STDs Expert Forum
Male Urethritis Causes?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Male Urethritis Causes?

Can male urethritis ever *not* be the result of an STD?  My husband claims his stemmed from overzealous masturbation with lotion as the lubricant, and that getting lotion in the urethra led to the irritation and infection.  But, he was prescribed the usual STD remedies (single does zithromax, etc.), and he didn't actually tell me what was up.  (I found out via a copy of the Immediate Care bill being sent to the house--no fun.)  To be on the very safe side, I went right to my gynecologist for testing--chlamydia, gonorrhea, HIV tests were all negative.  Husband says his chlamydia and gonorrhea cultures were negative as well.  But, I'm scared and distrustful--afraid to have intercourse again.  *Could* he be telling the truth?  And if so, is it normal for his symptoms to continue even weeks after the antibiotic therapy?  Help!  Is urethritis always sexually transmitted, or not? And even if it *isn't* chlamydia or gonorrhea, couldn't it be some other STI that is the problem?
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In 30+ years in this specialty, I have developed a love-hate relationship with it. Love because mostly I help people in an area where knowledge is scant.  Hate because often I have to give painful information.

From a purely clinical standpoint, your health probably is not at risk.  Chlamydia causes 30-40% of cases of nongonococcal urethritis (NGU)--so the answer to your last question is yes, sexually acquired infections other than chlamydia or gonorrhea could cause the problem.  However, no research has ever linked nonchlamydial NGU in men with adverse health outcomes in their partners, so the negative results on your husband's and your own tests for gonorrhea and chlamydia are reassuring with respect to your health.  From that standpoint, and assuming he has been treated (usually with azithromycin or doxycycline), you probably can rest easy and can safely resume intercourse with your husband.

But masturbation does not cause urethritis, and chemical irritation from lotion or other irritants do so rarely if ever.  Occasionally, oral sex may cause NGU; bacteria that are normal in the mouth and throat may sometimes cause inflammation in the urethra, perhaps explaining some cases of NGU in monogamous settings.  Perhaps this explains the problem, without implying other sex partnership.

Putting it all together, I have to be suspicious--as you clearly are--that your husband acquired the infection from another partner.  I can't judge the likelihood as well as you can; you know him, and your relationship with him, infinitely better than I do.  If you are truly confident in his fidelity, and assuming you have had no other partners, then looking for "innocent" sources may be reasonable.

I hope this helps.  Best wishes to you.

HHH, MD
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Thanks, Doc.  I appreciate your sensitivity about delivering the harsher realities to clients.  Can't be easy.  In any case, you've only confirmed what my own reading, discussion with my gynecologist, and gut instinct already suggested.  It's a bummer, but I always do prefer the truth to happy but misleading fantasies.
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Still stewing about this, so forgive me for venting, but maybe others will be positively influenced by one married woman's perspective.  I'm neither prudish nor naive, so I understand that extramarital attractions and affairs do happen, and probably far more frequently than anyone really cares to contemplate.  So, coping with that probability is a heartbreak, but survivable.  Much tougher is realizing that a person you love and trust can so cavalierly play fast and loose with your health.  Even a thorough grasp of the human animal's vulnerability to the "heat of the moment" doesn't make that lack of concern any easier to absorb with any equanimity.  It's one thing willingly to put oneself at risk, quite another to risk others' lives without their knowledge or consent.  In some ways, our culture is breathtakingly open about sex:  pornography is readily available with a click of the mouse, and a pornographic attitude permeates everything from music and advertising to prime-time dramas and even Monday Night football.  Any yet, we are bone-deep ignorant in some of the ways that matter most.  People routinely engage in sexual activity with people with whom they couldn't even comfortably talk about things like safe sex or responsibility.  We'll look at online pornography so explicit that's it's practically clinically detailed, but too often can't even begin to discuss needs, desires, emotions, or ethics.  Maybe I sound hopelessly old-fashioned to some, but let me just go on record as saying that the brain is by far the most crucial human sexual organ, and the one that most often goes almost entirely unused.  Too bad, because intelligence and honesty are by far the most appealing traits anyone can possess.
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Well said.  But since you obviously have insight into the complexities of human behavior, don't forget the power of the mind to rationalize, to convince oneself that the consequences of one's behavior aren't so bad--despite all facts to the contrary.  At some level, your husband might have genuinely believed his behavior or apparent infection had no implications for your health.  And at least you to be dealing with HIV (assuming he isn't having sex with men or otherwise at high risk).

My response was intended to leave the door open a crack for the possibility of an innocent explanation.  As I said, you know your husband, his ethical/moral standards, his susceptibility to such rationalization, and whether he is likely to have other sex partners.  Please factor that knowledge into your coming discussions with  him.

HHH, MD
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It's hard, sometimes, to be *that* broad-minded about things, but I'm mulling it over.  Evidence against "innocent" causes:  1) problem developed after a trip out of town, 2) he sought treatment without telling me, 3) went off insurance to avoid a paper trail, then destroyed what paperwork he was issued, and even destroyed the prescription containers, 4) urethritis is essentially always sexually transmitted.  Evidence in favor of "innocent" causes: 1) the immediate care doc may well have prescribed STD treatment presumptively, especially since compliance and follow-up might be very questionable with a walk-in patient 2) he did eventually tell me at least some of what happened, 3) I'm totally inclined to believe that masturbating with lotion would cause some irritation for him, since our play with other sorts of lubricants has often bothered him, too.  Would a doc prescribe antibiotics without a firm diagnosis? Mine didn't--but then I went to my regular doc with whom I have a relationship of long standing, and with whom I'm very comfortable all around.  It's never a problem to ask him a question or tell him what's up.  Also, I'm not overly plagued with self-consciousness about this sort of thing, where my husband is much more readily embarrassed by it.  The big unknown variable is faithfulness--I just don't know for sure, and that's both a recent development in our relationship, and a dilemma no medical fact could resolve.  Facts and truths, unfortunately, just aren't the same thing at all.  Would that they were.
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Hello Marriedlove.

I am very sorry that you are having to deal with this. Your post hit home with me. I am am a married man that went out of town on business and went to a massage parlor. To make a long story short I ended up very briefly receiving unprotected oral.

That was 18 months ago.  I immediately freaked out and convinced myself that I had every STD there was.  It has taken me this long (I still am not there yet) to get myself straightened out.

I went to the Doctor numerous times. I never had any symptoms, but I was still convinced that I was infected. After a lot of testing (on 2 different occasions) I was informed that I had not caught anything from this stupid act. I took 5 HIV tests just to be sure.

Now my problem was not that I was concerned with my own health, but that I had possibly risked the health of my wife. I was so terrified at the thought that I considered suicide.

Now I can't speak for your husband, and I very much hope that his problems were caused by masturbation just like he told you. All I can do is tell you what would drive me to such places as massage parlors and lingerie modeling places.

Over the years I have been to many places such as those. With the exception of the last time 18 months ago the only thing sexual that would happen is masturbation.

My thought process was: I work hard, don't have hobbies, and never reward myself. These were my little rewards to myself. Looking back I know how absurd that must sound, but we all need to justify our stupidity.  

I really think that is why a lot of us (guys) go to those types of places. I don't think I ever saw a guy at any of those places that didn't have a wedding band on.  

Anyway I know that I am physically okay. No STD from that encounter. I can't tell my wife. She would divorce me and take my kids. The guilt from that has really affected my health over the past year. It has aged me.

I know you want the truth and you need it. I don't know what you have told your husband concerning this, but if you were my wife and you told me that even if I had strayed that you would not leave me I would then tell you the truth.  You may have told him that or you may have told him that if he cheated on you that you would divorce him and take him for everything he has. If the latter is the case I don't expect that he will tell you that he cheated (if he did).

All I am saying is that if he is scared to tell you the truth he won't tell you. If you approach him in a way where he knows that it will be "ok" if he tells you then he might open up and tell you that he did.

Concerning evidence that he did cheat and evidence that he didn't.  From a guys point of view hearing what you have said I have to admit that it sounds suspect.  1) Out of town, 2)Didn't tell you about his problem  3) Went to Doctor and didn't tell you.

As a regular guy I just can't see him going to a Doctor and not telling you about it ahead of time or at least the day he went.

I mean I assume if you were having female problems I can't imagine you not telling him.  

I am telling you this b/c it is exactly what I did. I went to a very small town Dr. and gave a fake name and fake address.  They didn't ask for a SSN and I didn't offer one.

Looking back I am glad that what happened to me happened. I will never ever go to one of those places again. I won't even go to a strip club with a client.

I didn't see it as cheating, but I know that it was, and I will never ever do that again. So for me a lot of good came from it. No STD and no cheating ever again.

I am hoping for the best for you. I hope that your husband has not cheated on you, but if he did I hope that he will tell you and that the two of you can work it out.

Please post and let me know how it is going for you. I will be thinking of you and hoping for the best.
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Thanks, veryconcerned.  Well, it is a hard thing all around--especially after 16 years of marriage, and the five year courtship that preceded the marriage.  Sometimes, I think I must be a relic from some long-gone (maybe only mythical, at that) era wherein fidelity was an honorable thing.  

If I wanted to reward myself for hard work or for a tough week, I'd go to the bookstore, or sink into a hot tub full of bubbles, or paint my toenails in some uplifting shade, or dance madly about the house to a favorite cd, or maybe plot an extra-special seduction of my husband.  For me, it's tough to imagine anything less rewarding or alluring than any interaction at all with a "pro".  And, really, even if an utterly selfish orgasm were my goal, I could more than manage one or more of those totally on my own, and I could enjoy that both safely guiltlessly.  Being in touch with one's own sexual needs that way might even be construed as a gift to one's partner, who can only benefit from the sexual comfort and confidence it generates.  

But a promise not to leave?  Heck, I can't even promise that I'll ever really be able to wrap my mind around the thing at all.  Monogamy is so much an inherent part of my being--so deeply ingrained in the very stuff of which I am spun--that the discovery that this is a value my partner apparently no longer shares sets the very foundations of my world to trembling.  Everything I thought I knew seems to be entirely wrong.

This is all deeply ironic, because at 42 I'd say I'm just now coming into my own as a sexual being.  Our culture's apparent preference for prepubescent beauty notwithstanding, I feel more at home in my own skin now than I ever have.  I'd not willingly become a sixteen year old again for all the proverbial black pekoe in the Orient.  Whatever innocent appeal and effortless beauty I might have possessed then, I'd never trade it in for the knowledge, confidence, comfort, humor, experience, or more profound beauty of today.

Some people can compartmentalize sexuality, I guess.  They can somehow steep themselves in pornography or affairs or strip clubs and such without ever thinking of those things as a threat to love, marriage, or commitment.  I'm incapable of fencing and fractioning myself that way.  For me, it's neither a possible nor a desirable skill.  I don't think this is particularly a gender issue, either, though some would see it that way.  Perhaps it's simply a matter of differences in personality, or background, or any number of the things that shape who we are.

Meanwhile, I'm feeling distinctly uninclined to be sexual with my husband, which is a cryin' shame, since that's such an enjoyable and important aspect of intimacy.  Having to "assume the position" so my cervix could be cleaned and swabbed for testing?  Well, that's the psychological equivalent of about a million sub-zero showers, and very, very tough to get past on any level.



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