[Question #699] Could NGU have been caused by HSV

89 months ago

Several years ago, I had a sexual relationship with one woman. We had unprotected sex multiple times. The symptoms I began to have were: frequent urinating/and or the urge to urinate frequently, even if hardly any urine came out; slight burning during and after urinating; and pain/discomfort in my testicles. 

I went to and STD clinic to get tested, and they diagnosed me with NGU. They treated me with an antibiotic, I can't recall which type of antibiotic it was. After a week to 10 days, the symptoms subsided.  Following this, I also saw a urologist because after urinating, I didn't feel like everything was coming out. He ran some tests, which showed that my bladder was not emptying completely and gave some medication. That problem also seemed to subside for the most part.  Occasionally from time to time I will still get this feeling, as well as slight burn when I urinate. Usually it seems from dehydration as when I drink a couple of bottles of water it goes away.

So the reason I am writing this several years after the fact, is that I recently read that Herpes can be a cause of NGU. I never knew that. Is it possible my NGU could have been caused by Herpes? I never had any visible sores, blisters, or lesions on my penis at the time, or since. The burning I felt from urinating was never very severe, and certainly not excruciating pain. The most painful part that I recall was the pain/discomfort in my testicles, which went away after treatment.

So I now I am nervous again about this situation that I had many years ago. I'm hoping I'm getting worked up over nothing, however I would like to have an expert opinion. 

1. Do you think Herpes could have caused my NGU?

2. Do I need to worry about possibly infecting future partners with anything? 

Thank You, and I look forward to your response.

H. Hunter Handsfield, MD
89 months ago
Welcome to the forum. Thanks for your confidence in our services.

The bottom line is that most likely you are indeed "getting worked up over nothing". To your specific questions:

1) There is virtually no chance your NGU was due to herpes, if you had NGU at all (see below). Herpetic urethritis has specific symptoms and findings and your description doesn't come close. As you may already know from your reading (and on your emphasis of mildly uncomfortable urination), herpetic NGU typically causes dramatically painful urination (one patient of mine described it as the worst pain they had ever experienced and another said "like peeing razor blades"). Usually there is discharge and often redness and swelling of the meatus. Finally, I can also confirm your apparent awareness that it is uncommon for HSV to infect only the urethra; most patients also have typical blisters/sores on the penis.

2) NGU is not known to persist for years and, except for some causes (chlamydia, maybe Mycoplasma genitalium) not known to cause disease in female partners. And even these bacteria are cleared by the immune system over time, if not eradicated by the antibiotic treatment. There is no risk to your current or future sex partners.

As for the original diagnosis, your symptoms are not entirely typcial for NGU, which generally does not cause frequent or urgent urination, bladder discomfort, or testicular pain; and almost always causes abnormal discharge from the penis, which you don't mention. That said, if the STD clinic was confident in the diagnosis on the basis of examination (e.g. seeing discharge) and testing (e.g. white blood cells in your urethra), that has to be taken seriously. But even so, NGU probably did not explain all your symptoms, especially the testicular discomfort, urinary symptoms other than painful urination, and the continuing symptoms after treatment that led to seeing a urologist. Your description is more typical of prostatitis (not sexually acquired or transmitted) or genitally focused anxiety.

But all that is water over the dam and no longer relevant. If you had NGU, it wasn't herpes and doesn't imply any risk to partners.

I hope this has been helpful. Let me know if anything isn't clear.

Regards--  HHH, MD
89 months ago
Thank you for your timely and very thorough response. You have relieved me of my concern, and I appreciate your service very much!
H. Hunter Handsfield, MD
89 months ago
You're welcome. I'm glad to have helped.