[Question #9416] Treatment for nonchlamydial ngu

32 months ago

Hello,

I had unprotected oral (received) and vaginal intercourse about 2 months ago. I then noticed pain in my urethra afterwards. I thought maybe it was all in my head but I went to my general practitioner anyway about 3 weeks after the encounter. I’ve had non chlamydial ngu before and symptoms were similar but this time more mild so I thought it could possibly be ngu. STI panel came back all negative. This included gonorhea, chlamydia, trich, syphilis, HIV, and Hep. HSV wasn’t screened.

I asked the GP to give me azithromycin because it’s only one dose and I’ve seen great success with it before (2016), but he wanted to give me doxycycline saying that recent studies show it’s more effective for non chlamydial ngu treatment than azithromycin. I’ve taken doxycycline before (also back in 2016 simultaneously with the azithromycin) and the doctor who prescribed it (different person) told me not to consume alcohol because the interaction could really mess me up. Because of my social calendar for November (which I knew inevitably would include drinks) and the fact that I found no research indicating doxycycline is better than azithromycin, I was reluctant to take it.

Fast forward about 2 months after the sexual encounter, I am finally taking the doxycycline and I’m on Day 5 of 7. But urethra discomfort persists as well as tender testicles. The discomfort also radiates to my abdomen.

So my question(s) is this: Is doxycycline better than azithromycin for treating non chlamydial ngu? And is it even reasonable to think I indeed have non chlamydial ngu? I’m going to the GP again later today for persistent cough/phlegm/possible bronchitis and I’m wondering if I should ask for azithromycin while I’m there.

Edward W. Hook M.D.

32 months ago

Welcome to the Forum. Thanks for your questions as well as your detailed description of your history and current situation. Your doctor is well informed. Only recently, doxycycline has become the preferred treatment for NGU over azithromycin despite the inconvenience of having to take medication twice daily. You are also correct that there are no scientific data to suggest that alcohol impacts the effectiveness of either doxycycline or azithromycin as long as one does not forget to take it. Several addition comments which may be helpful going forward:

The best studies of NGU typically show that there is no identifiable pathogen present in 30-40% of persons with the infection. Recently a new pathogen Mycoplasma genitalium has been found to cause persistent NGU. It may not respond to azithromycin or doxycycline alone and requires a specific test to make the diagnosis typically with a urine specimen. If you go this route with your doctor, please be aware that related organisms, Mycoplasma hominis and Ureaplasma urealyticum are often present in the genital tract and are NOT pathogens. The test for M. genitalium is different from tests for M. hominis or U. urealyticum.

Also FYI, there are no data that other than the symptoms, non-chlamydial, non M. genitalium NGU does not appear to represent a serious threat to partners of persons with the syndrome. In a very small proportion of persons chronic non chlamydial, non M. genitalium NGU may persist for a while (weeks) before ressolving

One more FYI- other syndrome including prostatitis, kidney stones, and the so-called chronic pelvic pain syndrome (well described in Wikipedia) may mimic NGU.

My advice- consider testing for M. genitalium and perhaps ruling out other problems that I mention. I would also urge you to be sure this is NGU or some other inflammatory process by demonstrating the presence of white blood cells in the initial part of a urine specimen (not a mid-stream specimen) collected after not voiding for at least an hour. A portion of the same specimen can be used to test for M. genitalium

I hope this information is helpful. EWH

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32 months ago

Thanks for such a prompt reply. I will ask to be tested for m. genitalium. How would you treat it? CDC says doxycycline followed by high dose azithromycin, or moxifloxacin if resistant or not possible to test resistance. Would you agree with that?

Also, I foolishly misread the bottle of doxycycline and took 2 pills at once the first day or two. Will that make it less effective?

And thank you for the advice regarding urine collection and the ruling out of other conditions.

Edward W. Hook M.D.

32 months ago

Taking the two doxycycline pills will not be a problem.

Treatment of M. Genitalium can be challenging but doxycycline followed by moxyfloxacin is probamost effective, should the test be positive.

Again, first important to be sure NGU is present by verifying presence of white blood cells. EWH

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32 months ago

Just wanted to update you on this. Got re-tested for chlamydia, trich, and gonorhea. All negative. Also got tested for m. Genitalium, m. Hominis, and ureaplasma spp. All negative. Symptoms (urethra discomfort and tingling, tender testicles) still come and go but not quite as prominent as before. Guess I should probably see a urologist now.

Edward W. Hook M.D.

31 months ago

Thanks for the update. Seeing a urologist is the correct next step. EWH---