[Question #6533] NGU Follow Up

13 months ago
Hi Doctors. Apologies for coming back, but circumstances have changed which have nudged me to ask for advice again:

On 1/10 I got black out drunk at a house party and do not know what happened for about 2 hours. I got tested for chlamydia and gonnahrea on 1/12 (about 56 hours after potential exposure) and both came back negative. Dr. Hook originally indicated that this was conclusive and not to worry about having either.

Today, I have an inflamed/discomfort feeling in the tip of my penis, and feel the need to frequently urinate. No discharge or major pain when urinating. Based on what these symptoms and my study...it sounds like I could have NGU...correct?

Because this NGU was likely not caused by chlamydia or gonnahrea, it is just discomfort from potentially saliva or some else’s germs or something? I have a hard time understanding this...

Secondly, can I give my girlfriend NGU? We have slept together once on 1/12 and I am afraid that I could potentially give her something...

I plan on visiting a clinic tomorrow and getting 1G Arithromycin to rid myself of the NGU and symptoms. I am just concerned about potentially affecting my girlfriend.

Could i potentially have another STD? If so, what...?

Could you speak to this please, and what you would do in my case? I know I am anxious here but the symptoms i am experiencing certainly are not normal.

Thank you again!!!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Welcome back to the forum, although I'm sorry you found it necessary. I'll be taking your question this time, but I reviewed your recent discussion with Dr. Hook.

It is conceivable you have NGU, but unlikely. The main symptom of NGU is discharge; it usually does not cause urethral or urinary disomfort or urinary urgency or frequency. Such symptoms often are psychological, i.e. the result of genitally focused anxiety. And I agree with Dr. Hook that you probably didn't have sex during your blackout. As he said, people that drunk usually are unable to function sexually, so most likely you were not exposed. 

Because of your symptoms, I agree it makes sense to be professionally evaluated, but I'm betting all will be normal. (Please see a doctor or clinic with STD experience.) it would be wrong to insist on (or even request0 NGU treatment until and unless there is clear evidence of it when you are examined. Try to avoid urinating for 3-4 hr before being seen; if there is no visible discharge at that time, and no increased white blood cells in your urethra, no treatment will be necessary.

As for partner treatment, the answer is yes:  if NGU is diagnosed, your partner should be treated. In the absence of chlamydia -- the only cause of NGU known to be harmful to infected women -- treatment is given primarily to prevent reinfection of the male partner. It is unknown whether there is any health benefit to the exposed female. But as already discussed, it is unlikely you have NGU and therefore unlikely your partner will need treatment.

Could you have some other STD? Since you probably didn't have sex, probably not. And even if you did have sex, the large majority of sexual exposures do not lead to any infection. In all people tested or treated for STDs, it is normal to test for HIV and syphilis (4-6 weeks after exposure). No other testing is routinely recommended.

I'll be happy to hear the outcome after you have been examined. In the meantime, if no dsicharge shows up -- and no other symptoms like genital blisters or sores -- I really wouldn't be worried.

HHH, MD
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13 months ago
Thank you for your insight. I can certainly see it being anxiety related but also don’t want to ignore symptoms...

Years ago I tested positive for Chlamydia 3 days after exposure. This time around, I was tested 56 hours after my blackout and received all negative results. Is that ample time to receive a positive result, should there have been one?

I understand I am likely overthinking it at this point. I just don’t want my sexual partner or myself to be affected by one stupid night. 

Also, at my check up today my doctor indicated that, if anything, this may be NGU and only prescribed me 250 mg of Arithronycin. Would this be ample to rid any STI or NGU?

Sorry for the repetitive nature of my questions. This will be the last. Thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
You expressed concerns about time to reliable testing in your previous discussion with Dr. Hook. There is no research on this:  up til now, nobody has systematically analyzed people who were exposed then tested periodically (e.g. daily for 1-2 weeks) to know exactly what proportion would be positive at various intervals. In theory, it might take up to 4-5 days for chlamydia (and maybe just 1-2 days for gonorrhea, which grows faster) -- explaining advice I've given on the forum. However, clinical experience is that when someone has a negative chlamydia test 2-3 days after a known exposure, later testing has never been reported to become positive -- the perspective implied by Dr. Hook. When we add this fact to the probability you didn't even have sex, there is no realisic chance you are infected. Looked at another way, you indeed are overthinking all this.

It sounds like your doctor didn't examine you or test for urethral WBC, right? If so, there is no way s/he can know whether or not you have NGU and you should not have been treated. And if treated, it is hard to believe you were actually given only a single dose of 250 mg azithromycin. Are you sure it wasn't the standard 1 gram (1,000 mg) dose? If really 250 mg, that's almost the worst thing:  too little to reliably cure NGU (or any other STD), but likely high enough to interfere with accurate diagnosis later.
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13 months ago
Thanks Doctor. Feeing better about things already.

First off...my girlfriend seems to be having blood in her stool as of last week. Could this be a symptom of anything? Or is it likely just a coincidence?

Lastly, from an educational perspective:

Let’s say I have NGU. No chlamydia or anything that caused it. I understand that it may be passed on to a female by sexual intercourse, but what about oral sex? Would the causing bacteria just exist in her mouth and not in her urethra area? And wouldn’t the incoming bacteria get burnt up by her immune system and disappear relatively quickly?

I guess just trying to better understand NGU, as it interests me. I have never heard about it and find it fascinating that an unknown STI (?) is rarely discussed, if Chlamydia/Gonnarea did not cause it.

Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Blood in stool is usually due to hemorrhoids. In absence of anal sex, no STD is likely.

NGU not due to chlamydia is not known to be harmful to female partners by either vaginal or anal sex. However, there has been no research to be certain, which is one reason female partners of men with NGU usually are treated. But you don't have it, so it's not pertinent to your situation.

That completes this thread. Please note that repeated questions on the same topic are not permitted. This will have to be your last about this exposure event and your concerns about STD as a result. Thanks for your understanding.
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