[Question #8486] Follow up to Question #8448] NGU concern
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43 months ago
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Drs, I wanted to follow up with some additional info to provide clarity and to help decide how to move forward on my NGU concern.
1. My main concern has been the discharge. I first saw it 12 days after unprotected oral. It was white and cloudy and came out after straining to finish urinating. I was looking often but didn’t see anything like that again for 10 days and it happened in the same situation. Went on doxy for 7 days and then 2 days after finishing that I had the discharge again after urinating. 9-10 days in between seeing these. I had been looking often in between these for underwear stains but didn’t see anything except very small amounts after being aroused or after a bowel movement when I saw some in the the toilet as well. I smelled it and it is odorless. Does this sound like discharge from NGU or MGen? Or is that more continuous and I would notice it more often??
2. I read on another site that you all used to offer your expertise on, that a commenter (he hasn’t posted in 2yrs now) said he got MGen from oral and his prostatitis like symptoms are very similar to mine. So I became concerned . My LE tests for wbc have been neg at Drs office but that haven’t been first morning void and they haven’t done a gram stain. I did do an at home uti test of FV urine and it showed a small amount of wbc, further concerning me. Should I return to Dr and ask for additional testing? And should I get an MGen test to rule it out?
3. This is from an oral exposure which I know MGen is rare. My last unprotected vaginal exposure was 2y ago and I was fully tested and neg 3 mos after, but had never heard of MGen. Could I have been carrying it since then and it only flares up occasionally?
4. I was tested for gon and chlymidia 10 days after exposure. Can I rely on these tests and also that the symptoms didn’t go away after doxy make it even more unlikely that it was a false negative??
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Edward W. Hook M.D.
43 months ago
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Welcome to the Forum. As you know, Dr. Handsfield and I share the Forum. On this occasion I happened to pick up your question. I'm sorry you continue to worry about this situation. I have reviewed your earlier interaction with Dr. Handsfield and agree with all that he has said. Straight to your new questions:
1. The intermittent intermittent nature of the discharge you have observed, as well as its association with arousal or following bowel movements argues strongly against a diagnosis of NGU, irrespective of the cause (including M. genitalium). The discharge of NGU is typically continuous or progressive- not intermittent.
2. As you note, acquisition of M. genitalium from oral sex is most unusual. OTOH, the presence of small amounts of WBCs on a first void urine is not. I see no reason for testing for M. genitalium but if you feel it would help you deal with your anxiety obviously there is no harm, other than the cost and inconvenience of getting tested. I would predict that the result will not show the presence of M. genitalium.
3. This really is not a story suggestive of NGU including that caused by M. genitalium. It is consistent with prostatitis (which I note you have had in the past) or the chronic pelvic pain syndrome (CPPS), neither of which is infectious in origin.
4. If I were you, I would have no hesitancy to have unprotected sex with partners. I would not worry
I hope these comments are helpful. EWH
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43 months ago
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Thank you Dr Hook and Happy New Year. Yes, I do find your responses helpful. A few brief clarification La for my continued knowledge.
1. By the discharge being “progressive” do you mean it would continue to get worse until treated? That has not been the case here. Just seemingly infrequent unless I somehow am missing seeing it, but from what I understand it would be hard to miss.
2. I have a scheduled appointment with my urologist tomorrow and will discuss the symptoms with him as well.
3. I am favoring taking your expert advice and not testing for MGen. My concern is getting the best of me and I appreciate your reassurance. If I do decide to test after the appt tomorrow I’d like to post the results here for the forums help if that’s ok. If I don’t test, I’d like to let everyone know that as well in my final a response just to complete the thread.
Again, thanks for your expertise and guidance.
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Edward W. Hook M.D.
43 months ago
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1. At the very least it would stay the same but more typically it would increase. Given your concern, I would not be concerned about you missing something. Rather, if anything, I would worry about you misidentifying the small amount of normal discharge or normal sensations as abnormal.
2. Understood. I'll be interested to hear what he has to say. Feel free to share the information I have provided
3. Understood. Either way, I will look forward to hearing more.
EWH
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43 months ago
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The urology appointment went as I suspected. Gave another urine sample that he said was clean and there was nothing to suggest any kind of infection. He did not prescribe antibiotics nor do I want to take any due to no evidence of infection. I did discuss our interaction here with him and he drew the same conclusions as you did. I told him that I had seen some intermittent discharge and he thought that prostate fluid was very likely and in fact is commonly seen in similar cases. Since I have a history of prostatitis, he called it CPPS in my case, he has referred me to a pelvic floor PT. I have not been able to make that apt yet, but will soon. I have decided also that I’ll take everyone’s advice and not waste time testing any further. Just the lack of worrying and researching this incessantly has already reduced some of the symptoms and tension. Thanks for your help Drs.
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Edward W. Hook M.D.
43 months ago
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Thank you for the follow up. I’m pleased to hear that your urologist agreed with our assessment. I applaud your plans tonight take further antibiotics and to move forward. Take care. EWH---
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Edward W. Hook M.D.
43 months ago
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I would add that I agree with his recommendations. EWH---