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Non-chlamydial NGU
29 y/o male, unprotected sex with 5 different women in the past 10 years, not prostitutes
Last year urethritis. Before urethritis, swollen inguinal lymph node (small hard ball which hurt when touched) Disappeared in a few days.
Chronology:
Sexual contact with girl A
13 days after
Swollen lymph node
8 days after
Again sexual contact wirh girl A
19 days after
Sexual contact with girl B
17 days after
Urethritis
urine test, microscope exam of discharge, Gram staining.
Everything normal except leukocytes in the urine (100 Leu/uL). Fungus and trichomones not observed.
Took a 100 mg Doxycycline every 12 hours for 5 days and a 500 mg Ciprofloxacin every 12 hours for 1 day.
Discharge reduced but it picked up again in a few days.
Microscope exam results read "Gram Positive Cocci - medium amount" and "Leukocyte Reaction - Observed".
I took a shot of 2400000 units of Procainic Penicillin, which had no effect.
After the above, Thayer-Martin culture for Neisseria Gonorrhoeae and direct immunofluorescence for Chlamydia trachomatis. Both results negative.
Took zithromax 500, 2 pills together and another the next day. The discharge cleared up within a few days.
I have felt tingling and stinging sensations after.
Girl A said she went to see a gynecologist and took tests for Neisser. and Chlam, everything OK. Girl B only saw a general doctor, who supposingly said everything was all right.
Hep B and Syph test 19 days after last sexual encounter, and a IgG HSV II test 4 months after last sexual encounter.
Last sexual contact 6 months ago. Taking an HIV test this week.
Other tests? Hepatitis C? repeat Hep B and syph? HPV?
What did I have? other bacteria?
Could it have been not sexually originated?
Can a women generate an infection by herself and then pass it on sexually?
Can a male generate an infection by himself?
Does swollen lymph node mean I already had the infection?
Clinical difference depending on the bacteria?
Last year urethritis. Before urethritis, swollen inguinal lymph node (small hard ball which hurt when touched) Disappeared in a few days.
Chronology:
Sexual contact with girl A
13 days after
Swollen lymph node
8 days after
Again sexual contact wirh girl A
19 days after
Sexual contact with girl B
17 days after
Urethritis
urine test, microscope exam of discharge, Gram staining.
Everything normal except leukocytes in the urine (100 Leu/uL). Fungus and trichomones not observed.
Took a 100 mg Doxycycline every 12 hours for 5 days and a 500 mg Ciprofloxacin every 12 hours for 1 day.
Discharge reduced but it picked up again in a few days.
Microscope exam results read "Gram Positive Cocci - medium amount" and "Leukocyte Reaction - Observed".
I took a shot of 2400000 units of Procainic Penicillin, which had no effect.
After the above, Thayer-Martin culture for Neisseria Gonorrhoeae and direct immunofluorescence for Chlamydia trachomatis. Both results negative.
Took zithromax 500, 2 pills together and another the next day. The discharge cleared up within a few days.
I have felt tingling and stinging sensations after.
Girl A said she went to see a gynecologist and took tests for Neisser. and Chlam, everything OK. Girl B only saw a general doctor, who supposingly said everything was all right.
Hep B and Syph test 19 days after last sexual encounter, and a IgG HSV II test 4 months after last sexual encounter.
Last sexual contact 6 months ago. Taking an HIV test this week.
Other tests? Hepatitis C? repeat Hep B and syph? HPV?
What did I have? other bacteria?
Could it have been not sexually originated?
Can a women generate an infection by herself and then pass it on sexually?
Can a male generate an infection by himself?
Does swollen lymph node mean I already had the infection?
Clinical difference depending on the bacteria?
A related discussion, Recurrent Non-chlamydial NGU was started.
OK, thank you very much, you have been very helpful.
MEDICAL PROFESSIONAL
Either you misunderstood your doctor's comments about doxycycline or he is wrong. Doxy is as reliable a treatment as there is for NGU; not perfect, as you found out, but still the best overall. The recommended duration is 7 days, but 5 days normally would work just fine. He is correct that cipro is not reliable against NGU, especially with only 1-2 doses. But NGU isn't the reason you were treated with it. The cipro was intended to cover gonorrhea, often done routinely at the start of treatment for NGU.
It is true that your initial antibiotic therapy could have made test results for gonorrhea and chlamydia falsely negative. However, if you had either of them, the combination of cipro and doxy would have cured you. In other words, the persistence or reappearance of discharge after treatment is proof against both chlamydia and gonorrhea as the original infection.
That will have to end this thread. I won't have anything more to say. Please re-read my replies above, and concentrate on the truth that nonchlamydial NGU is not known to bring any long term harm or complciations. Try to put these events behind you and stop mulling over any "yes but" or "what if" thoughs that come to mind.
It is true that your initial antibiotic therapy could have made test results for gonorrhea and chlamydia falsely negative. However, if you had either of them, the combination of cipro and doxy would have cured you. In other words, the persistence or reappearance of discharge after treatment is proof against both chlamydia and gonorrhea as the original infection.
That will have to end this thread. I won't have anything more to say. Please re-read my replies above, and concentrate on the truth that nonchlamydial NGU is not known to bring any long term harm or complciations. Try to put these events behind you and stop mulling over any "yes but" or "what if" thoughs that come to mind.
OK, thank you very much.
Just one last thing, one of the doctors I saw suggested that the Doxycycline treatment (100 mg Doxycycline every 12 hours for 5 days and a 500 mg Ciprofloxacin every 12 hours for 1 day) wasn't effective, not because the bacteria was resistant, but because the dosage wasn´t adecuate, and that that's why the discharge reduced at first but then picked up again. He said that Ciprofloxacin for just one day wasn't enough.
He also said that it was possible that the tests for Neisseria and Chlamydia might have been negative because I had taken antibiotics, despite the fact that the discharge was still present.
How true is all of this?
Again, thank you very much.
MEDICAL PROFESSIONAL
The large majority of NGU is sexually acquired; it is virtually nonexistent in virgins. But there may be rare exceptions.
I continue to believe the lymph node inflammation (if in fact that was what caused the lumps in your groin) and your NGU were unrelated to one another. Inguinal lymph node inflammation is extremely common, caused by such things as ingrown toenail, any skin inflammation of the legs, and a number of other (often unknown) factors.
Don't overreact. Your negative tests are reliable -- indeed, you were over-tested. Do your best to put all this in the past and move on with your life. Nothing bad will come of it.
I continue to believe the lymph node inflammation (if in fact that was what caused the lumps in your groin) and your NGU were unrelated to one another. Inguinal lymph node inflammation is extremely common, caused by such things as ingrown toenail, any skin inflammation of the legs, and a number of other (often unknown) factors.
Don't overreact. Your negative tests are reliable -- indeed, you were over-tested. Do your best to put all this in the past and move on with your life. Nothing bad will come of it.
Thank you for your response.
I have a few more inquiries though:
Was the urethritis certainly due to sexual contact?
I understand that it's not "spontaneously generated", but could it have a different cause? manipulation for example?
I had never had a swollen inguinal lymph node before in my life, and the urethritis appeared 1,5 months after... It's hard not to think that the two things are connected somehow.
What can cause an inguinal lymph node inflammation?
This whole incident has been very traumatic, I basically have had my life paused ever since.
I've also been very concerned about STD's in general. As I've mentioned, I've taken tests for Hepitits B, syphilis and HSV II. I've also taken a HIV 1/2 and p24 antibody detection test (4th generation) 82 days after my last sexual contact.
What's most important to me right now is to be certain I've done everthing in my reach to make sure I'm ok; I don't want to be a threat to anyone.
What other tests should I take/repeat for a complete, reliable STD screenig, considering types of tests available and window periods?
Thank you very much.
I have a few more inquiries though:
Was the urethritis certainly due to sexual contact?
I understand that it's not "spontaneously generated", but could it have a different cause? manipulation for example?
I had never had a swollen inguinal lymph node before in my life, and the urethritis appeared 1,5 months after... It's hard not to think that the two things are connected somehow.
What can cause an inguinal lymph node inflammation?
This whole incident has been very traumatic, I basically have had my life paused ever since.
I've also been very concerned about STD's in general. As I've mentioned, I've taken tests for Hepitits B, syphilis and HSV II. I've also taken a HIV 1/2 and p24 antibody detection test (4th generation) 82 days after my last sexual contact.
What's most important to me right now is to be certain I've done everthing in my reach to make sure I'm ok; I don't want to be a threat to anyone.
What other tests should I take/repeat for a complete, reliable STD screenig, considering types of tests available and window periods?
Thank you very much.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help, but not sure I can.
NGU largely remains a mystery. We know that chlamydia, Mycoplasma genitalium, trichomonas, and a few other causes, all taken together, account for roughly half of all cases. The causes of the rest are unknown. Most NGU patients' female sex partners have nothing abnormal on examination or testing. The standard approach is to treat NGU with doxycycline or azithromycin, and if that doesn't work (about 20% of cases), to try the other drug. So your sequence of events -- persistence after doxy and cure after azithromycin -- is very common. The opposite might occur in some patients, i.e. persistence with azithro then cure with doxy. Some cases don't respond to either antibiotic; in that sense, you can consider yourself fortunate.
An important aspect is that this sort of problem is not known to have any serious health consequences, either for affected men or their sex partners. Unless due to chlamydia, most cases of NGU probably are more appropriately considered inconveniences, not important health problems.
To your specific questions:
1) Hepatitis and HPV are not known to cause NGU.
2) What did you have? A fair guess might be Mycoplasma genitalium, which tends to respond better to azithromycin than doxycycline.
3) In a sense, you may be onto something. It is possible that unidentified normal vaginal or oral bacteria, causing no harm in the woman carrying them, could cause NGU in men. This is only a theory, however.
4) I doubt NGU is ever "generated" spontaneously in men's genital tracts.
5) I don't know how to factor in the apparent lymph node inflammation. It is not normally a feature of NGU.
6) Various bacteria have variable sensitive to different antibotics, which probably explains why some cases repond better to some antibiotics but not others.
I hope this helps. Best wishes-- HHH, MD
NGU largely remains a mystery. We know that chlamydia, Mycoplasma genitalium, trichomonas, and a few other causes, all taken together, account for roughly half of all cases. The causes of the rest are unknown. Most NGU patients' female sex partners have nothing abnormal on examination or testing. The standard approach is to treat NGU with doxycycline or azithromycin, and if that doesn't work (about 20% of cases), to try the other drug. So your sequence of events -- persistence after doxy and cure after azithromycin -- is very common. The opposite might occur in some patients, i.e. persistence with azithro then cure with doxy. Some cases don't respond to either antibiotic; in that sense, you can consider yourself fortunate.
An important aspect is that this sort of problem is not known to have any serious health consequences, either for affected men or their sex partners. Unless due to chlamydia, most cases of NGU probably are more appropriately considered inconveniences, not important health problems.
To your specific questions:
1) Hepatitis and HPV are not known to cause NGU.
2) What did you have? A fair guess might be Mycoplasma genitalium, which tends to respond better to azithromycin than doxycycline.
3) In a sense, you may be onto something. It is possible that unidentified normal vaginal or oral bacteria, causing no harm in the woman carrying them, could cause NGU in men. This is only a theory, however.
4) I doubt NGU is ever "generated" spontaneously in men's genital tracts.
5) I don't know how to factor in the apparent lymph node inflammation. It is not normally a feature of NGU.
6) Various bacteria have variable sensitive to different antibotics, which probably explains why some cases repond better to some antibiotics but not others.
I hope this helps. Best wishes-- HHH, MD
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