[Question #618] Explanation of an NSU

43 months ago
Hi doctor Handsfield, I know you've told to relax about any NSU in our last conversation. Fortunately I've been able to get my appetite back! But I've still gone and done a PCR test for Mycoplasmas for my piece of mind.  I have a couple of questions.

1) For NGUs what symptoms should I be looking out for if it ever happened to me? 

2) Do past infections of chlamydia make it easier to contract an NSU infection? I remember I had once and my foreskin inflamed and it looked like I had balanitis.

3) I heard Ureaplasmas show up positive in 50% of males. Should I take that diagnosis seriously since you don't even test it in your clinic? And if so should my partner get treated?

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome back to our Forum.  I reviewed your earlier interaction with Dr. Handsfield and agree with all that he said.  It is important to realize that although chlamydia and M. genitalium clearly do cause NGU, in the majority of men with NGU (NSU), no pathogen is detected and there is no evidence that men with pathogen negative NGU or their sexual partners are at risk for complications related to the presence of NGU.  It appears that here are non-infectious causes of NGU and that in some with NSU the irritation encountered may be due to temporary changes related to the non-pathogenic introduction of a sex partner's own normal genital flora into a partner's urethra. this latter circumstance is not an infection as such but simply reflects an equilibration process due to the fact that everyone has a different spectrum of normal bacteria which are present in their genital tracts and, on occasion, they need to re-equilibrate.  As for your specific questions:

1.  I agree with Dr. Handsfield that your symptoms were in no way suggestive of NGU.  Classical symptoms of NGU are mild burning on urination and, in some, a small to moderate amount of clear to cloudy urethral discharge (this should not be confused with the slight normal discharge which is present in most men if they look hard enough.

2.  No, past chlamydia infections do not change the future susceptibility to NGU. 

3.  to the best of our knowledge, despite more than 50 years of work to try to show that Ureaplasma might cause NGU, there is no evidence that this is the case.,  In fact, trying to treat Ureaplasma is an error and in most people the organisms recur weeks to months after treatment.

I hope this comment is helpful.  My sense is that you may be over thinking this  EWH

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43 months ago
Sorry Dr. Hook I was a little confused by this sentence  "It is important to realize that although chlamydia and M. genitalium clearly do cause NGU, in the majority of men with NGU (NSU), no pathogen is detected and there is no evidence that men with pathogen negative NGU or their sexual partners are at risk for complications related to the presence of NGU" Are you saying it could be regular bacteria causing these changes to my body? And if so is it okay to resume regular intercourse with my partner if these PCR exams come back negative? 

43 months ago
Also I came across this answer on medhelp from Dr. Handsfield. 
"It is unknown whether NGU due to such causes carry any health risks for a person's partner.  However, some NGU following oral sex appears to be due to bacteria that could be harmful to a partner, for example, Mycoplasma genitalium.  Unfortunately, there are no tests for specific causes of NGU other than chlamydia.  Therefore, to be safe and to protect partners' health, all female partners of men with NGU should receive antibiotic treatment."

I know the answer was in 2008, so has there been any new research provided that MG can't be passed orally? Dr. Handsfield seemed pretty confident in telling me I could continue to have intercourse with my partner. I know I must seem crazy, but guilt and not wanting to infect my partner is killing me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

In answer to your first question, if you had the sort of NGU that occurs due to normal bacterial , then having unprotected sex does not put your partner at risk for and consequences.

As for oral transmission of M. gent, Dr. Handsfield reviewed the quote you inserted above and states that if he typed this phrase, he did so in error. Neither he nor I are aware that M. genitalium is found on the oral cavity or transmitted by oral sex. 

From what you say, I would urge you not to worry further about infecting your partner at this time.  My sense is that you have a pervasive sense of guilt and are overthinking this.  EWH

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43 months ago
Thanks again for the reply doc. I'm trying to relax, but my PCR exam has yet to come in. I live in Canada Ontario and the test has to go through Public Ontario and apparently they sent my test to another lab. Lord knows what that means. In the mean time I've been doing my own research. In 2009 there was a study done in Japan with 403 fsw and NONE had MG in their pharynges. Second one MSM at male saunas only 521 attendees. 0 infections in the pharynges. Third, another study done in Japan 149 FSW attended. 1 infection found in the pharynges 0.7%. I've also been messaging members on medhelp and know of 1 person that contracted MG through oral although one can never be certain it was from oral. Clearly my worry stems from the possibility of contracting MG from oral. My questions are:

1) Have you dealt with patients who had NGU from MG?

2) Have you had patients who had NGU from oral and if so did you ever recommend them to do a PCR screening?

3) is there any further scientific literature that finds no MG strains in the oral cavity? Reason I ask this question is because when researching I found answers from you and Dr, Handsfield that you guys aren't certain due to the lack of scientific studies?

4) it's almost been three months would my partner be showing and symptoms by now?

5) What are the typical symptoms for MG? As I've said before I don't have discharge, urine feels warmer but I wouldn't label it as burning, pain in the testicles, and a sensational feeling in the urethra.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Sigh, you continue to worry needlessly. Continuing to troll the internet will not resolve your questions but it will provide you with mis-information.  As you know, Forum Guidelines allow for a total of three responses to questions,  This is my third and therefore this thread will be closed later today.  If you continue to worry (needlessly), you will have to start another question.  In answer to today's questions:

1) Have you dealt with patients who had NGU from MG?

Numerous times.

2) Have you had patients who had NGU from oral and if so did you ever recommend them to do a PCR screening?

Yes and we have tested for gonorrhea and chlamydia by PCR-type tests.  Based on the sort of literature you cite, we have not tested for M. genitalium, in these situations

3) is there any further scientific literature that finds no MG strains in the oral cavity? Reason I ask this question is because when researching I found answers from you and Dr, Handsfield that you guys aren't certain due to the lack of scientific studies?

Dr. Handsfield and I both attend numerous scientific meetings in which M. genitalium has been discussed.  NONE of them have reported pharyngeal infections due to M. genitalium.  Similarly, in my own research at at my University where one of the world's premier Mycoplasma laboratories is located, again there is no evidence of transmission of M. genitalium by oral sex.   

4) it's almost been three months would my partner be showing and symptoms by now?

Persons can be infected with M. genitalium without symptoms.  How long the asymptomatic state can last is unknown (to study it would be un-ethical)

5) What are the typical symptoms for MG? As I've said before I don't have discharge, urine feels warmer but I wouldn't label it as burning, pain in the testicles, and a sensational feeling in the urethra.

When men are symptomatic from Mg, they have either discharge, burning on urination, or both.  Urine warmth is not a symptom of M. gent or NGU.  Pain in the testicles likewise is not a sign of either NGU or Mg but it is a common finding in persons who are anxious over past exposures and who focus their anxiety on looking for signs or symptoms of an infection they do not have. 

I urge you to relax and try to move forward.  There is no evidence to support your concern by the exposures that you have described.  EWH

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