[Question #950] NGU or Prostatitis?

50 months ago

Hello doctor. It all started on may 25th, I recieved unprotected oral sex from a sex worker (female), protected vaginal. 5-6 days later, after taking a shower, I felt the top of my penis was really itchy, but it went away in an hour. Two days later, I started with a severe pain after urinating, and feeling like having needles inside my bladder, I barely could sleep so I went to a doc the following day. I never had any kind of discharge. The doc took a sample of my urethra (swab) and right away looked into it using a mic. He detected WBC and told me I had Chlamydia. I took 2g azithromycin plus 400mg cefixime, symptoms improved in 48 hours, but came back. The doc then put me on levofloxacine for a week and gave me trinidazol (although I did not have vaginal contact), but I did not feel fully recovered so he changed to Doxy for 10 days.

After all those drugs and not feeling OK, I visited another doc. He told me to wait four days after finishing doxy and have a propper testing which came back negative in Chlamydia, Gono, Myco, Ureaplasma and showed no WBC in urine but positive in candida. I am still now having symptoms: pressure in the pelvic area, discomfort in the testicles, and around anus, and some slight pain after urinating. Sometimes I feel better sometimes worse.

1)      Do you think I had NGU or like my new doc suspects it is a case of prostatitis plus anxiety? Test done after 4 days is reliable?

2)      I had unprotected sex with my wife after the exposure, before the symptoms began. I did not tell her anything, but following doc instructions I gave her the 2g azitro plus cefixime. She has not showed any symptoms at all and we are having protected sex. Do you think she is OK? Can I have uprotected sex by now?

3)      What can I do to really being fully recovered? Do you think this could be dangeours?

THANKS. I am 38, diabetic (need insulin). English is my 2nd language.


Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago

Welcome to our Forum. I will be pleased to comment.  The exposure you describe was rather low risk.  Condoms are highly effective for STI prevention and few STIs occur from receipt of even unprotected oral sex, even from high risk partners.  the symptoms you describe are a bit unusual for STIs, penile itch and in particular needle-like bladder pain are not suggestive of STI.   It sounds as though your doctor did exactly the same things we would do in evaluating your symptoms and provided you with therapy which would be highly effective for treating gonorrhea, chlamydia, and NGU.  Further your current symptoms are not at all typical for STIs' thus perhaps you have prostatitis or alternatively the Chronic Pelvic Pain Syndrome which is well described on Wikipedia (I favor CPPS, the latter).  Anxiety can certain amplify such symptoms greatly as well.  Thus, in answer to your specific questions:

1.  See above, I favor CPPS or prostatitis, This does NOT sound like NGU.

2.  Your wife is OK.  Your tests are negative, your symptoms do not suggest STI and she has received medication which she probably does not need.  I would not worry that you acquired and STI which you gave to your wife.

3.  I think you need to address your anxiety and try not to worry that this is an STI.  I hope my comments will help you to do that.  EWH


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50 months ago
Many thanks Doctor Hook. The thing that really scared me the most was having WBC in the urethra, which I currently don't have. And I thought "if Azithro and cefixime seemed not to have worked for me, maybe didn't work for my wife either". That was my biggest concern in all this nighmare I am going through which of course I deeply regret. But now I am much more relaxed considering your opinion.

In case of CPPS or prostatitis as you suggest: are they dangeorus? Should I visit an urologist? Or try to relax and move on? I reckon I can have unprotected sex with my wife from now on, even though my symptoms haven't completely cleared. And last thing please, a test done 4 days after finishing the therapy (doxy) is fully reliable? Thanks, thanks and thanks again. You can not imagine how much you have helped me with your response. 
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago
The best management for CPPS is not clear.  If you had an STI however, I am confident that the medications you took would have worked and between that and your negative tests, I am confident that your wife is not at risk.  I am not confident that seeing a urologist at this time will help and if ossicle, would suggest you work to confront your guilt and anxiety and work to move forward without concern about STI.  EWH---
50 months ago
Last thing Doctor Hook. Two days ago I had protected sex with my wife, and when we finished, I noticed a creamy discharge surronding the base of my penis, like a full spoon. The condom was ok, so it was not mine. It was completely white, it did not smell, and it didnĀ“t have any lumps. It was like shower gel, in fact she thought it was gel, but I find it quite rare. No more discharge so far, she cleaned it up and did not find anything dripping. It's the first time it happened to us, I think it was not the usual stuff that comes out when she is excited. Should I be worried and take her to be tested? Many thanks for your knowledge and patience with me.
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago

The sort of creamy discharge you describe can occur after sex and is not in itself suggestive of STI.  It may be that you were looking more closely than has been the case in the past.  I would not worry that it is an indicator of an STI that you transmitted to her after having acquired it in the encounter you described.  Believe your tests- you are OK and did not get an STI.

This is my third reply to your questions and so as per Forum guidelines, this thread will be closed later today.  I wish you well.  Try not to worry, there is no reason for you to be concerned about STI from the encounter you described above.  EWH

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