NGU due to M. Genitalium?

[funkydave]

Hi Doc,

more than 8 months ago I contracted chlamydia.  I took 10 days doxy, which cleared it up.  I had multiple tests to confirm over the months.  At the 6 month mark I tested for all other STDs as well, herpes, hiv etc.  All negative.  My girlfriend gets recurring BV, and was prescribed 7 days metronidazole.  My doctor gave me the same, and we took it together to ensure there was no Trich present.  However, I still get a tiny drop of whitish discharge in the morning. (when I squeeze the tip. actually, the drop is very very small (less than a tear drop, sometimes too small to even become a drop) This has persisted for months.

To recap, I don't have CT, GN, HIV, Herpes, HIV, Syphilis, or Trich.
Could this be m. genitalium?  Could that be causing the recurring BV?

[Edward W Hook, MD]

That your specimen was a clean catch shold not ahve a negative impact on the test results. You should have faith in them.

There are a small number of perosns who get persistent non-chlamydial NGU.   when things get to this stage, i.e. multiple negative tests, partner is not a cosideration and having beeen treated several times this changes from a threat to the health of you and your partner to a nuisance.  The work that has been done suggests that after a thorough workup, neither you nor your partner are at risk related to the prior NGU

My advice would be to wait this out and let it subside.  I do not see much to be gained with further testing or antibiotics.  EWH

[funkydave]

HI Doc,

I did the follow up shortly after my last correspondence.  My Dr. said he didn't see any WBC, and I gave the sample 3 hours after last void.  Also, he sent me to the lab the following morning for another CT/GC test.  I gave a first void sample, but it was clean catch, it came out negative.  Is the clean catch an issue for test accuracy?

I did two weeks Levofloxacin, and I felt better toward the end, but 3 days after the end of treatment the symptoms came back.  (I did have unprotected sex with my girlfriend the day after ending treatment)  

Would NCNGU go away over time on it's own?  Should I just deal with it?

I'm not really sure what to do.  If it's NCNGU, it definitely does not feel like the chlamydia did.  It's not painful or burning or itching.  Just "weird" feeling with a drop in the a.m.  If it's a prostate issue, could it be the 2 week treatment was just not enough?  I do notice more urine "dribbling" after voiding than I used to.  Is that indicative of NGU?

[Edward W Hook, MD]

No, the flagyl will be cleared from your system at 72 hours.  That is a good time for re-evaluation.  EWH

[funkydave]

Thanks doc for your help!

One last question, I have a follow up with my Doc, 72 hours after finishing flagyl treatment.  Will that skew the results of any tests he might perform, such as Chlamydia, NGU etc?

Thanks gain Doc, that'll be my final question.

[Edward W Hook, MD]

Trust your test results.  they prove that you do not have chlamydial infection.  In cases such as yours these things tend to resolve over time.  In the interim, my recommendation is that you try not to worry (and that your partners are safe as long as they were treated for their original infection).  EWH

[funkydave]

Thaks Doc for your input!

The weird thing is, I do feel something strange, especially after urinating or ejaculating.  Though, it's not really a burning sensation.  And sometimes, immediately after urinating, there's a very slight clear discharge that will slightly smear my underwear.  Doesn't happen all the time though.  Seems to come and go, but the one drop in the morning is consistent.

When I took the Doxy, I tested for Chlamydia cure at 3 weeks after treatment and at 6 weeks after treatment.  Both were negative using a urethral swab.  Is it safe to assume those are accurate?  Or, would antibiotics or the presence of m.genitalium skew those?

I just can't seem to figure this out.  My urologists says my prostate could be "slightly" enlarged, but my urine culture came back negative.  I've treated with Doxy and flagyl, so I'm not sure what else it could be except m.genitalium, but I read that co-infection with chlamydia is not common.  sigh.

[Edward W Hook, MD]

Good questions which show that you are working hard to sort this out.  I hope my comments will be helpful to you.  Doxycycline therapy for chlamydia is excellent therapy.  Mycoplasma genitalium MAY be an STD pathogen but at this time this is still debated by experts.  Tests are not widely available.  For M. genitalium, azithromycin is preferred over doxycycline however, in your situation, I doubt that azithromycin treatment is needed.  

Bacterial vaginosis, recurrent or otherwise, is not due to M. genitalium. this is known to be a fact.  What causes recurrent BV is unknown and is a subject of intense study by medical scientists but remains unclear at this time but it is not M. genitalium..  There is little evidence that treating sex partners helps with the problem which appears to be due to the overgrowth of bacterial normally present in the vaginal for unknown reason.

Finally, regarding your recurring discharge.  It is not unusual for men to have small amounts of urethral discharge and when it is present it is most evident in the morning. furthermore, squeezed long and hard enough, you can see what appears to be discharge in most any male.  Sometimes after an experience that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital findings than in periods when they are not so concerned.  This in turns leads to noticing what turn out to be normal findings, including discharges that might have been not noticed or ignored at other times.  Perhaps this was a contributor to your situation.  

I hope this helps.  there is little in your note to suggest that you have an STD at this time. EWH