Follow up to Swollen Lymph Node post on 11/9

Hello Dr.  This is a follow up to a question posted on 11/9 about NGU titled Swollen Lymph Node.  To recap, I am a 26 yr old male.  In August, I recieved unprotected oral sex from a stripper.  About 10 days later I had some burning during urination.  4 days later I felt on swollen lymph node in my groin.  It was tender for about 2 days, but remained swollen for a few weeks.  I also had a few drops of very clear discharge, and that was only if I milked my urethra very hard.  I saw a Urologist 18 days after the exposure and told him I had unprotected oral sex.  He said it was just mild urethritis.  He said there was no sign of infection in my urine and that the symptoms would clear up on their own and did not prescribe anything.  I went back and saw another urologist 24 days after exposure and he told me the same thing.  No sign of infection.  I went and got tested for Ghon/Chlam to be sure and it came back negative.  The symptoms did go away a few days later and have not returned.  12 weeks after exposure I had a HerpeSelect test for Type 1 and 2 as well as an HIV test.  All were negative.  So I have a few questions..

1.Is there anything else I should be worried about?  
2.Could I have had NGU and it not show up in a standard urinalysis?  My urethra was never swabbed.
3.Is there any health risk to my girlfriend?  We waited a few weeks after the symptoms went away to start having sex again per the urologist's orders

[H. Hunter Handsfield, M.D.]

Thanks for the follow-up.

Last question first:  Probably no risk to your girlfriend.  Your urethritis clearly wasn't due to chlamydia or gonorrhea, and unlike those STDs, non-chlamydial NGU has never been shown to pose a health threat to female partners.

Urinalysis:  It depends on how the urine was collected.  If you were instructed (and follwed instructions) to give a "midstream" urine specimen, the urinalysis might miss signs of infection.  When checking for urethritis with urine, the proper approach is to ask the patient to start voiding into the container and stop after only a tablespoon or so--basically, just washing out the urethra.  If that is what was done, a negative urinalysis is reassuring.

But for the reasons implied above, even if you stil had mild urethritis, there is little or no risk toyour partner and probably not to you.  So as long as you remain asymptomatic, I wouldn't lose any (more) sleep over this episode.  I think you hare home free.

Good luck--   HHH, MD

[mp7474]

One last thing.  My concern here is that i have read that NGU left untreated could casue fertility problems.  Also, my girlfriend has not had any symptoms either.  We have been having unprotected sex since mid september.  The exposure I am concerned about happened in early august.

[H. Hunter Handsfield, M.D.]

Chlamydia can cause infertility, but other causes of NGU do not.  And when chlamydia does so, it is the result of epididymitis, which causes painful swelling of a testicle, often with fever; you would know if you had it.  Your fertility is not at risk from this episode.

HHH, MD