Concerned about infecting my wife

[Aquaman]

Rookie mistake with a professional 32 days ago while on business  trip (Asia): I received an unprotected blowjob with a lot of  tongue attention to the  head, and a handjob  with  large  amount  of  body  lotion  as  lubricant.
On day 2,no symptoms, but guilt and worry sent me to a clinic  where the doctor gave me a course of amoxicillin to take for 10  days.
Later that day started having uncomfortable feeling in urethra. Continued for the rest of the week, varying in intensity but no  burning during urination, no discharge, no dysuria. Feeling of heat when lying in bed at night, itchy  back.
Day  7, went to specialist Dr. of "Dermatological and Veneral  Medicine".  He  didn''t even examine me, told me it was all in  my head.
Day 8, went to another Dr who examined me, and told me it was  all in my mind. But with rolling eyes did give me a six tablet  pack to take all at once (I think it was Zithromax)) and told me  to stop taking amoxicillin, which I did. And told me stop  obsessing with my member. And said it was perfectly safe to have  sex with my wife.
Day 10, had sex with my wife.
Day 11, evening, first sign of discharge, a teardrop of clear  sticky fluid before urinating.
Day 12, went back to Dr.again he told me nothing was wrong, normal discharge.
Day  13--20, same uncomfortable irritated feeling in urethra, only one more noticable teardrop of discharge.
Day 21--- more volume in discharge in  morning, difficulty  emptying urethra of urine. More regular discharge during day. No burning during urination.
Day  22- Went to male health clinic, got swabbed,diagnosed NGU. Took blood to test for Syphylis, and for the first time raised  the spectre of HIV. Told  the  results  for  Chlamydia, Syphillis,and HIV would take 3 weeks. Gave me one week course  Doxycycline, 2 a day.
Day  22--29: the discharge and dysuria stopped, still  occasional  irritated feeling in  urethra. Finished course of Dox. Irritation  was back the next day, and  I can sense a return to the  discharge on its way, difficulty voiding the urethra of urine.
My  Questions::
1) Would  amoxicillin  have  any  effect  on  incubating  syphylis or the testing of its presence? Could it have irritated my urethra?
2)Could  amoxycillin  have interfered with the effectiveness of zithromax??
3) My wife has a pap smear scheduled in 4 days (Ive told her Ive  got NGU so she can alert the Dr.). Could I have passed on this infection to her?  I wont know the results of my swab for another 12 days.
4) What  would  be  the  best  guess  as  to  what  my  problem  is:A)Chlamydia B) Ureaplasma C)Infection  from  other  bacteria  found  in  mouth D) Chemical irritation from body lotion. E)Trichomoniasis F)Overactive imagination.
5)When they diagnose NGU, what are they looking at under the microscope? Visible bacteria, or pus, or what? Is it possible to have an irritated urethra, be diagnosed with NGU, and not actually have any bacterial infection at all?
My sincerest thanks for the work you are doing.

[H. Hunter Handsfield, M.D.]

I cannot improve on the diagnosis and advice that comes from multiple health care visits, tests, and treatments, especially when that care was provided by providers who are knowledgeable about STDs, as in your case.  You need to direct your questions to your providers; if they differ from mine, consider that they may be right, not me, since they are more familiar with your case.

1) Amoxicillin would cure incubating syphilis if present; the syphilis test would never become positive.  It does not irritate the urethra.

2) No, amox will not interfere with azithromycin.

3) If you had sex with your wife after your outside sexual exposure and before treatment, you might have transmitted something to her.  On the other hand, NGU not due to chlamydia probably carries little risk for serious health outcomes in women.  But this is an area of uncertainty.  But if you received azithromycin before you had sex with your wife, there is no risk.  Otherwise, your wife needs to be checked for STDs.  (I don't know what swab test takes 12+ days for a result.  Anyway, if that was done after all the treatment you had, you can be sure it will be negative.)

4) Any of those is possible except chlamydia.  Ureaplasma is not an abnormal bacteria and can be disregarded even if present.

5) NGU is diagosed by a combination of abnormal discharge and white blood cells visible microscopically. The causes of cases not due to chlamydia are uncertain.  It is possible, but really not known, whether some cases involve no infection at all.

Best wishes--  HHH, MD

[ryn21]

I am not a doctor, but I will say this, oral sex carries a near zero risk of HIV infection.  Zithromax is a highly effective antibiotic and im sure it would have killed off any infection you would have had.  Your doctor

[tadphillips]

Hate to jump on someones question but I was wondering if you could give me a quick answer. If one was going to be tested for ngu with a urine test. How should I be tested? First catch, midsteam? thanks again doc

[susannak]

The doc won't answer you if you tag onto someone elses question.  One of the forum regulars might, though.

You have to pay to ask a question of the doc.

[tadphillips]

Thanks for pointing that out. But I was thinking my question is related to the post. What is the perferred method of NGU testing?

[susannak]

Look under the archives.  There is a whole section under NGU that might answer your question.  Or someone else here who is knowledgable might answer.

[probneurotic]

The traditional testing for NGU and gonococcal urethritis, in males, is typically a urethral swab of the discharge with a smear, gram stain, and culture.  If a certain kind of bacteria, "diplococci" are present are present in the smear, then you have Gonococcal urethritis.  However, if no bacteria are present, it is most likely chlamydia or some other non-gonococcal cause.  NGU can also be diagnosed by some nucleic acid assays, though those are not typically preferable over gram stain and culture.  
Regardless of the etiology of the Urethritis, a few things are certain.  Standard of care these days in the US, due to emerging bacterial resistance states:
1.  NEVER give amoxicillan for expected urethritis (NGU or Gonococcal) unless sensitivity testing has been done.  Most strains of Neisseria Gonhorrhea are resistant to penicillan and its cousins (amoxicillan, nafcillan, oxcillan, etc.)  In addition, these drugs do not penetrate intracellularly to take care of chlamydia trachomitis (the most prevelent BACTERIAL STD in the US)  However, the Pcn or amox would have taken care of Syphilis.

2.  Any case of Urethritis should be treated with a double whammy of Abx to treat gonococcal and intracellular (NGU) infx. ie. Cefriaxone and doxycycline (or azithromycin).