Confused about NGU?

Hi. I'm really confused about things. I think I might have something persistent.

My parter, with whom I've only had oral sex, had discharge, so I went to the doctor, who gave me the one-dose Azithromycin and also some Ciprofloxin in case. (I did not have symptoms and he did not test me.) About 5 days AFTER taking the antibiotics, I developed symptoms - mainly "itching" and twinges in tip of the urethra.

My parter tested postitive for Chlamydia, so I assumed that's what I had, even though I've never myself noticed discharge. I went back to the doctor and was tested for Chlamydia - that came up negative.

So I figured I was on the mend with whatever I'd gotten, but now I continue to have urethral irritation, over 3 weeks after taking the antibiotics, the tip of my penis still seems irritated, and the area around the urethra is still red. And the irritation continues sometimes, especially after drinking caffeine.

I am really trying not to poke or prod down there, but this is worrysome. I'm just really confused.  

Was this NOT Chlamydia? If not, and it was NGU or whatever, was I not properly treated?  If this is persistent urethritis, will it go away, or am I stuck? Is there another antibiotic I should try? Can I have sex/masturbate or should I stop doing that? Could I pass something on to someone else?

I'm just really frustrated.

[H. Hunter Handsfield, M.D.]

You're confused?  I'm confused too.  Two men cannot share a urethral infection through oral sex or any of the other usual modes of contact. I suppose if the two urethral openings were directly and vigorously opposed, it might be possible.  Your partner's urethral chlamydial infection cannot explain your NGU.  And chlamydia doesn't infect the throat, or only rarely.  And transmission of chlamydia from mouth to genitals has never been documented--if it occurs, it is very rare.  In any case, only 30% of NGU is due to chlamydia--and in gay men, it's probably closer to 15-20%.  Normal oral bacteria probably cause some cases.

Having said all that, I doubt you have urethritis at all.  I'm not sure what is causing your "urethral irritation", but you are correct that onset a few days after azithromycin is peculiar. Herpes is a theoretical possibility.  Or irritation from lubricant (especially spermicide).  Adenovirus causes a few percent of NGU cases, often in association with a common cold in the infected person, a sex partner, or both.

Bottom line:  You might or might not have NGU; if so, it isn't chlamydia, but could be due to the other things I mentioned.  Or nothing at all--some sort of irritation that will clear up on its own.  Unless your own doctors disagree, I suggest just sitting tight for a week or two; see a provider if your symptoms don't go away by then, or if they get worse at any time.  Protected sex or masturbation won't hurt anything.

Bottom line 2:  Somebody brought chlamydia into your relationoship.  There is a third party somewhere who needs evaluation and treatment.

Good luck--  HHH, MD

[blue8]

well, i definitely had some kind of urethritis. Twinges, burning especially after urinating. SEems worse after I drink coffee. It's definitely improved, but it's still there.

If I did have NGU, would the antibiotics have taken care of it?

[H. Hunter Handsfield, M.D.]

If you had NGU, most likely azithromycin would work, perhaps explaining why your symptoms are improving.  Or it could be clearing up on its own if you had a non-infectious cause or a virus (e.g., adenovirus).  Whatever you had, it isn't chlamydia that you caught from your partner.

HHH, MD