STDs Expert Forum
NGU
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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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NGU

Dear Doctors,
Heterosexual Male in the UK in long term relationship
Situation: 2 separate incidents outside my relationship, 1 receiving unprotected fellatio in Sept 2011 and 1 of unprotected intercourse in December 2011. Tested for all common STDs after each incident – all negative. I had unprotected sex with my partner between September and December and then protected immediately after the December incident until May of this year.
Concerns:
Recently read about NGU & read that symptoms could be mild & might be missed. I was concerned I might have passed an infection that could lead to PID to my partner, I went back to my NHS GUM clinic who confirmed that I'd not been tested for NGU as I'd not reported symptoms. However, I always thought symptoms would be obvious – burning etc and wasn’t checking for discharge.
Tested privately  3 weeks ago and had had a swab for white blood cells & urine PCR test for Mycoplasma Genitalium & UU (on my request) - results were negative. However, I was concerned that I may have had an NGU infection, passed it to my partner when we started having unprotected sex again in May & it clear from my system between then and being tested 3 weeks ago. My Dr said that given my partner & I had been having sex since May I would have picked any infection back up from her and given my results were negative I could rest assured that my partner didn't have an infection that had persisted.
Questions:
- I'm concerned  that  unprotected sex 25 times of  three minutes actual intercourse each time between June & Sept wouldn't have provided sufficient opportunity to pass an infection on, it potentially clear from my system &  then me be re-infected. Should I be re-tested (white blood cell swab) at a later date?
- There was some confusion about which tests I wanted and my swab test for white blood cells was taken a few mins after my urine test - I've read that swabs should be done before urine samples are taken - should I be re-tested?


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Your question is quite similar to those asked by a prior client who could not get by his guilt and was asking very similar questions and ultimately had to have his participation on the Forum censored, I hope you are not that person again.  We'll check.

I think you are worrying far too much.  I agree with your doctor's assessment.   You are playing numbers games which simply do not reflect what we see in real life.  The facts are:

1.  You do not know that your two exposures outside your relationship were with infected persons.  It is unlikely that either was.
2.  Even if they were, most unprotected exposures do not lead to infection.
3.  The is a question as to whether "asymptomatic NGU" even exists as a disease state.
4.  There is no evidence that NGU following oral sex has deleterious consequences or is even transmissible to sex partners.  Is seems to be local irritation due to the introduction of oral bacteria into the urethra which typically subsides even without treatment.
5.  You have been repeatedly tested for STDs, including most recently Mycoplasma genitalium and ureaplasma which are not clearly even STDs or pathogens for most people.
6.  As your doctor has said, if you had been infected with something, transmitted it to your partner, she would have transmitted it back to you after more than 20 unprotected sexual encounters and  you would have become symptomatic now that you are looking for it.

While you are correct that a urethral swab taken after urination is less sensitive for NGU than a swab taken before voiding, given all the other evaluation and testing you report, I really see no need for further testing.

My sense is that you are over testing and overly concerned.  Could your concerns perhaps be more of a manifestation of your guilt over the two exposures you mentioned than anything else- I suspect so.  EWH
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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