[Question #8246] Confirmed NSU - confused

47 months ago

Drs,

4 months ago, deep kissing and received fully protected BJ from a MTF trans escort.

Throat swab at 4 wks & 10 wks - NEGATIVE.

SIX tests for gonorrhoea and chlamydia out to 13 wks - ALL NEGATIVE.

In the interim, have been having regular sex & received fellatio a few times from pregnant wife.

As you know from previous threads, I've been super anxious, so have been examining my penis & underwear every day for signs of infection.

- I occasionally have a sting when beginning to urinate.

- Have noticed a couple of super small white stains in underwear from time to time.

- Have seen small amount of completely clear discharge occasionally - usually in the morning, but once or twice at night.

- Constant feeling of discharge, but when I check, nothing there.

Finally managed to see a NHS GUM clinic in person today, & the nurse took a swab and said there were pus cells present. When I pressed her on it, she said there was a 'significant amount'.

I was tested for gon & chlam (again), as well as Mycoplasma genitalium. Currently waiting results & have been prescribed doxycycline.

1) Is it possible this diagnosis is linked to the aforementioned incident?

2) Is M. genitalium transmitted through kissing?

3) Is my wife at risk? Unborn child?

I am completely confused and worried once again. I don't know how to approach this now. She said my wife should be treated and I just can't bear the thought of bringing this up with my previous indiscretion.

Please can you advise.

Thank you

47 months ago

Also, this comment from Dr HHH has worried me a little bit.

"I would also recommend re-testing for gonorrhea and chlamydia, preferably on a urethral swab specimen -- especially if you had a urine test last time. (Urine testing misses 5-10% of gonorrhea and chlamydia.)"

Would this still apply to me consider i have tested 6 times via urine testing?

47 months ago

Have just received the gonorrhoea and chlamydia urine results (record time) and they are negative. Just waiting on M. Genitalium.

As I asked above, can I trust these urine results in light of Dr Handsfield's above comment?

Edward W. Hook M.D.

47 months ago

Welcome back to our form. Thanks for your question. Before I comment on your specific questions a few more general summary statements. As I believe you know, risk for acquisition of any STI including Gonorrhea from either deep kissing or receipt of condom protected fellatio is close to zero. On the other hand, it would not be terribly unusual if you had acquired non-chlamydial NGU from receipt of fellatio from your wife. Your recent urine test for gonorrhea and chlamydia prove that you were not infected with either of these pathogens. The fact that you were tested multiple times with the same results adds further assurance to the fact that you were not infected. FYI, non-chlamydial NGU is occurs due to introduction of normal oral bacteria into the male urethra. While this may lead to the presence of white blood cells on a swab or urine specimen, the irritation is non-specific and does not represent a known hazard to either the person with Urethritis or their sex partners. In answer to your specific questions:

1. Your symptoms may reflect your possible non-chlamydial NGU, your well documented genitally focused anxiety, or both in which minor irritation or normal sensations are heightened in intensity by your anxiety.

2. While in science and medicine one can never say never, the frequency of oral mycoplasma genitalium is very, very low and there are no data to suggest that when present the infection is transmitted through kissing.

3. Nothing you report above suggests any threat to your wife or unborn child’s health. None at all. Based on your test results, I see no reason that your wife requires treatment.

With each test of the total proportion of infections that are missed with urine testing diminish steadily. After six tests, you can be entirely confident that you do not have gonorrhea or chlamydia. I see no reason for a swab test. Believe your results.

I hope the information I have provided is helpful. Take care. EWH

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46 months ago

Thank you Dr for your reassuring words. I have mentally accepted that there is nothing wrong now (finally) & would just like to close the loop here.

FYI, I tested negative for mycoplasma along with my G & C results.

1) Trichomonas is not a concern at all here right, no need for testing?

2) The nurse did a urine dipstick test AFTER saying there was 'pus' in my swab sample. From what I remember, the urine test was fine according to her. Does this potentially negate the NSU diagnosis?

I personally do not feel I even have NSU.

I went to the clinic to rule out, rather than confirm anything was wrong. I think I have genitally-focussed anxiety. I had NSU a couple of years ago and noticed prominent white liquid.. I have noticed nothing like that this time. Browsing a question I asked you here from 5 years ago, I also noticed some clear fluid from my penis then and nothing turned out to be wrong.

3) As a result, I am reluctant to take the prescribed doxycycline. While I am not asking you to contradict medical advice, do you foresee any harm if I elect not take it, to me or my wife?

4) What would be meant by 'pus' seen under the microscope?

5) If indeed it was NSU from oral sex from my wife, which I am not sure about, is it reasonable to expect it to clear up by itself?

Thank you so much Dr for helping me through what was a difficult time for me

46 months ago

6) In summary, can I finally breathe (as you advised me to long ago) and resume a normal sexual life with my partner without worry.

Thank you

46 months ago

And finally addendum to 6,)

If I had passed anything to my wife initially but had cleared it from my own system, after four months of unprotected vaginal sex, I would most likely be reinfected right?

Please close this thread after your reply, thank you sir.

Edward W. Hook M.D.

46 months ago

Thanks for your follow up message. I am pleased, and not at all surprised, that your mycoplasma genitalium test was negative. I do agree with you that you are most likely experiencing genitally focused anxiety. I will work through your follow up questions and then close the club and she was a question:

1. Correct, trichomonas is not transmitted through oral sex. It is not a concern for you.

2. When clinicians refer to “pus”, they are referring to the presence of white blood cells. As mentioned above you do not need to worry about this.

3. I see no reason that you need to take the doxycycline.

4. See my comment about pus above. Please do not fixate on this. You do not have NSU.

5. Yes

6. Correct. It is past time for you to put your concerns aside and to move forward without concern. There is no reason to abstain or worry about unprotected sex with your wife.

Addendum. Your concerns about resolution of infection and then re-infection from your wife are miss placed. Please move on and stop worrying.

As per your suggestion this will complete this thread and it will be close shortly. Take care. Please do not worry. EWH

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