NGU Concern

[ss12344321]

I am a 40+ male.  Around 10 days ago I went to a strip club and received a handjob w/ salvia.  I also fingered her vagina.  I had been drinking and felt guilty the next day.  I checked the site to confirm there are no STD risks for masturbation including salvia. Therefore, I continued a normal sexual relationship with my wife.  4-5 days later I noticed a tingling/burning sensation at the tip of my penis. Please note that I suffer from anxiety issues.  This has been going on now since.  I have no recollection of receiving oral sex.   However, after experiencing this possible symptom,  maybe she got one by me.  I must note this is the only symptom I have.  I have not noticed any discharge coming from my penis.  I do not have any burning sensation when I urinate.  I have examined the head inside the hole of penis.  Nothing seems out of the ordinary.  I have not noticed any lesions, sore etc. in my genital area.

A few questions.

Do I have an STD symptom?
Can you have an NGU with only one symptom?
Can you have an NGU without any discharge?
My tingling/burning sensation will change by the day.  Today I hardly noticed it.  Yesterday I noticed it all day.  It can also vary from the type of clothing I wear.  Do symptoms like this fluctuate?

What should I do if any for my symptom?  I understand this could be genital anxiety.  

Thank you.

[Edward W Hook, MD]

No, isolate testicular discomfort of the sort you describe is not a sign of STI and my opinion and advice is unchanged.  EWH

[ss12344321]

I would like to and to the question to include any testicular pain.

Thanks.

[ss12344321]

I have one last question.  Could a warming sensation in my testicles( I do not think I would call it burning) be a symptom?  If so, would it chang your original advice?  I realize this probably is anxiety, and I am trying to think rationally, but it is difficult.  I want to overcome this anxieties and not give in to them.

[Edward W Hook, MD]

Correct. there is no medical reason to test.  

There is debate about whether non-chlamydia NSU is infectious for partners or not but the standard of care is to treat exposed partners.  Should you have it, that is what I would recommend.  no further on this however until you know what is going on.  "what if" questions are of no value.  EWH

[ss12344321]

Thank you Doctor. I am interpreting your answer that I may wish to get tested to "give me peace of mind" rather than from exposure. Is that correct?

I know chlamydia and gonorrhea are contagoius through intercourse, but what about other NGUs?

[Edward W Hook, MD]

Welcome to our Forum.  Thanks for the thoughtful description of your encounter and your thoughts after wards.  the short answer is that there is virtually no chance that you acquired any STI from the exposure you describe and that your symptoms are a reflection of guilt and anxiety more than anything else.  I'll provide more detail as I address your questions below but my statement above is really the bottom line on my thoughts.  Let's work through your questions:

Do I have an STD symptom?

The problem with NGU is that the symptoms are so vague and nonspecific (hence the fact that the English call this non-specific urethritis [NSU], probably a more accurate term).  Symptoms of NSU can be mild and typically manifest themselves as burning on urination or urethral discharge. Local discomfort at the tip of the penis might be prominent in some persons with NSU but if that is your only symptom, it is unlikely to be a manifestation of NSU.

Can you have an NGU with only one symptom?

Yes.  symptoms are subjective.  That's part of the problem,  But yes persons can have NSU with a single symptom but I would not consider tingling at the tip of the penis a symptom of NSU.

Can you have an NGU without any discharge?

Yes, burning on urination can be the only manifestation of NSU, other than abnormal lab tests for inflammation of the penis.  

My tingling/burning sensation will change by the day.  Today I hardly noticed it.  Yesterday I noticed it all day.  It can also vary from the type of clothing I wear.  Do symptoms like this fluctuate?

The fact that your tingling fluctuates and when you are busy it is not noticed is strong evidence that this is a manifestation of genital anxiety rather than anything else.

So, what to do?  NGU is best diagnosed with a swab specimen taken from the penis at least an hour after last urination. On occasion microscopic evaluation of urine collected just as a person begins to urinate can serve the same purpose but the  swab is the preferred  approach.  With either method, one is not looking for bacteria but for white blood cells which are a sign of inflammation.  It is the signs of inflammation, manifest as increased numbers of white blood cells, which are the basis for the diagnosis of NGU.   While I am confident that you did not get an STI from the exposure you describe, you may wish to get tested.  If so, I suggest testing for chlamydia, gonorrhea and get tested for NSU as described above.  I recommend against letting someone treat you "just in case" before testing.  In my experience this causes more trouble than it prevents.

I hope this comment is helpful. EWH