[Question #7852] Persistent NGU symptoms- possibly Trich?

51 months ago

Hello, unfortunately I'm writing once again. I realize my previous questions were due to anxiety around my encounter and I was fixating on HIV and syph. But I felt the need to write again as I've been having persistent NGU symptoms that have been very distressing and it’s been difficult finding answers. I thought maybe it was related to my withdrawal from weed but I don't think that's the case. The symptoms are a leaky, "crawling" irritated feeling in my penis along with a slight discharge that is constant along with some precum every now and then despite no sexual arousal. Slight odor but hard to tell. I know genital secretions are normal but this is constant and very distracting and the spot in my underwear where the penis sits has been wet. The symptoms have come and gone. Here's a timeline:

12/28 and 1/6: unprotected piv sex with female

2/22: discharge and leaky crawly feeling appears. given a shot of ceftriaxone and given doxy for 7 days @ ER. symptoms go away a few days in.

3/02: symptoms come back. a few days later begin a course of penicillin as a swab taken by my doc revealed E. faecalis infection which i know is not an sti. symptoms go away a few days into course.

3/18: symptoms reappear and stay

3/30: begin another penicillin course

4/4: symptoms go away, stay gone until 5/5.

5/7: took 1g of zpak, no real effect.

The symptoms are still here unfortunately. My scrotum has also been tingly, and achey jaw joints. I went to an ER 5/8 just so a doc could see the discharge and that it wasn't my imagination. He saw it and asked if I had been tested for trich. I did test for trich via urine dna test @ quest on 3/4, negative. tests for G/C have also been repeatedly negative. Test on 5/4 for Mgen was negative as well. He prescribed me 7 days Flagyl and said it should clear up my symptoms as trich was the only thing I wasn’t treated for and that he’d be surprised if it didn’t work. Thank you drs. I’m just looking for ideas. Could it be anxiety manifesting the symptoms?

Edward W. Hook M.D.

51 months ago

I am sorry to see that you have returned. The fact that you think that your symptoms have continued suggests that you are noticing normal sensations and normal urethral secretions. Trichamonas is a very rare cause of urethritis and men and when it does it typically resolves without therapy over a short period of time. The symptoms you describe are not at all typical for urethritis in men. On the other hand they strongly suggest that you are experiencing general general totally focused anxiety and as a result detecting otherwise normal sensations. There is really no reason for additional testing, for additional antibiotics, or for additional discourse on your symptoms. EWH ---

51 months ago

Thank you Dr. It just seems very perplexing as the head of my penis feels constantly moist from this and the doc at the ER seemed to confirm it is discharge. If I wipe it away with toilet paper it will come right back very quickly and I've never seen or felt anything like it so its very distracting and distressing. My penis feels very irritated constantly and I have a constant tingling in my scrotum which I usually will feel when slightly aroused but this time it's constant. The doc I saw said trich invades the seminal vesicles so would that explain the scrotum tingling? And my jaw also has been very stiff, especially on the right side where a swollen lymph node has been for the past 2 months almost though it has diminished in size greatly. Also in the month of March my butt and right thigh and calves were very achey. I've also had a stiff lower back in the morning past couple days.

At the ER my doctor said they looked at my urine under a microscope for trich, didn't find it, but 1- the urine cup was sitting out for quite some time before they took it and 2- he said the parasite can die very quickly as soon as they put it on the slide. I've also read that urine is toxic to trich. I was just under the impression that might be it as its a mild symptom that has come and gone several times. It almost feels like my penis is "exercising" in my underwear or something and it's very distracting. Would any of these symptoms indicate trich or MGen or Urea-U? Or even prostatitis? I'm only 26 but It almost feels too coincidental but I do know anxiety can do crazy things (a friend of mine mentioned her friend's bones became like that of an old woman's due to anxiety).

I apologize again for writing another forum question, I just really would like this to resolve somehow and my lack of answers via testing isn't helping. Has anyone ever reported to you or Dr. HHH of these types of symptoms actually being involved with trich or mgen, or have you seen them clear up in time with patients? I know this won't last forever, I'm jut trying to get as much opinion as possible to narrow what it could be and how to resolve it. I read people struggling with Mgen despite negative tests and I'm just very afraid of possible complications or something going undetected.

Edward W. Hook M.D.

51 months ago

I am concerned that your fear and anxiety is affecting your perceptions and decision making. You need to believe your test results. From that point that you need to accept that, in the extraordinarily circumstance that both your test results were inaccurate AND that the therapies that you have taken would have failed to cure NGU, chlamydial, gonorrhea and trichomonas. This sequence of events and the likely hood that any infection present occurred in totally improbable.

This is not trich, M. genitalium or any of the other STIs you are worried about

The only possibility here (and I doubt that this is the case) is that your multiple courses of UNWARRANTED antibiotics has led to a yeast/fungal infection.

You need to move on and ive p on the fact that your perceived symptoms are due to an STI.. EWH

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51 months ago

I think you may be right doctor. The more I think about it it seems my symptoms come and go with more space in-between (like several days, to a week or so, then an entire month gone). One thing I noticed around Feb, when I quit smoking, was that I was having frequent wet-dreams and waking up to ejaculate in my underwear several nights in a row for about a week. I even had wet-dreams happen a couple times during naps in the daytime. This also happened in March a few days after smoking again. It hasn't happened since. This is what made me think my urinary symptoms I'm so concerned about may have had to do with my weed withdrawal. So my last few questions:

1. Do frequent wet dreams have anything to do with any bacterial stds/urethritis? (i expect the answer to be no bc there doesn't seem to be any evidence there anywhere i look)

2. Does scrotum tingling have anything to do with bacterial stds or urethritis?

3. If it actually were sexually communicated urethritis, would it have appeared earlier in the timeline? And would it be more severe (pain during urinating, which there is none for me). And would there be any real abnormalities in my urine(like white blood cells and whatnot)? When I did go to the ER recently they told me it was crystal clear, no problems.

4. Do urethritis symptoms like this normally come and go and just linger instead of getting worse? I get the sense not. This is what made me think it was trich as it comes and goes.

At this point I'm just waiting for my ureaplasma and mgen tests I took on 5/4 but I honestly expect them to be negative. The 1g zpak didn't do anything to my symptoms so it makes me think it isn't anything in the class of mgen. And the only thing that leaves is trich, and signs point to no for that. So, that must mean I don't have anything. If anything I'm just trying to narrow everything down to calm myself and my ocd about the situation. Thank you dr.

51 months ago

One very last question to add before the thread is closed: From a dipstick urinalysis that I had done last friday at my PCP's office:

Test:

Blood (reference range: 0 - 4 RBC/uL)

Value:

+- (5 - 7 RBC/uL)

Could this be a sign of any kind of malignancy or anything that could have arisen from my encounter? I did have trace blood appear in my urine on 2/21 at a clinic and 3/12 or so at my PCP's office. Upon a second urine immediately afterward there was no blood detected. Is this anything to be concerned about?

Anyway thank you Dr. It probably seems like I'm being very OCD but I just want to exhaust whatever possibilities I know of that could possibly be wrong, if there is. Thank you for the forum's service.

Edward W. Hook M.D.

51 months ago

As you point out, this will be the final reply as part of this thread and further anxiety driven questions may be deleted without a response and without return of your posting fee. You are seriously overthinking this and nothing that you have described suggests an STI in anyway. On to final questions:

1. Wet dreams/nocturnal emissions are in no way related to urethritis or any other STI.

2. Scrotal itching or tingling is not a sign of any STI and in no way suggests the presence of urethritis.

3. If you had urethritis, not only would your symptoms have been expected to occur sooner but they would not follow the intermittent pattern that you describe. Rather the symptoms would be expected to be present consistently and if anything worsen over time.

4. See above.

You indicated earlier that you were test for mycoplasma genitalium taken on May 4 was negative. Further, the presence of Ureaplasma would not suggest an STI. Ureaplasma is normally present in the genitourinary tractor of many people.

Finally, the small number of red cells noted in your urinalysis are not suggestive of a pathological process. It is not at all unusual for men, particularly if they have engaged in regular self examination such as you have, to show small numbers of red blood cells in the urine.

This will complete this thread. I urge you once again to set aside your concerns regarding having acquired an STI, to stop testing, and to stop taking antibiotics that you do not need. At this point my sincere and heartfelt advice would be to seek counseling in order to help you move forward from these anxieties. Take care. EWH

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