STDs Expert Forum
NGU Question
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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 Question

Hello Dr.  I had an incident recently that I need some advice on.  Was in a strip club about 9 or 10 days ago and the stripper pulled out my penis and manually stimulated me along with using a bunch of her saliva as lube.  I was fairly intoxicated and don't remember every detail, but she may have given me oral for a few minutes as well, but do not think we actually had intercourse.

This happened on Saturday night, and on Thursday morning (4 days later) I noticed a small yellowish spot of dried up stuff in my underwear.  Some tingling on the tip of my penis on and off throughout the day, but not much more discharge.  Friday morning found another, but smaller yellowish spot in my underwear.  Went to have a urine test for Chlam/Gon and that came back negative today.  Since Friday, everything is back to normal and no more discharge.  Throughout the whole time there was never any pain during urination.   So a few questions:

1. Since the Chlam/Gon test was negative is this definitely NGU or can this sometimes occur from other stuff?

2. If she didn't perform oral, could just bacteria in saliva (which was used a lube) be the cause of such an issue?

3. Friend called in a Z-pack just to be cautious, do you think that is needed since my symptoms are gone.

4. I know Trich is just transmitted by intercourse, but given that my memory is spotty is this a possibility based on symptoms.

5. I know it was low risk for HSV, but given that we are 10 days out now, I assume the likelihood is even less?  I think you say 2-10 days for most cases to show symptoms, I know it can take longer, but not as common.

Thanks for your help -
239123_tn?1267651214
Welcome back to the forum.

As Dr. Hook told you in one of his responses, without penile entry into a partner's vagina, rectum or mouth, there is no STD risk. So you can dismiss the hand-genital contact.

If indeed there was oral contact with your penis, you could have acquired gonorrhea or NGU (but not chlamydia, or only very rarely) -- which could cause yellow urethral discharge.  On the other hand, underwear staining, without visible pus or mucus dripping from the penis, may just be urine.  In any case, with your negative gonorrhea and chlamydia tests, and with the symptom now gone, I wouldn't worry about it.  To your specific questions:

1) See above.

2) Hand-genital contact, even with saliva as a lubricant, has not been known to result in NGU or any urethral infection.

3) I see no need for treatment and would suggest you not take azithromycin (Z-pack).  Instead, wait and see if your symptoms reappear in the next week or two, especially with a visible discharge.  If so, don't treat yourself; get professionally examined .

4) You would have remembered if you'd had vaginal intercourse.  Anyway, trichomonas in men rarely causes any symptoms.

5) I agree herpes is not a realistic possibility and should not be a concern

Regards--  HHH, MD
11 Comments
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Avatar_m_tn
Thanks Dr. A few follow-ups and then I am done as I know you have more pressing questions to answer.

I don't think the stuff in my underwear was urine as it was kind of crusty when it was dried up.  And I should add that over those two days if I squeezed my penis it did appear that there was a clear substance that didn't necessarily come out, but you could tell it was there.  If I dabbed it with a tissue it seemed like water, not thick (like mucus) or yellow.  Now on to my follow-ups.

1. In normal NGU cases do symptoms usually persist without treatment, or at least persist longer than 2 days.

2. In looking for symptoms over the next week (particularly discharge as you noted) am I looking for any little thing like maybe my penis slightly sticking to my underwear throughout the day or am I looking for something obvious coming out of my penis and not just in my underwear.  Is that the main symptom to be looking out for?

3. I think you also noted that these things usually clear up on their own.  My wife recently had surgery and we won't be able to have sex for at least 5-6 weeks.  Is that ample time to clear this up (if it is anything) where it is safe to have sex with her.

Thanks again -
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239123_tn?1267651214
1) The natural course of NGU without treatment isn't relevant here, since you were treated with one of the standard recommended treatments for it (azithromycin).  After such treatment, it sometimes takes up to 1-2 weeks for symptoms to completely resolve.

2) Sticking to underwear could indicate there is continuing inflammation, such as persistent NGU.  If it continues beyond another few days, I recommend you see a doctor or clinic for professional re-evaluation.

3) NGU, not due to chlamydia, has not been linked to important problems in affected men's female partners.  That's probably especially true for cases acquired by oral sex.  Having said that, these are assumptions, not science based.  The normal practice is to treat affected men's sex partners, both to protect them from possible adverse effects and to prevent recurrent infection in the male.  On the other hand, if you didn't have sex with your wife from the time of the strip club event until now, then obviously there is no need.
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Avatar_m_tn
Thanks Dr.

But I have not taken the z pack yet, sorry if I confused that.

Found another little yellow spot this morning, may take the z pack to see if it clears it up.

Thanks, I have not had sex with my wife since the incident so should be good.
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239123_tn?1267651214
Sorry I misunderstood.

DO NOT TAKE THE ANTIBIOTIC!  If you do so you will destroy any chance of knowing what you have (or have had).  See a doctor or clinic with experience in STDs and then follow their advice.  Let me know what is found after you do so, and then I may have other comments -- but will have nothing more to say until then.
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Avatar_m_tn
Thanks - last question until I get checked out.

Am I still Ok to wait a week or so to monitor symptoms as you recommended? I think I have irritated things by checking so much and that may be cause some of it.

Everything is fine this morning.
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239123_tn?1267651214
There's no hard and fast rule about when to be examined in situations like this.  There's no harm in wating a few more days.  I agree you should keep your hands off, i.e. no squeezing in an attempt to see discharge.

That's my last advice unless and until you report the result of professional evaluation in the future.
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Avatar_m_tn
Thanks Doc - probably going to Dr. tomorrow.  But I really have not had any symptoms since last week.

Can NGU symptoms really come and go without ever being treated?
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239123_tn?1267651214
Yes.
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Avatar_m_tn
Thanks Dr.  Went to the Dr. today.  They did a urine test that she told me came back negative for white blood cells, nitrites??? etc.  Must have has a lab there as it came back pretty quickly.  I had not urinated for like 4 hours so hopefully that was a good sample. Coupled with my negative Chlam/Ghon test she was kind of puzzled as to what it could be.  She said maybe yeast but doubtful.

So to be safe she prescribed me Cipro (500mg) for 7 days and said that would likely clear up anything it might be. A Z-pack was out because I had an allergy to erythromycin as a kid.  Also gave me something else for yeast but I can't remember what that is called.

So in light of all of the negative tests do you think I even need to take the Cipro.  I have not had any symptoms in the past week or so, and really don't like taking medications for "heck of it".

Thanks Doc.
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239123_tn?1267651214
Your negative exam is good evidence you aren't (currently) infected.  At this point, I cannot judge whether you had NGU that has spontaneously cleared, or never had it at all.  However, a distant online expert shouldn't override a user's own doctor unless it seems overt harm would result otherwise.  I recommend you follow your doctor's advice.  
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