[Question #8380] Follow up on Question 8372 - NGU concern

45 months ago

I did want to follow up on question 8372, partly because I think I snuck in an unrelated question that was kindly answered and also because the third answer to this final follow-up question got my anxiety up.

Six weeks after my exposure, I began to have symptoms that felt very UTI-like – discomfort in my lower abdomen (bladder area) and a dull pain and some discomfort in my right testicle. These symptoms would come and go…not constant and days would pass. Based on my earlier negative tests, I believed the symptoms to bladder/prostrate related. The telehealth doctor agreed, based on my age (late 40s) and prescribed a 10 day CIPRO treatment.

I do believe its anxiety more than anything at this point, and I will take your assessment without reserve. So my final two questions related to this exposure so I can put this all to bed:

-given this additional information, does any of this additional detail lend you to believe I might have gotten non-chlamydial NGU from my exposure? I’ve seen a lot of reference to no discharge/no dysuria being fairly definitive (I’ve had none, and believe me I’ve been checking since week 4) , as well as symptom onset typically no later than 2-3 weeks post exposure.

-I’ve seen a lot of reference to non-chlamydial NGU clearing itself without antibiotics through a normal functioning immune system. Is this still the case, and what is a typical timeframe for this to occur?

45 months ago

A) And in the interests of full disclosure, about 5 weeks after my exposure I visited an immediate care clinic because of discomfort/skin irritation/red rashy-ness on the tip of my urethra and head/upper shaft of the penis. The doctor diagnosed it as a penile yeast infection and provided a prescription for fluconazole. Although circumcised, my specific anatomy/excess weight likely contributed to the development (when flaccid, my excess penis skin often will completely cover the head, especially when sitting down.) I believe its improving slowly now that I'm religiously using the Lotrimin AF (and I now realize 10 days of CIPRO may not have helped this along).

H. Hunter Handsfield, MD

45 months ago

Welcome back; thanks for your continued confidence in our services. Also sorry if my last comment raised your concern, probably unnecessarily.

As you already have surmised, your symptoms indeed are typical for prostatitis (or the chronic pelvic pain syndrome, or CPPS -- the newer terminology often used for non-infectious "prostatitis" -- such as diffuse pain, which often radiates into the testicles, discomfort often felt at the tip of the penis, and so on. For more info, google CPPS (spell it out) and start with the excellent Wikipedia article and/or information offered by the Stanford University Department of Urology. That there may be an anxiety component to your intermittent symptoms also is typical. Antibiotics like ciprofloxacin or others often are tried, but usually make little or no difference. In contrast to your symptoms, those of urethritis typically are discharge and painful urination perceived only in the urethra. (As it happens, my colleague Dr. Hook was the lead investigator on one of the main studies documenting the symptoms of urethritis, not including the sorts of things you report.

As all this implies, this problem doesn't change my opinions or advice about your original concerns. There actually hasn't been much research on NGU that may be caused by oral bacteria following oral sex, but my clinical experience suggests that symptoms probably resolved within 1-2 weeks. As for the urethral irritation you describe, a yeast infection indeed could be responsible, given the circumstances of your obesity etc. And it is correct that broad spectrum antibiotics like ciprofloxacin also can predispose to yeast infections and/or contribute to their resistance to treatment.

All things considered, I continue to believe it unlikely you have any STI. And I'm glad to hear the Lotrimin seems to be clearing things up. Let me know if anything still isn't clear.

HHH, MD

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44 months ago

I think my major concern with potential NGU would have to be for the STD I didn't test for (wasn't offered at my lab)...Mycoplasma Genitalium.

1) In my absence of obvious NGU symptoms discharge and dysuria, and with my only outside exposure (in over 10 years) being unprotected oral, is this a legitimate concern for me? It seems there has been some evolution over the years from M Gen never being in the mouth throat and not a risk to occasionally being found there and a very small risk for transmission. What is the latest guidance?

I really don't want to spend money on this test if my intermittent symptoms described above are likely prostrate related and or CPPS coupled with my extreme anxiety and google searching.

Thank you again for your services Dr.

H. Hunter Handsfield, MD

44 months ago

For sure don't get tested for M gentalium, which would be a waste of money. As you already know, M gen rarely if ever infects the mouth or throat; the "evolution" is from never infecting the oral cavity to very rarely ("occasionally" overstates it), and oral sex still is not a signfiicant risk for M gen infection. In addition, M gen testing isn't recommended in this situation -- only for documented NGU that fails to respond to initial treatment.

That concludes this thread. I hope the two discussions have been helpful. You can move on with no worry about any STI from the exposure you have been concerned about. Best wishes.

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