Hi Dr's.

Firstly, I just wanted to say thank you for providing such a useful service. 

Based in the UK and male. 18 days ago (Sept 5) I engaged in unprotected oral and rimming with someone outside of my monogamous relationship (i haven't slept with this person in almost 2 months). I cannot remember if there was genital rubbing.

Since the exposure, I've experienced on and off symptoms of urethritis. Occasional penile pain, and on Day's 7 and 10, I noticed some clear discharge from my urethra. On Day 13 I awoke to find some dried white substance on my shorts. 

Day 7 - I took a gon/chl, hiv and syphilis test - all negative

Day 16 -  another gon/chl, hiv and syphilis test - all negative. Awaiting MGen results. she found some inflamation on a swab she took. Prescribed doxy

Day 17 - Started taking Doxy

Day 18 (today) - during defacation, I noticed a milky/white discharge from penis. I know prostate fluid is possible during defaction, i also haven't masturbated since the incident so perhaps a build up?

Questions

1) How likely is it that my NSU can be attributed to MGen following this oral exposure? I am terrified that my test is going to come back positive and I will have to take more antibiotics/discuss with others. I'm aware that oral is rare for MGen but I just need to know if I am at risk.

2) Is genital rubbing a risk for Mgen? 

3) Do my symptoms sounds like NSU given the intermittent nature? Do any of the discharge episodes sound worrisome?

As you can tell my anixety is running wild and I've been researching MGen. 

By this i mean I haven't slept with my monogamous partner in 2 months, and the person outside of my relationship was someone I met on that day 18 days ago (never met before). I hope this is clearer. 

What clinician, in what setting, found the "inflammation" (probably elevated WBCs?) by urethral swab? What was the remainder of her evaluation like? Did she diagnose NGU (nongonococcal urethritis, same as nonspecific urethriis or NSU, typically the American vs UK terminologies for the same condition)? With what level of certainty? Most of what you say argues against it, although I cannot fault the prescription of doxycycline if NGU was suspected. While some of your symptoms are consistent with NGU (nongonococcal urethritis, same as nonspecific urethriis or NSU, typically the American vs UK terminologies for the same condition) most are not, and I'm betting that she treated you as a precaution.

Even if you had NGU or still have it, and whether or not you have Mycoplasma genitalium (probably you do not), you're overreacting:  NGU itself is harmless, and unless due to chlamydia, has never been associated with any significant complications (no infertility or epididymitis, the main complications of chlamydia in males) and little or no potential harm to sex partners. So the username you chose and terms like "MGen scare" and anxiety "running wild" really aren't justified. Whatever is going on, there is nothing in your story that suggests serious risk for importat harm to you or your partner(s).

To your speciifc questions and issues. I'll start by saying that the negative results of your tests so far all are reliable.

1) M genitalium is rarely present in the oral cavity -- this has been studied pretty extensively -- and therefore rarely if ever acquired by oral sex. In the unlikely event you were to test positive for M gen, it would not be from the exposure described and not a likely cause of any of your symptoms (more about which below).

2) Genital rubbing is essentially risk free for all STIs transmitted through genital fluids, like chlamydia, gonorrhea, HIV, or NGU -- including M genitalium.

3) Your symptoms are not typical of NGU. On and off (intermittent) symptoms don't occur with NGU as far as known -- certainly not with any frequency. And the overall pattern of symptoms doesn't favor urethritis, which doesn't cause penile pain, and occassional scant clear discharge is normal in healthy males. So is expression of genital fluids during defecation -- more often in some men than others, but occasionally occuring in most men. (Stool passing over the prostate and seminal vesicles, plus straining, can express semen or prostate fluid.)

As mentioned above, the finding most consistent with possible NGU is the finding of "inflammation" (probably WBC) on urethral swab. But all things considered, I doubt you have (or had) NGU. As also implied above, I will be surprised if your test for M genitalium is positive. Assuming a negative result, I would recommend against any further treatment -- and against any further worry or concern. It is unlikely you have any infection of any kind from the exposure described.

I hope these comments are helpful. Let me know if anything isn't clear, or if you have more detail about your clinical evaluation.

HHH, MD

The further description of your symptoms doesn't change my evaluation. I continue to be confident you do not and did not have NGU. And indeed repeated massaging the penis looking for discharge can create mucus discharge. Stop looking! If there's not enough to drip spontaneously from your urethra, then you don't have discharge.

"Has there ever been a case of NGU from oral sex caused by Mgen where oral sex was the only exposure?" In biology and medicine, it's wise to never say never. I can't say whether this has ever happened, but I doubt it.

Whether she said I had NSU or not, does it matter based on the case and symptoms I've outlined? i,e. are you saying it doesn't sound like I don't have NSU based on my details? 

I also want to thank you for your detailed feedback too. I've been reading your comments for years and you have a way of telling people the reality of their situations. Like you said, there's a lot of mis-information out there and it's great to see a forum where you and Dr Hook are the main sources of information. 

Also, thank you for reassuring me about MGen. Your thoughts on what the outcome will be of the test are reassuring, and much better than me scouring the internet and scaring myself. 

Thanks for the kind comments. I'm glad to have been of help.

That completes the two follow-up exchanges included with each question and so ends this thread. Best wishes and stay safe.