[Question #9168] oral gonorrhea and ngu 2

Avatar photo
35 months ago
Doctor Handsfield, my apologies for my new question. 
After the shot of rochefin and azytromicin my symptoms improved. But just one day after sex with my wife symptoms  started again. 
High frequency of urination, dribbling after 5/10 minutes finished urinate.  At this point i'm not sure it's urine , it's very watery, trasnparent and not sticky so for me it look like urine but i'm not so expert ( it happen at maximun after 10 min urinating). This morning i woke up and before urinating i always control if there is any discarge , but i never see before urination. In the morning the meatus is a little bit glued, but with no crust and quite easy to open it.  Anycase this morning after urinating , i feel my penis wet so i open my meatus and i could se sticky filament inside my uretra and my anxiety grow up again. I continue not see stain in my underwear or feel pain during urination. 
-What is strange is that i have improvent with antibiotics so it made me think some infection is going on?
-Could be gonorrhea also with so slight symptoms ?  As i said before  i haven't be test tested for lack of clear symptoms and discharge. Do you steel remain i do not have to bee tested ? My first symptoms started 45 days after having sex with my wife after the meeting with the escort. 
-Could these symptons  also be due NGU like mycoplasma genitalium ?
-I don't know if is important but yesterday my wife she want to the gynecologist , and told her everything was fine.

I know that you told me that i couldn't pass any NGU to my wife 36 hours after takin  1.85g of azitromicn but i still so afraid for my symptons and this filaments of mucus that i see. 
Thank you so much for helping. 
Avatar photo
35 months ago
Just to clarify this morning i see the mucus filament 40 minutes after urination.
Avatar photo
H. Hunter Handsfield, MD
35 months ago
Welcome back, but I don't see how I can be helpful. You are asking pretty much the same questions as last time and the answers have not changed.

No STI causes most of symptoms you describe:  frequent urination, post-void dribbling, and bits of mucus in the urethral opening. And as already discussed, it is very unlikely you caught any STI from the exposures described, and none that could persist after the antibiotics you received. There is no possibility you have gonorrhea.

To your specific questions:

1) On and off symptoms like this often have a psychological origin:  your anxieties may be making you more aware of trivial symptoms or even normal body sensations that otherwise you would ignore or not even notice. If you in fact have urethritis, the timing suggests you are getting repeat infections from your wife.

2) We previously discussed the reasons your current symptoms cannot be due to gonorrhea.

3) Given your sexual exposures, it is unlikely you have M. genitalium.

4) That your wife has had a normal gynecological exam doesn't mean very much, unless her doctor knew to test her for STIs. Was that done?

If you choose to pursue these issues, you should see an STI or infectious diseases specialist in person. Professional evaluation is far more likely to reassure you than than anything I can say on an online forum. And that person ideally would also either evaluate your wife, or at least communicate with her doctor. To be very complete, such an evaluation might include testing for other pathogens, such as M. genitalium and Trichomonas vaginalis, and even repeat testing for gonorrhea and chlamydia. For all the reasons above, I would be very surprised if anything turns up -- but such negative results probably are the only way you will be sufficiently reassured. If you pursue such a consultation, I suggest you print out this and your previous thread as a framework for discussion with the doctor. In any case, do not expect any more conclusive answers on this or any other online forum. In-person care if your only option. 

Best wishes and good luck--  HHH, MD


---
Avatar photo
35 months ago
I had a visit and the doctor agree with you that my symptoms and the type of exposure didn't suggest any STD. He did not consider necessary testing for M.genitalium and Trichomonas for the exposure of cunnilingus. He take me a urethral swab and did a cultural examination(9 days finished antibiotics). The results where negative for gonorrhea , but positive for Staphylococcus Haemolyticus. He told me that is probably due contamination but send me to the urologist. 
My symptoms are improving and stop examining my self. 
In my city I can't find NAAT examination and I should drive 200km.
-If I decided to repeat testing by a NAAT exam of Gonorrea, Clamidia, M genitalium and Trichomonas they would be conclusive, even if I stopped the antibiotics 15 days ago but possibly being reinfect having sex with my wife ?

thank you so much.

Avatar photo
H. Hunter Handsfield, MD
35 months ago
I'm glad to hear your doctor and I are in agreement; that your symptoms are improving; and especially that you have stopped examining yourself. Staph hemolyticus is normal in the genital tract and on the skin.

The way you ask the question suggests you are not necessarily planning to be tested, but thinking about it. If you proceed, the tests you mention would be conclusive:  they would accurately indicate whether or not you are infected at the time you are tested. However, negative results will not mean you were not infected earlier:  if you were, you would have successfully treated gonorrhea, chlamydia, most NGU infections, and some infections with M. genitalium. In that case, tests for them will be negative, but there are no tests that can tell if you previously were infected before treatment. This is the main reason that experts recommend patients who suspect they have STIs not treat themselves before being medically evaluated. All things considered, I now suggest no testing at all -- or if you insist, have only a test for trichomonas. (Also remember it is not possible to be infected with M. genitalium by oral sex, because M gen does not reside in the oral here. There is no point in testing for it.) However, in the meantime I strongly recommend you resume sex with your wife, is you have not yet done so. It is very unlikely you currently have any STI. And by the way, I doubt you really need too travel 200 km for NAAT testing. Your doctor probably can arrange for testing at a local lab.

That completes the two follow-up comments and replies included with each question and so ends this thread. This being your second question about this particular exposure and symptoms, it will have to be your last; repeated discussions of the same event and questions are not permitted. Thank you for your understanding. I hope the two discussions have been helpful. Best wishes and stay safe.
---