Aa
? Treatment resistant NGU
Hello Doctors. Thank you in advance for answering my question.
I am a 32 Y/O male who had unprotected oral sex and protected vaginal sex one month back with a CSW. Exactly two days later I developed a burning sensation on the foreskin of my penis and itching in the area. Since it was a weekend, I spoke to my PCP on phone who called in a treatment of acylovir for me saying that it could be prodrome of herpes.
I took the meds only after 24 hrs after Sx started. The burning and itching subsided soon after starting acylovir which I did take for 7 days. After about 3 more days, I started having burning sensation when I used to urinate and burning at the tip of my meatus off and on through the day. I did visit my PCP who ran a UA, urine for GC and chalmydia which were negative. THE UA did show some wbcs, but no Leuckocyteesterase. He diagnosed me with NGU and did prescribe me with Doxy for 2 weeks. ( I cannot tolerate Azithromycin). After I had stopped the acyclovir after 7th day, I felt some burning and tingling in the same areas 24 hrs later. I then completed 3 more days of acylovir and till date have not had any more burning on the foreskin or itching on the foreskin.
However during the course of Doxy, I still had some mild burning sensation while I urinated, it was much better then before. After finishing my treatment for doxy ( full two weeks), I had a blood test for herpes and both type-1 and 2 were negative. 3 days after finishing doxy, the burning during urination returned with great intensity and lasted for two more days before decreasing in intensity, but did not go completely. I still get it when I urniate in morning or after several hours. I never developed any herpes vesicles at all, nor did I get any erythema on my meatus.
My question is, am I cured for NGU? Is it safe for me to resume sex with my Fiance? I have not had any sex with anyone since that fateful encounter. Do I need further testing or treatment?
I am a 32 Y/O male who had unprotected oral sex and protected vaginal sex one month back with a CSW. Exactly two days later I developed a burning sensation on the foreskin of my penis and itching in the area. Since it was a weekend, I spoke to my PCP on phone who called in a treatment of acylovir for me saying that it could be prodrome of herpes.
I took the meds only after 24 hrs after Sx started. The burning and itching subsided soon after starting acylovir which I did take for 7 days. After about 3 more days, I started having burning sensation when I used to urinate and burning at the tip of my meatus off and on through the day. I did visit my PCP who ran a UA, urine for GC and chalmydia which were negative. THE UA did show some wbcs, but no Leuckocyteesterase. He diagnosed me with NGU and did prescribe me with Doxy for 2 weeks. ( I cannot tolerate Azithromycin). After I had stopped the acyclovir after 7th day, I felt some burning and tingling in the same areas 24 hrs later. I then completed 3 more days of acylovir and till date have not had any more burning on the foreskin or itching on the foreskin.
However during the course of Doxy, I still had some mild burning sensation while I urinated, it was much better then before. After finishing my treatment for doxy ( full two weeks), I had a blood test for herpes and both type-1 and 2 were negative. 3 days after finishing doxy, the burning during urination returned with great intensity and lasted for two more days before decreasing in intensity, but did not go completely. I still get it when I urniate in morning or after several hours. I never developed any herpes vesicles at all, nor did I get any erythema on my meatus.
My question is, am I cured for NGU? Is it safe for me to resume sex with my Fiance? I have not had any sex with anyone since that fateful encounter. Do I need further testing or treatment?
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
It can be difficult for a distant expert to judge the diagnosis of a patient's own health care provider. However, I am skeptical that you have NGU or that you ever had it. Your symptoms are not typical. By far the most common symptoms of NGU is abnormal discharge from the penis; although urinary discomfort or pain can accompany it, most men with only that symptom usually are not found to have urethritis. "Some WBCs" in urine doesn't mean much by itself; a few WBCs can be found in most urine specimens, and the negative LE test indicates the numbers were small and probably not significant.
Having said that, the improved symptoms with doxycycline is suggestive. Doxy can initially help NGU, followed by relapse of symptoms -- but in general that relapse occurs 1-3 weeks later, not 3 days. And doxy has anti-inflammatory characteristics, so it might have just helped control the symptoms without having any effect on the cause.
The standard recommendation for NGU that fails to respond, or relapses, after doxycycline is to treat with a macrolide antibiotic plus a treatment for trichomonas, i.e. metronidazole (Flagyl) or tinidazole (Tindamax). If you cannot tolerate azithromycin in the usual 1 gram single dose, you could take 250-500 mg once daily for 3-4 days. At that dose I doubt it will cause any side effects. If you still can't tolerate it, discuss erythromycin or clarithromycin (trade name Biaxin) with your doctor.
As for herpes, it also is not a common cause of symptoms like you describe. If there are symptoms at all from new genital herpes, the typical blisters/sores are usually present.
But you should expect that no specific cause is going to turn up, and over time, the symptoms probably will gradually resolve. There is really nothing to worry about in terms of serious health impact. I have never heard of problems like this leading to anything important (no cancer, infertility, etc) or to cause any health problem in patients' sex partners.
Here are a few other threads that discuss various aspects of NGU that you might find interesting.
http://www.medhelp.org/posts/show/757304
http://www.medhelp.org/posts/show/757304
http://www.medhelp.org/posts/show/774818
http://www.medhelp.org/posts/show/1228688
Regards-- HHH, MD
It can be difficult for a distant expert to judge the diagnosis of a patient's own health care provider. However, I am skeptical that you have NGU or that you ever had it. Your symptoms are not typical. By far the most common symptoms of NGU is abnormal discharge from the penis; although urinary discomfort or pain can accompany it, most men with only that symptom usually are not found to have urethritis. "Some WBCs" in urine doesn't mean much by itself; a few WBCs can be found in most urine specimens, and the negative LE test indicates the numbers were small and probably not significant.
Having said that, the improved symptoms with doxycycline is suggestive. Doxy can initially help NGU, followed by relapse of symptoms -- but in general that relapse occurs 1-3 weeks later, not 3 days. And doxy has anti-inflammatory characteristics, so it might have just helped control the symptoms without having any effect on the cause.
The standard recommendation for NGU that fails to respond, or relapses, after doxycycline is to treat with a macrolide antibiotic plus a treatment for trichomonas, i.e. metronidazole (Flagyl) or tinidazole (Tindamax). If you cannot tolerate azithromycin in the usual 1 gram single dose, you could take 250-500 mg once daily for 3-4 days. At that dose I doubt it will cause any side effects. If you still can't tolerate it, discuss erythromycin or clarithromycin (trade name Biaxin) with your doctor.
As for herpes, it also is not a common cause of symptoms like you describe. If there are symptoms at all from new genital herpes, the typical blisters/sores are usually present.
But you should expect that no specific cause is going to turn up, and over time, the symptoms probably will gradually resolve. There is really nothing to worry about in terms of serious health impact. I have never heard of problems like this leading to anything important (no cancer, infertility, etc) or to cause any health problem in patients' sex partners.
Here are a few other threads that discuss various aspects of NGU that you might find interesting.
http://www.medhelp.org/posts/show/757304
http://www.medhelp.org/posts/show/757304
http://www.medhelp.org/posts/show/774818
http://www.medhelp.org/posts/show/1228688
Regards-- HHH, MD
Thank you. That defnly answers my question....Thread closed :-)
MEDICAL PROFESSIONAL
My reply above includes "I have never heard of problems like this leading to anything important (no cancer, infertility, etc) or to cause any health problem in patients' sex partners." Sex is not likely to be harmful for you either. Since there has been no research on this, it can't be guaranteed that sex with your partner is safe. But if I were in your situation, I would continue unprotected sex with my wife with no fear for her health or my own.
I had a follow-up question. My only query is if I can resume sex with my GF? I still get "recurrences" occasionaly. I have 2-4 days completely symptom free and then I might have some dysuria for a few hours to a whole day which spontaneously disaapears. I have still refrained from sex since that day so far.
Thanks.
Thanks.
Thanks a lot Doc. The links to the other threads do make sense and helped. I am going to just wait it out without further treatment. If anything changes, I will let you know. Thanks for the good work on the forum. It is important for people like me who have no access to a good STD clinic due to being in a rural area.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
