.D.
70 months ago
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As you know, this will be my final answer.
There are no data to answer the question you ask. That said, I have never seen a positive test associated with symptoms become negative and then become subsequently negative without re-exposure.
Take care. EWH
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