Question about NGU

[junc321]

I had an encounter with a CSW where I received unprotected oral sex, rimming and then ejaculated in the mouth of the CSW.  5 days later I received unprotected oral sex from my partner and ejaculated in her mouth.  Next day again received unprotected oral sex without ejaculation in the mouth.
Later that same day I felt a slightly increased urge to urinate with possible very light burning after urination or a sensation that I had not completely voided.  This sensation came and went.  The following day ( =7) I was examined and tested for Cly/Gon.  Current symptoms were occasional sensation in the penis / increased frequency of urination.  Burn if any, after urination was very slight.  No discharge to date (no staining)  No visible symptoms.  Diagnosed urethritis / e.coli likely?  Prescribed 1gm azith on day 7.
Symptoms of urge to urinate and sensation seemed to come and go on day 8+ 9.  Still no discharge or visible signs.  Day 10, when defecating (straining) slight burn in urethra, and small amount of white to clear discharge post void.  First discharge observed.  There is a still slight sensation/awareness/urge in the tip of my penis, however I am not sure if this is anxiety related.  Could the discharge observed today be related to something with the prostate as opposed to continuing symptoms of the Urethritis/NGU?

Does this appear to be NGU?
How many days would it normally take for NGU symptoms to clear after treatment?  How many days until not infectious?  What is the likelihood that I infected my partner by receiving unprotected oral sex (1 ejaculate in mouth, 1 not) on days 5 and 6 after risky encounter?   Would I be contagious 5/6 days after medicating?

Thanks

[Edward W Hook, MD]

I think you are reading too much on the internet and it is fueling your anxiety.  

Azithromycin is the currently preferred treatment for M. genitalium.  The importance of treating M. genitalium is unknown at the present time and again, if you had NGU due to M. genitalium, or anything else, WBCs would be expected to be present.  EWH

[junc321]

What are your thoughts on mycoplasma genitalium?  The stinging/burning sensation in the tip has still not subsided after approximately 4 days from azith. I know I need additional testing for WBC or m genitalium but can't get in right away.

I'm afraid I'm self diagnosing from reading too much but the constant sensation is very much at the front of my mind.

[Edward W Hook, MD]

No, I would not trust these strips. EWH

[junc321]

Sorry If my post was confusing.  There was never a WBC test conducted. Do you feel the AZO strips that I could purchase in a store could give a fair presentation of current WBC presence?

[Edward W Hook, MD]

The fact that there were not WBCs to start with suggests this may not have been NGU, at least STD related NGU. After all, there are occasional  non-infectious causes of NGU symptoms such as non-STD viruses, medications, other irriation. EWH

[junc321]

At the initial screening a WBC count was not done. If I took one now, it would only show whether or not I currently had an infection.  Since I took the antibiotics, it could be inconclusive as to whether NGU was ever present?  I guess what I'm wondering is.. if it were NGU there may or may not be a few lingering wbc 3 days after treatment.

Thanks for your help

[Edward W Hook, MD]

Welcome to our Forum.  You mention symptoms which certainly suggest NGU but another important part is distinguishing NGU from other causes of urethral discomfort is the demonstration of inflammation (increased white blood cells).  You don't mention whether or not this was done- was it?  The reason I ask is that there are other causes of urethral irritation.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.

With NGU following oral sex, there is some debate as to whiter this is a problem which can be transmitted to sexual partners and put them at risk or if it is just irritation from the process of oral sex.  

The therapy you mentioned, azithromycin 1.0 gram as a single dose, is a recommended therapy for NGU.  symptoms can persist for 3-4 days after therapy and tend to get better. Sometimes when folks get NGU they become so focused on the presence or absence of discharge that they tend to note the small amount of normal discharge men get from time to time and think it's abnormal  for instance, it is not at all unusual for a small amount of normal secretions to be expressed as a person strains at stool (sounds like this happened to you).

I would not be worried about being contagious for your partner. At this time, you need to be checked for WBCs with either a swab or a urine specimen collected at the very beginning or urination (the swab is a better specimen). If there are no WBCs, you do not have NGU at this time.

Hope these comments are helpful.  EWH