Info Request

[roy888]

Hi, I have never had any symptoms of STDs but decided to go and get checked regardless. I have always been careful and have only had unprotected sex with 1 girl. I was therefore surprised when the doctor said the immediate initial urethral swab showed evidence of bacteria which he said may be assymptomatic non specific urethritis and gave me a single antibiotic there and then. The subsequent urine results all came back negative with no std present, negative for chlamydia, gonnorrhea etc.

I am just looking for extra advice as the doctor was not very helpful regarding info. Should I be worried about the girl having bacteria or is urethral bacteria normal? Why did this bacteria appear on the urethral swab but urine analysis was clean?

Thanks for your help.

RDL

[H. Hunter Handsfield, M.D.]

And by the way, this is one reason that most STD experts no longer do urethral swab tests on men who request STD screening tests in the absence of symptoms or known exposure to a partner with STD.  There are too many false positive results, i.e. WBC that don't mean anything.  If such men have a normal exam (no discharge) and no symptoms, the only urethral testing they have is a urine test for gonorrhea and chlamydia.  If your doctor is an understanding sort and you have had a collegial relationship with him, he might appreciate an update about this -- you could print out this thread as a starting point for a discussion with him.

[H. Hunter Handsfield, M.D.]

Sorry it took a while to get back to this thread.

Finding increased WBC on a urethral swab, in the absence of other symptoms and signs, is a clue about NGU but not diagnostic.  Normal men probably have increased WBC from time to time, and this might occur more frequently in uncircumcised men.  When we see that in men attending our STD clinic, we do not treat unless we also see abnormal discharge on exam, or if the patient gives a clear history of discharge.  Otherwise, we test for gonorrhea and chlamydia, wait for the results, and also ask the patient to return to the clinic for a repeat urethral swab test.  If the repeat test shows no WBC and the tests are negative, we assume nothing was wrong in the first place and do not recommend treatment.

Of course I cannot say what would have been seen if you had a repeat urethral swab WBC exam, but my guess is it would have been negative -- especially now that I know you had not been sexually active for over 4 months.

So I am not criticizing your doctor; the decision to treat for presumptive NGU is justifiable, i.e. better safe than sorry.  However, based on the entire story, a definitive diagnosis of NGU was not justified and I believe you were not infected with anything.  And it is certainly plausible that some minor inflammation (balanitis) might occur under the foreskin, as you describe -- which could result in a finding of WBC on urethral swab.

At this point I would just forget the whole thing and not worry about it, assuming you continue with no symptoms aside from the occasional moisture under your foresckin.  And don't worry about contacting your partner; if you run into her, you could mention it as a false alarm, or not bring it up at all.

[roy888]

Hi, I just wondered if you had any more information on my query. I think my initial swab test was for white blood cells. Is there an explanation for this when urinalysis came back neagtive for the tested stds?

A bit more background info - I did not have unprotected sex for almost 4 months up to the std test and had no symptoms during this period just occasional light moisture beneath the foreskin particularly on hot days and this has always been the case (and is still the case now after the azithromycin.)

Thanks

[roy888]

Hi, this was initially predicted from looking at the swab immediately under a microscope (looking at cells per high power field). I was given azithromycin at the time but was not called back to check if it was effective. I just wondered if this was anything to worry about as it has been difficult to locate the girl and inform her of the test.

Thanks

RDL

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

This is indeed peculiar.  It would be good to have more information about what your doctor actually found on examination.  What exactly was the evidence of "bacteria" on the immediate swab?  Looking under a microscope, or a chemical test like a nitrite test?  Or did your doctor actually find increased white blood cells, not bacteria?  That could also be under a microscope, or a dipstick test for leukocyte esterase.

NGU does not have any abnormal bacteria that can be seen under the microscope, and does not cause a positive nitrite test.  And having WBC in the urethra usually is not, in itself, sufficient to diagnose NGU.  Finally, the various rapid tests I just mentioned are very imprecise; false results are very common, which could explain why something showed up but the rest of the urinalysis, and tests for gonorrhea and chlamydia, were negative.

So my guess is that you didn't have NGU at all, especially in view of your sexual history.  But see if you can fill in some of the missing information about exactly what tests were done.  Also let me know what treatment you were given -- probably azithromycin, but please confirm.

Regards--  HHH, MD