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NGU or Prostatis or thrush
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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 or Prostatis or thrush

Dr EWH gave me great advice last week on my 12 wks of urethritis, but I come back with different specific qns as I take Dr HHH pr EWH to be best NGU expertise available to me.  I have read a lot about NSU but can not seem to find these answers:

1 I used an online STI urine test that uses a private Laboratory, but I had finished antibiotics 17 days earlier - would this put me a risk of a false negative?

2 Great that you say no harm to me or partner if I have NSU long term but does this extend to no harm to a baby if I were to get partner pregnant (I am hoping to have kids in a year or so)?

3 I have read Moxifloxacin side effects are v strong. Which course if any out of Doxy, Erythromycin, further Ofloxacin, Fluconazole or Azithro/Metronidizole sound worth trying? With any of these, does drinking alcohol make them less effective or only make the side effects worse?

4 Is a urine test enough to pick up active HSV - and I cannot find what is the max no of years first symptoms of HSV has/could occur after catching it?

5 Is it possible Prostatis would cause only an inflamed urethra with no other symptoms? I have v occasional aches in testicles/penis but not severe at all (so only definite symptom is my swollen urethra) and if I can rule out Prostatis I can stop taking Ofloxacin which I would like as it made an old tendon injury and stomach hurt after 5 days of it.

6 You are right that I use condoms - the last time I didn't was 10 years ago, so sexual transmission of my NSU would have been oral or hand-to-genital (with hand-to-genital more likely due to the timing of first symptoms), so does this make you think that it is a UTI bacteria rather than an STI bacteria that has given me urethrirtis and a high urethra wbc count (or can non bacterial urethritis also show 10 white blood cells phpf)?

So grateful for advice on each to help to a) treat the NSU and b) worry less and stop me spending hrs searching online without getting these 6 answers. Thank you.G
300980_tn?1194933000
Welcome back.  These are a new set of questions so I will address them here using the same numbers that you have used above.

1.  The passage of 17 days since your last antibiotics and your most recent testing is more than enough to make your testing reliable.  If you were infected, the tests should have detected an infection.  Negative tests should also be believed.

2.  Yes, as I said earlier, the available data indicate that persistent urethritis with negative tests and unresponsive to recommended therapy is not a risk to you,  to your partner and, by extension, to a child born to you and your partner.  While rare, there are some forms of urethritis with non-infectious causes- in some instances these are rare medical syndromes such a "reactive arthritis" or Bechets syndrome" but these are quite rare and most persons with persistent urethritis.  (these are diagnoses far beyond the scope of this site and should have been considered by the doctor you have seen).

3.  All drugs have side effects.  In my experience my patients tolerate moxifloxacin is well tolerated (you haven't been reading about moxifloxacin on the internet have you?  Not a good idea). Given the treatment you have already had, if you feel you must be treated with something I'd recommend moxifloxacin (a case can be made for not treating further and just observing).

4.  A urine test is not a good test for herpes but what you describe in NO way resembles herpes urethritis.

5.  This really does not sound like prostatitis which would not present as isolated urethral irritation.  Before you stop any medication however, you owe it to the doctor who prescribed it to let them know.

6.  Your condom use makes the possibility of any STI much, much lower.

My sense is that you are feeling desperate, perhaps going form doctor to doctor and working through this on the internet. As frustrating as it is to not have a clear answer- seeing serial doctors is not a good idea, nor is trying to solve this through internet searches.  Rather you need to settle down and work this through with a health care provider who is willing to do so and whom you feel comfortable with.  EWH
12 Comments
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Avatar_m_tn
Thanks Doctor but my questions 1 and 3 are different after I did some further reading.  This thread is the more up to date summary so would make sense for Dr Hook to see this.  I also thought that as I had 6 questions it warranted a second contribution to your great site and was not sure Dr Hook would see my other comment as not a new post?
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300980_tn?1194933000
I answered this post, including questions 1 and 3, taking into account both psots.. EWH
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Avatar_m_tn
Dear Dr Hook, I cannot see your answers to q 1 to 6 above on either of my posts in this forum ?  Please could you tell me where the answers are as I need closure on this? Thank you. G
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300980_tn?1194933000
I have pasted in a copy of my repleis from earlier today below.

Welcome back.  These are a new set of questions so I will address them here using the same numbers that you have used above.

1.  The passage of 17 days since your last antibiotics and your most recent testing is more than enough to make your testing reliable.  If you were infected, the tests should have detected an infection.  Negative tests should also be believed.

2.  Yes, as I said earlier, the available data indicate that persistent urethritis with negative tests and unresponsive to recommended therapy is not a risk to you,  to your partner and, by extension, to a child born to you and your partner.  While rare, there are some forms of urethritis with non-infectious causes- in some instances these are rare medical syndromes such a "reactive arthritis" or Bechets syndrome" but these are quite rare and most persons with persistent urethritis.  (these are diagnoses far beyond the scope of this site and should have been considered by the doctor you have seen).

3.  All drugs have side effects.  In my experience my patients tolerate moxifloxacin is well tolerated (you haven't been reading about moxifloxacin on the internet have you?  Not a good idea). Given the treatment you have already had, if you feel you must be treated with something I'd recommend moxifloxacin (a case can be made for not treating further and just observing).

4.  A urine test is not a good test for herpes but what you describe in NO way resembles herpes urethritis.

5.  This really does not sound like prostatitis which would not present as isolated urethral irritation.  Before you stop any medication however, you owe it to the doctor who prescribed it to let them know.

6.  Your condom use makes the possibility of any STI much, much lower.

My sense is that you are feeling desperate, perhaps going form doctor to doctor and working through this on the internet. As frustrating as it is to not have a clear answer- seeing serial doctors is not a good idea, nor is trying to solve this through internet searches.  Rather you need to settle down and work this through with a health care provider who is willing to do so and whom you feel comfortable with.  EWH
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Avatar_m_tn
Thank you many times over Dr Hook.

You are right that I have been a bit desperate to resolve my inflammation. I saw a Dr yesterday before I saw your answer and he gave my prescriptions for a longer 5 day course of azithromycin and metronidizole combined, and after that he said 7 days of doxycycling would be the only thing he would try as I have tried most treatments. However I have had muscular and joint aches and stomach problems towards the end of my ofloxacicin so I think I need to wait 2 or 3 weeks until I try further antibiotics. A) do you agree?

No Dr has mentioned penile thrush/yeast when examining me, but it occurred to me that B) perhaps I should try 1 dose of 150mg fluconozole to treat thrush? Or would my body get rid of thrush itself?

Your answers have definitely helped me move on. I think I could live with the discomfort if I had negative urethral swabs as that would reassure me of no infection. But C) are you saying that I should not worry about harm to me or my partner even if I continue to get swabs with over 5 wbc per high  p field?

I think this really does cover everything now..

With thanks and best wishes. G
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300980_tn?1194933000
A.  I would not have treated you with these medications again.  I see no benefit to repeating what has already been done.  I think however that you need to discuss this further with your doctor, not bounce from source to source.  there are many ways to manage these problems.

B.  Again, self-medication is NEVER a good idea.  Why not discuss this with your doctor. this might help your perceived urethral irritation but not testicular symptoms.

C.  Correct
EWH
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Avatar_m_tn
Thank you Dr. Just to clarify on A), I have not actually tried doxycycline yet, and only had single doses of azithromycin and metronidizole at separate times, which is why the Dr thought they were worth a try. But do you think I need to give my body 2 or 3 weeks test before trying them since the oxfloxacin seemed to make me ill ?

I will also ask my Dr about thrush and reactive arthritis as you suggest, although I think both are unlikely as my only symptom is urethritis...
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300980_tn?1194933000
There is no need to "give your body a rest".  If you are infected (which I doubt) you would need treatment and there would be no rason to delay this.  The side effects of the ofloxacin, in general, should not effect your ability to tolerate other medications. EWH
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Avatar_m_tn
Thank you again.  This site is such a great idea and getting expert personalized advice has significantly improved my mental state and perspective about ngu.  

On re reading your initial answers above, I noticed that your answer to q2 was cut off...what was after 'rare and most people with persistent urethritis'? I am guess it was something like ...'do not get reactive urethritis or any complications past urethritis' but thought I should check?
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300980_tn?1194933000
Correct.

It is now time for this thread to end. EWH
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Avatar_m_tn
Perfectly understandable. Best wishes and I hope you have a good holiday period...
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