[Question #7417] NGU Reoccurrence

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57 months ago
Hi Doc,

About a month ago I was diagnosed with NGU. My urine and swab tests were negative for chlamydia/Gonorrhea and other bacteria. I was initially given a shot of Rocephin and 1g of Azithromycin. That cleared up the pain on urinating but not the discharge. I went to see another doc who prescribed me doxy twice daily for 10 days. That pretty much eliminated the discharge. I have been off it for a little over a week and this morning I noticed the discharge is back again. I had been feeling some slight irritation in my urethra since being off the doxy but it was so slight I didn’t think it was a big deal and I didn’t pay attention to it because I didn’t always feel it. I should mention that once I got off the doxy and was feeling better I did have protected intercourse so I’m not sure if somehow I reinfected myself although my current partner was not the one I initially contracted NGU from. At this point I’m frustrated and confused and don’t know what to do. I have made another appt to see my doc but I think he is going to refer me to a urologist. Any advice  would be appreciated!
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Edward W. Hook M.D.
57 months ago

Welcome to our Forum and thanks for your questions.  In reading your question several times, I have several comments.  I hope they will be helpful.

1.  You don't mention any exposures you might have had before your diagnosis (i.e. numbers of partners, their gender, or types of sex acts), nor whether the health care provider you saw looking for white blood cells in your urethral discharge or not.  Certainly the combination of urethral discharge and burning on urination are sufficient to make a diagnosis of NGU following an exposure and testing for gonorrhea and chlamydia are the right tests to do.  In about 40% of men with NGU, tests for gonorrhea and chlamydial infection are negative.  most such infections do respond to treatment of the sort you received but there are some treatment failures (see below)

2.  You describe at least a partial response to therapy.  In some persons, following the diagnosis of urethritis, heightened vigilance looking for signs of continued infection leads them to notice the small amount of normal genital secretions that are variably present in most men.  These secretions are variable in amount, typically most noticeable first thing in the morning and tend to be clear, not cloudy.  Is this possible?

3.  In recent years, a new bacteria, Mycoplasma genitalium, has been described which may not be effectively treated by either azithromycin or doxycycline and required different antibiotics for successful treatment (moxifloxacin).  When you see your doctor, I would suggest that you request a urine test for Mycoplasma genitalium (AVOID testing for other sorts of Mycoplasmas such as Mycoplasma hominis which can normally be present in the genital tract). 

These are my initial comments. I hope you will find them helpful.  We do allow for up to two follow-up questions for clarification so if anything I've mentioned is unclear, please feel free.  EWH

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57 months ago
Hi Doc

1. Yes I had a urine culture for WBC that came back negative twice as I did see a couple different docs. I only had one female partner at the time and it was just one encounter and prior to that hadn’t been sexually active for 8 months with anyone. After that encounter about 5 days later I started to exhibit symptoms so I know it didn’t come from anyone else.

2.  Unfortunately I know this isn’t a heightened sense of me checking as the discharge did virtually disappear after treatment and it is cloudy(white) not clear and usually my penile head is stuck together.

I just saw my doc today and he gave me another round of doxy and said If this doesn’t help then he would suggest I see a urologist. I will have to mention the mycoplasma test to him. Do you have any other recommendations? It appears most primary docs aren’t well versed in STDs that aren’t the common ones.
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Edward W. Hook M.D.
57 months ago

Thanks for the additional information.  Comments:

1.  Urine can be cultured and can be tested for WBC.  I am not sure which test you had, or both.  If this was NGU, I would anticipate that there would be WBC detected in your urine test, particularly if it was a test performed on urine collected just as you began to void (not mid-stream which is good for detection of UTIs but not testing for WBCs).  Classical urine cultures which look for bacteria are typically negative in men with STI-related urethritis. 

2.  The timing of your exposure and the onset of symptoms certainly suggests an STI.

3.  I agree, a substantial amount of cloudy discharge is not just "hyper-awareness".

4.  since you improved somewhat with the doxycycline, it may be worth trying again but I still think I'd test for M. genitalium before I went to a urologist.  If the test (again, collected just as you begin to void) is positive, I would treat with moxifloxacin. 

Hope this helps. EWH

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56 months ago
Doc,

You were right I did test positive for MG. I requested the test through an online std company since I have been out of town and cannot see my primary doc.  They  used Quest Diagnostics who took a sample of my urine. Should I take my lab report from Quest  to my primary doc when I get back? I did make an appt already. I assume he knows what the treatment would be. I know not that many doctors know about MG or even suggest testing for it. I could’ve been cured a month ago! So I am wondering if it has caused any damage such as stricture or infertility? 
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Edward W. Hook M.D.
56 months ago
I’m pleased that you found out what the problem is.  Now that you know, you can be treated. The recommended therapy for azithromycin-resistant mycoplasma genitalium is to take doxycycline 100 mg twice daily for seven days and, upon completion of that, immediately begin moxifloxacin 400 mg daily for seven days. Curates with this regimen are excellent.

Your risk of infertility or urethral structure is low. Irrespective, there is little to do at this point but to take the treatment and to move forward. 

I hope the information in these replies has been helpful to you. Take care. EWH
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56 months ago
Hi Doc,

My doctor decided to just prescribe me moxi for 400mg for 10 days. I know you mentioned 7 days of doxy then 7 of moxi but I’m wondering if what he is prescribing me still going to be just as effective? I should note that I was in the middle of my second go around of doxy 2x day 100mg (about 6 days) when I began taking the moxi since my MGen results came back. Are there any stats on effectiveness of just the 10 day course of Moxi? I read online that some people had success with 7dag 100mg of doxy followed by 2.5g of Azithromycin as a first line treatment. I was never given that at all but that was due to my doctors at the time not knowing initially I had MGEN. So I’m wondering if that regimen would have been effective or not or worse case if Moxi doesn’t work could I try that instead?