[Question #6577] NGU and HIV

14 months ago
I have had 3 partners over the last 3 weeks.  Two of them I met via a dating site and one is my wife.  The first encounter was 17 days ago, where we had unprotected oral and protected vaginal sex.  She told me that she gets tested but does have other partners.  6 days later I had unprotected vaginal sex with my wife. 3 days later I started having some testicular and abdominal pain and pain in the tip of my penis.  No discharge that I could see. Felt more like my bladder is full. I do have prostaititis as well. I thought it may be this.  Went to my primary and they did urinalysis and culture.  Came back with some 1-3 WBD cells and a few mixed gram stain negative bacteria - below 10,000/hfu.  I started on a Zpak and Doxycyline.  I gave my wife a spare zpack 4 days after this but not doxy.  The lab lost my chlamydia and gonorrhea test so I went back, gave them another sample, negative, but this was 5 days after I started with antibiotics. Primary thinks it is NGU - must be from oral.  Last night I had sex with another partner - I know, I am so mad at myself.  And am in a cycle of self sabotage.  I think it is time for therapy.  We had protected oral and protected vaginal, but the condom came off inside her.  Not sure how long I was exposed - maybe as much as 10mins.  I am freaking out.  She was not worried said she is safe and that she will get tested and prove it to me.  My questions are as follows: 1) Do you think with that urinalysis this could have been gonorrhea or chlamydia? Could it be even be herpes? 2) Does my wife need to take doxycycline or do you think she is safe? 2) Would the Zpakshe took - 1000mg - have wiped out chlamydia or ngu? 3) What are my risks from the most recent encounter? 4) If I am still feeling pain in my genitals,- meaning I may still have ngu? is my risk of acquiring HIV higher?5) If i continue to take doxy, would that wipe out any risk of chlamydia or gonorrhea from the latest encounter?  I hope you can follow this and thank you for all yo
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome back to the Forum.  In preparing to answer your questions I started by reviewing your prior interaction with Dr. Handsfield.  I am struck by how similar the two episodes are, as well as the similarity of your response including stating to take antibiotics before test results are available.  Certainly having sex with partners who have other partners does put you at risk for acquisition of STIs but the symptoms you report are not those of STIs. They are suggestive of prostatitis which you already acknowledge having. 

Persons can get NGU due to the introduction of mouth/throat bacteria into the urethra during oral sex.  This form of NGU is not considered by most experts to represent a threat to sex partners in the same way that NGU due to chlamydia is.  NGU from mouth organisms typically clears on its own improvement can be hastened with antibiotics, most typically azithromycin or doxycycline (not need to take both).

In response to your specific questions:

1) Do you think with that urinalysis this could have been gonorrhea or chlamydia? Could it be even be herpes?

There is nothing here to suggest herpes.  As far as gonorrhea or chlamydia, as I already told you, your symptoms are not typical and a urinalysis is a poor test for detection of NGU.  Your urinalysis results are non-specific and do not provide helpful information to determine what may be going on.

2) Does my wife need to take doxycycline or do you think she is safe?

You have no evidence that you have an STI or that your wife needs treatment of any sort.

 2) Would the Zpakshe took - 1000mg - have wiped out chlamydia or ngu?

1000 mg of azithromycin is highly effective, recommended therapy for chlamydia.  Women do not get NGU.

3) What are my risks from the most recent encounter?

Please see my comment above. Despite your multiple partners, your risk is modest at best and your recent negative tests suggest that you did not have gonorrhea or chlamydia.

) If I am still feeling pain in my genitals,- meaning I may still have ngu? is my risk of acquiring HIV higher?

If you had NGU, you would have improved by now.  As I said earlier, there is little to suggest STI here.

5) If i continue to take doxy, would that wipe out any risk of chlamydia or gonorrhea from the latest encounter

Please see my comments above.,  your concerns about STIs are likely misplaced.  That said, which either the azithromycin or the doxycycline would be expected to reliably cure chlamydia, neither is reliable therapy for gonorrhea.

I hope this information is helpful.  EWH

---
14 months ago
Hi Dr. Hook,

Thank you for your prompt response.  There is no doubt that anxiety is playing some part in this for me. That said, however, I have a few followups and clarifications.

The hard part about the NGU diagnosis is that I did have a gon/chlam test - actually two of them - and two different labs lost the samples.  By the time I was able to REsubmit a sample, I had been taking antibiotics for 5 days, so in all my reading of your and Dr.Handsfield's collective posts, this would have cleared up or confused any real risk.  I will say that the pain I had did not really feel like prostatitis, BUT the absence of discharge I guess means that it could have been prostatitis.  Moreover, in my reading of your past posts, I did see that Gonorrhea is exceptionally rare and that Chlamydia does not get passed by oral sex.  
So, that said, 
1) Does the presence of bacteria in my urine at the levels I mentioned suggest any infection? 
2) if I did have something that was developing - and I will assume not Gon or chlam - could i have passed this to my wife? I am assuming it would be Mycoplasma Genitalium, Ureaplasma Urealycticum, Adenovirus or some oral bacteria that irritated me. It was 5 days after my oral sex and 4 days before I began antibiotics.  
3) If I did, would the Zpack have cured it in my wife?

Secondly, I had vaginal sex with another person and the condom came off.  I have read that the risk here is basically 1 in 2000 for passing from female to male 
if the female is positive for HIV.  I think it's unlikely that this person had HIV, but Dr. Hansfield has quoted white, western women to be infected something like 1 in 1000.  
4) So theoretical risk would be 1 in 2000 x 1 in 1000 or 1 in 2million?  Approaching zero? Do I understand this right?
5) Certainly if she gets tested and has no HIV, then the risk is, in fact, zero, unless she acquired within 2-3 weeks prior to her test?
6) If I wanted to be tested for HIV for peace of mind, I should wait 2 weeks for a PCR and 4 weeks for an ag/ab test?
7) I was tested today for HIV and it was negative.
8) Do you feel with the all of the above circumstances, I can safely resume sex with my wife?

Thank you, Doctor.


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

Boy, you must have very poor labs if they can loose two successive specimens.  I don't think I've ever heard of that!  My comments were not limited to the absence of discharge or your negative tests while early on during therapy.  Testicular pain is non-specific and neither abdominal pain nor pain at the tip of the penis are typical for any STI, OTOH, pain at the tip of the penis is a well described symptom of prostatis. 

With regard to your follow-up questions:

1. No, the quantity of bacteria you mention is not statistically significant or associated with STI.

2. Mycoplasma genitalium is rarely if ever passed through oral sex.  Ureaplasma is not an STI pathogen but normal flora. There is no therapy for adenovirus and your symptoms are not suggestive of adenovirus disease. 

3.  See above.  In the very unlikely circumstance that you had an STI, sex several days after starting azithromycin would be unlikely to infect your wife.

4.  Correct

5.  Correct

6.  correct.  In theory, you would need to wait for 6 weeks for a 4th generation HIV test to be conclusive but 99.9% of tests that are going to be positive would be positive by 4 weeks.

7.  OK

8.  Yes, I believe it would not put your wife at risk to resume sex with her

EWH


---
14 months ago
Dr. Hook,

Thank you again.  Yes, I couldn't believe two different labs lost the samples, either.

One more clarification and one more question

For my wife's risk, on the low chance that I had an STI from my oral sex encounter- NGU for sake of argument - that I was exposed to on Day 1, we then had unprotected sex on Day 6, and then I started on antibiotics on Day 10.  She did a Zpack on Day 12.  Do you feel she has risk of anything with this timing?

Two, for my accidental condom slip, what other STDs am I at risk for - I am still on antibiotics, so I am assuming no Chlaymida risk.  I think it is HSV 2, Gon, Syph, any others?  And could you provide any kind of percentage risk of those for a one time slip of unknown duration - I am assuming 5-10 minutes.

Thank you Doctor, your information and responses and this service in general are very much appreciated!!!




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

As you know, this will be my final response, provided in the context that I find little reason from what you have said to worry that you have an STI or have placed your regular partner at risk.

I see no risk associated with your wife from your dalliance, given the antibiotics and your low baseline risk.

Being on antibiotics your risk for most STIs is even lower than average- no meaningful risk for chlamydia, gonorrhea or syphilis.  There is a tiny risk for acquisition of HSV.  It is not well quantified but, as a generalization, much lower than even 1%

end of thread. Take care.  Please don't worry.  EWH

---