[Question #9187] Testing for NGU
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35 months ago
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Doctors. Thx so much for your work here. I notice that there are many hundreds of men online claiming they got prostatitis after receiving oral sex. Many if not most of these guys test negative repeatedly and never find a bug. I have e noticed that you nearly always attribute their prostatitis to anxiety. But research shows the testing is not particularly accurate and some bugs can simply not be identified. I received oral sex from a young girl. Two days later I had a definite paper cut sensation on the side of my penis. It’s stayed three days. Then I started getting urinary frequency. And incomplete emptying. This was not psychiatric because I foolishly believed I could not get anything from oral. I tested for all the standard bugs chlamydia gonohrea sylhet etc urine tests. But was not swabbed for NGU. Subsequently urine tested for MYcoplasma and ureaplasma trich . All tests were negative. Urinary symptoms came on within three days or oral. No discharge. After 4 weeks of urinary issues my prostrate began burning and has been burning for a year as I test over and over for bugs. Eventually swabbed positive for urea parvum and myco hominis. And treated them. I know treatment is controversial. My question is this since I was not swabbed for NGU. Could I have been infected with an NGU bug that has now made its way into my prostate? I know chlamydia and mg only make up a small portion of nGU infections. So did some mystery nGU bug infect my urethra and prostate ?
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H. Hunter Handsfield, MD
35 months ago
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I'm afraid I can't help much more. That we commonly attribute certain symptoms too -- including those often thought to be caused by prostatitis -- reflects the simple fact that it is anxious persons in whom previous diagnostic efforts have not given the answers they expected or hooped for dominate this forum, as well as many online resources. And that there are many men who attribute their symptoms to an oral sex event is just about the least reliable of all kinds of epidemiological data. On top of that, diagnosing prostatitis is a very inexact science -- the proportion of the "hundreds" online who actually have true prostatitis is impossible to judge, but undoubtedly many do not.
The entire topic of the relationship of prostatitis in which no infection can be found to be responsible to sexual exposures and STIs is fraught with controversy and inexact science. Same for the chronic pelvic pain syndrome (CPPS), which causes pretty much identical symptoms. Some respected STI experts believe that a true STI, with or without treatment, may set up an aberrant immune response that leads to cycles of non-infectious true prostatitis. Others are more in favor of the same idea, but with recurrent symptoms more frequently attributable to psychological factors. (It's important to understand that "psychological" does not mean the symptoms are not real and physiologic. Tension headaches are real and can be debilitating, and are the direct result of increased tension in muscles of the scalp and neck. That psychological factors cause the increased muscle tension isn't controversial, including among most sufferers of such headaches. Much the same likely explains most symptoms of CPPS, via increased tension in pelvic rather than scalp & neck muscles.)
That you experience "burning" in that part of your body does not, in itself, implicate the prostate. But even if you have true prostatitis, there is no evidence that a persisting STI is a direct cause of the symptoms -- even if an initial STI set off the chain of events causing current symptoms.
That M. hominis and U. parvum rarely if ever cause disease or inflammation is a fact, and that they rarely infect the oral cavity also is clear. And if you acquired one of them back when all this started, why do you think they only showed up recently, after previous negative tests? Or that they explain your symptoms?
There is no such thing as a known "NGU bug" or a lab test for NGU, other than identifying the established causes of urethritis (gonorrhea, chlamydia, M. genitalium, rare cases of U. urealyticum, and even rarer cases of enteric bacteria [like E. coli], HSV, adenoviruses, and maybe a few I don't remember right at the moment. In other words, nothing else that medical science knows you could be tested for. Around 40-50% of NGU cases test negative for all of these. There simply is no lab test to diagnose NGU. Maybe someday research will sort this out, and as a scientist, I certainly acknowledge that one day we may have evidence that some hitherto unrecognized bacteria or virus (or "mystery bug" to use your term) is sexually acquired and responsible. But we're certainly not there yet, if ever we will be.
A final take-home message is that chronic prostatitis (or CPPS) has never been associated with a serious health outcome, except for the symptoms themselves and the psychological impact of having an undiagnosed condition (whether or not psychology has a causal role). There are no reported cases of the standard complications of lower genital tract infections in men like urethral stricture, epididymitis, or infertility; no increased rate of prostate cancer or other malignancies; and no reported complications or health problems in affected men's sex partners. In other words, it appears to entirely be an issue of symptoms and comfort, not physiologic disease. Indeed, some of the strongest evidence of a psychological/emotional origin in many cases is that in the large majority of men, the symptoms ultimate fade away, or recur periodically in mild form -- suggesting that once men become convinced (truly convinced and believing) that nothing serious is going on, the symptoms clear up.
All of which ignores the possibility that you in fact have (or had) an E. coli lower genital tract infection, which could cause prostatitis. I think we previously discussed the "three glass" urine testing that might be used to help sort out whether this is an issue, or even to document (or refute?) the possibility of true prostatitis.
Beyond these generalizations, I have no way of knowing exactly what is going on in your particular situation, except that it remains exceedingly unlikely that any infection acquired during the oral sex event is present now or explains your current symptoms.
HHH, MD
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35 months ago
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Thx doc the Amt of info we get for 25 is terrific. I guess my question is this given that symptoms came on directly after exposure why shouldn’t I assume that NGU is a likely cause. With testing either missing chlamydia mg etc or the bug being something we can’t ID now ? It’s just too coincidental and if uti goes untreated which mine was. It develops into bacterial prostatitis. It all fits yet you say it’s extremely unlikely? Why. Thx doc
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H. Hunter Handsfield, MD
35 months ago
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First, your symptoms began too soon: NGU is not known to cause symptoms sooner than a week after exposure, up to 2 weeks or more. Second, you never had the right symptoms for NGU, especially urethral discharge, by far the main symptom. My colleague and co-moderator Dr. Hook was the lead investigator on perhaps the best study that showed that urinary urgency, frequency, etc are not associated with urethritis. Third, your negative test results: gonorrhea is commonly transmitted by oral sex, but chlamydia and M. gentalium rarely if ever are so transmitted, because they uncommonly infect the oral cavity, and research has not found oral infection to be present in the sex partners of men with NGU. Combining those facts with your negative test results, it simply is not a realistic possibility that you had any of these.
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I don't disagree your symptoms are related to the sexual exposure; they probably are. But I have given my reasons that your symptoms probably have a non-infectious causes. Your statement about "bacterial prostatitis" resulting from NGU conveys a misunderstanding. The possible association of NGU with prostatitis is for nonbacterial (also called "nonspecific" ) prostatitis. Bacterial prostatitis is a real entity, but its symptoms generally are more severe than you describe. That said, E. coli is one of its causes, taking us back to your previous questions about that test result. It's something to discuss with a knowledgeable urologist.
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H. Hunter Handsfield, MD
35 months ago
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Your latest new question. Excessive questions and threads, especially since this one (and still another) was still open. Your new question is being closed and deleted. I will ask the forum moderator to reimburse your posting fee.
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Dr Handsfield. First let me thank you for the service you provide. The amt we pay you for this service is silly low so I know you are working out of the goodness of your heart. Thx so much for your thorough and quick responses. In your last response you advised that my oral sex encounter likely caused my prostate burning but not due to infection. Did you mean to imply that the burning is due to psychiatric causes? I know you have suggested ecoli from my hernia operation as a possible cause. But symptoms did not come on for over 6 weeks after I was cathed. Your esteemed colleague Dr Hook said cath infections mss as infesting 6 weeks later would be rare. I did get an ecoli finding on my microgen dx dna test but my experienced UTI doc Hseaih dismissed it as unreliable. Saying that test is flawed. That leaves my oral sex encounter. I should mention that this lady had performed oral sex on my friend only moments before me. He is fine. But maybe he had something that infected me?I did started getting symptoms two days later. A scratch sensation on the penis. Then urinary frequency and delayed emptying before weeks end. These were not psychiatric symptoms as I foolishly believed oral sex was safe sex. And didn’t follow up with a practitioner. Not that it mattered as all testing has been consistently negative. My question is this could some unknown mystery parasite or bug have caused these symptoms. You suggest that there are likely bugs which we may never identify that could be wreaking havoc on the urinary tract. This would certainly explain the legions of men suffering with “non bacterial” prostatitis. I have spoken personally to numerous men who have the same experience as me. They got a bj. Within days got symptoms. Tested neg for everything and eventually developed “non bacterial” prostatitis. This suggests to me that our ability to identify bugs is limited. It’s just too coincidental that I got these very obvious symptoms within days of exposure
Thanks for the thanks, but you are raising the same issues as before, and asking pretty much the same questions, in different words; they have already been answered, or the answers are obvious from our discussions up to this point. A couple of final comments, then this and the other threads will be closed without further comment. This isn't a debate forum: you can accept or reject our judgment and advice, but we feel no need to justify it beyond the most basic level.
"This suggests to me that our ability to identify bugs is limited." Which we have already discussed. Maybe someday a new pathogen, as yet undiscovered, will be documented to be the cause of your symptoms, which are the same as in hundreds of men both on this forum and in Dr. Hook's and my in-person clinical experience. But in every case, no long term harm has ever resulted, and I remain confident that most such cases have emotional/psychological explanations, not infectious.
"It’s just too coincidental that I got these very obvious symptoms within days of exposure." We discussed this too and I don't disagree the exposure and your symptoms likely are linked, but I still believe the psychological explanation is more likely than an infectious one -- based on our experience with the hundreds of patients like you, just noted above. We also discussed the possibility you had an initial inflammatory or infectious event that was treated successfully (or responded spontaneously), with residual symptoms not caused by ongoing infection. I have nothing more to say about possible causes.
Please note the forum policy that limits repeated and often anxiety-related questions. This being your third (with your fourth attempt, deleted), it must be your last on this exposure and the symptoms you attribute to it. There is not likely to be any new information that would change our perspectives and advice, and ASHA is not keen on collecting fees for questions with obvious answers. In addition, such questions have limited educational value of other readers, one of the forum's principal goals. Repeated questions are subject to deletion without reply (and usually without reimbursement of the posting fee, unlike your earlier thread today). Thank you for your understanding.
I do hope the discussions have been helpful. Whatever is going on, I remain confident it is an issue of comfort, not one ever likely to cause harm to you or any future sex partners. But I do recommend continuing to follow up with your doctor(s), depending on your symptoms and concerns. Best wishes and stay safe.
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