NGU and external symptoms

[nwman]

Dr. H, 8 months ago I had one-off unprotected sex with a female friend.  About 10 days afterward I started to have discomfort in my urethra.  I had a full set of STD tests then and at two months which came back negative.   Symptoms worsened over the next couple of months: urethral burning sensation, clear discharge,redness on meatus and swelling on the glans.  A round area developed to the right of the meatus that was raised and reddish, sometimes with small dark bumps appearing under the skin.  At this point I had taken azithromycin, and then a 2 week course of doxy at about 2-2 1/2 months. I then saw a urologist in a major university hospital, who diagnosed NGU, thought it would pass, but recommended a 7 day course of flagyl, completed about 2 1/2 months ago. I noticed improvement. Since then symptoms have contnued to improve very slowly but seem to cycle in intensity every few days.  
In the last week the clear discharge (like pre-ejaculate) has returned.  With it, I get mild irritation in my urethra.  It often coincides with some redness, swelling, and small dark bumps in the same round spot, and redness at the top of the meatus.  These symptoms will vary over the course of a day.
At this point, I'm calm, just confused.  The physical variation concerns me, as it's not a typical ngu symptom.  I'm wondering what could be causing this, and should I just continue to wait it out?  I am in a long term relationship that has suffered and I want to move ahead.  Thanks.

[UnluckySoul]

I understand exactly what your going through your not to concerned cause its curable and you know for a fact its real cause all symptoms go away with the meds Ive been there. I have to say what I always say about people in our situation, listen to your body cause you are the only one that can feel what you feel. The most damning thing you can do in your situation is tell yourself false truths like that discharge is normal or I feel great on Doxy but maybe it wa something I ate, face it either your getting reinffected by a past partner or your only suppressing the infection and not CURING it.

I reccomend a month long course of Doxy 2 100mg cap a day and no drinks or sex of any kind for a month, because the infection is actually an sore inside of you that needs to heal completely before resuming sex.  

[H. Hunter Handsfield, M.D.]

Well, don't feel like the Lone Ranger:  everybody is 'confused' about your sort of situation, including all STD experts.  A proportion of NGU cases are followed by persistent or recurrent symptoms, often similar to the things you describe.  Some cases might have a component of prostatitis, but prostatitis is often a 'wastebasket' diagnosis--i.e., something providers come up with when they can't otherwise tell what's going on.

Several important facts about such persistent symptoms.  1) They probably are not due to infection.  You don't have a persistent STD, and further antibiotics probably will make no difference.  2) They are harmless.  Such problems are not known to lead to anything serious-- no infertility, no cancer, etc.  3) You have nothing you can transmit to or harm a sexual partner, now or in the future.  You may proceed right now to a fully satisfying, unrestricted sex life.

Having said all that, I cannot comment on the apparent physical changes of the penis externally.  No STD does those things, so you needn't worry about that aspect.  Based on similar stories from other patients, I have to suspect you are just examining yourself too closely and are noticing normal variation in skin appearance.  In other words, I suspect a health care provider won't see anything abnormal. But I could be wrong about that, and you definitely should be examined either by your urologist or a dermatologist.  Then follow his or her advice.

Bottom line:  Based on your symptoms and the treatments you describe, I'm sure you have no STD and doubt you have any other serious health problem.  If you just live with the symptoms, they probably will fade with time.  But as I said, follow your own providers' advice if it differs from mine.

Good luck--  HHH, MD