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NGU or Trichomoniasis in a Male.
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NGU or Trichomoniasis in a Male.

I had (regrettably) unprotected oral and about a minute of unprotected vaginal sex two and a half weeks ago with a college student I knew just a little.  It was my first sexual contact in about a year.  

The next day, I started having urethral burning  during urination.  Two days later, it burned enough to wake me from my sleep.   I also found that the urine flow was not as strong as it usually is.  Otherwise, however, the discomfort is mild but persistent, and there has been no discharge. At first, I thought, given how soon the symptoms appeared, that it was just irritation.  But after symptoms failed to resolve, I went to the county STD clinic, 10 days after the episode, and was tested there for Chlamydia and Gonnorhea (Gonorrhea).  I was also given 1G Azithromycin on the spot.  The doctor who examined me noted that i jumped when she felt my epididymis on the left side, which made her think I was getting epididymitis from chlamydia.  I got the results yesterday, and they were negative.  And while the urine flow is better, I still find that I feel like I have to urinate more often than usual, and there is still a burning -- but only after I finish urinating.  

I went back to the clinic yesterday (a week after my first visit), and the doctor told me that since my symptoms hadn't resolved, I likely had NGU (which they don't test for).  She gave me 100mg doxycycline (twice per day, for seven days).  I asked her about trichomoniasis (on the theory that the Azithromycin should have cleared up NGU, and that the burning was mild and *after* urination), and she dismissed the concern, saying it was rare in males couldn't understand where I got the idea that it could be involved.  

My question arises because I don't feel comfortable with the doctor's thoughts, given what I've read here.  Should I be worried about trichomoniasis, and whether doxycycline is the right drug at this point?  
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15 Comments Post a Comment
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1318465_tn?1340571541
Hello

You were treated correctly, and yah dont' worry about trich.  Thanks for posting this and showing how a one time exposure of UNprotected sex still pretty much poses a good chance that one will NOT be infected with gonorrhea and/or chlamydia.    You did put yourself at risk there, but your tests shows you were not infected.  

Your symptoms should resolve on their own in one month (yeah, sorry for the wait).

Wear condoms --they work.

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Avatar_m_tn
I believe you story shows that there is a good chance of contracting something from a 1 time unprotected exposure.  Obviously you have something going on, and most likely it is NGU.  NGU mean you have urethritis not due to Gonorrhea.  Which means it could have been Chlamydia, Trich, or other bacteria.  Since your test results were negative, you know it's non chlamydia NGU, which means there could be other bacteria causing your issues, or it was due to some irritation.  If it's not due to NG or CT, then it's very difficult to determine exactly what was causing you problems.  

You health care provider is not informed on Trich and should not dismiss it as a possibility.  Trich is not rare in males, but symptoms are.  Most men do not show symptoms and therefore do not know they have it.  In addition, some sources state that Trich will clear up within a couple weeks to a couple months in males, but this is not true either.  Lack of symptoms does not mean lack of infections.  Symptoms may go away, but a male partner will still be able to infect a female partners, therefore Trich is something that can be carried for long periods of time without knowing it.  Females can also carry Trich for a long period of time without detection and without showing symptoms, but can manifest its self down the road as PID and Cervicitis in women and prostatitis and epididymitis in men.  Please do not let anyone dismiss Trich as possibility.  In cases of persistent NGU, the CDC even recommends treatment for Trich (not that everything the  CDC puts out is true either).  

To make a long story short, you should go back a get treatment for Trich if your symptoms do not improve.  It may not necessarily be Trich, but could be some other aerobic bacteria that is causeing you problems, and the Trich treatment will help that as well.  Continue to do your research and inform yourself, and most importantly, find a doctor who will work with you and explore other possibilities if your symptoms do not imporove.  Please let us know how things go, it's a great way to help others who end up in your shoes.  
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Avatar_m_tn
Thank you so much for your feedback.  I think your disagreement isinteresting, although I'm uncomfortable not being treated for trich given the possibility of passing it on, since (1) symptoms haven't gone away yet and (2) even if they do, I could still be infected.  I suspect that Azith and Doxy would have killed any other potential NGU organisms (right?) but would have no effect on trich.  Is there a type of doctor who would be best for this?  I was hoping the County STD clinic would do the trick, given their presumptive expertise, but I am thinking I need to look elsewhere.
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Avatar_m_tn
By the way, is the PCR urine test for trich sufficiently accurate to be worth doing?
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Avatar_m_tn
Although I disagree with Jessy from time to time, I do agree with him a lot of times and respect his knowledge.  

You're correct, Azithro and Doxy will not treat Trich.  The County STD clinic should be a good place to go.  They should be familiar with all this stuff, that's why I'm surprised by the reaction you got.  I think you will be fine if you go back and discuss it with them.  Print out the CDC guidlines as well, just so you have something in hand to back up your position.  They should be following these guidelines anyway, so I do not see why they would refuse to treat you for Trich if you're still having persistent NGU.  

A PCR urine test would be the most accurate test you can take, but it's expensive and you will pay for it out of pocket.  I single dose treatment for Trich would be less expensive and easier.  Of course, if you're the type of person who doesn't perfer to take antibiotics if not warranted, then opt for the PCR test first.  Again, let us know how things shake out.
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Avatar_m_tn
Thank you so much, shaken, for your comments. I'm so grateful for them, as well as for this site.  

I think you're right.  I will go back to the county clinic next week.  They seem to assign doctors to the clinic almost randomly, so I will likely have a different one this next time.  And I'll bring the CDC guidelines with me.  Do you happen to have a link to the current ones?

I have no problem in this case taking the appropriate treatment (Flagyl for trich would be the right one I think) without doing a PCR test first.  I'd rather end this, the sooner the better.  

I'll report back.
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Avatar_m_tn
So I wanted to report back.  I finished the 7 days of Doxy on Monday night.  Symptoms -- a bit of burning after urination -- had not changed.  Then on Tuesday, they improved a bit, and by Wednesday I felt 80% better.  They was just a hint of burning, but I'm not sure I would have noticed had I been paying less attention to it.  By yesterday it was 90% better, and it's the same way this morning.

On Monday, I took a bright flashlight and looked inside the urethra.  I noticed what looks like a red spot a little bit in on the left side, which is where it hurts when I squeeze the glans (glands).  (It still hurts slightly when I do that, but less than it did before.)  That red spot was still there yesterday, and I'm not really planning on checking again because I don't want to irritate it, and Dr. Hook often advises against self-examination.

So the question now is what to do.  One option is to assume that the combination of Azithro and Doxy cleared whatever NGU I might have had up.  Another is to test for trichomonas.  The reason for doing that would be because trich can be asymptomatic or can stop causing symptoms, and I don't want to harbor it.  Is there something else to test for, or do you think I'd be better off letting it all go at this point?
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Avatar_m_tn
It wouldn't hurt to test for Trich and also to take the treatment.  The antibiotics are cheap and do not have harsh side effects.  I'm sure some people on here would tell you not test anymore or take anything else and wait to see if it clears up, but my personal opinion is to test and be sure instead of "waiting it out" and potentially infecting someone else or your condition getting worse.  It sounds like you're getting relief from the Doxy so thtat's good.  Again, keep us updated.  
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Avatar_m_tn
Yeah, I agree.  I decided to do a PCR test for trich today rather than wait and wait in the clinic; I'll get the results next week.  If it's negative, there will be no need to take flagyl.  

I'm still not sure what it might be.  The weird thing is that it started early -- within 24 hours. And yet it it was just irritation, it's lasted a long time.  
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Avatar_m_tn
So my PCR test for trichomonas (done by Quest labs) came back negative.  I'm not sure if I should just leave it all alone and assume everything is ok, since I've tested negative for gonnorhea (Gonorrhea), chlamydia, and trichomonas, or whether I should get seen again, since I have a bit of burning right as I finish urinating.  
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1318465_tn?1340571541
"Your symptoms should resolve on their own in one month (yeah, sorry for the wait)."

so what... 15 more days?

It took me just over a month to get back to 100%  of course they stuck a Q-tip/cathader looking thing in my penis... never again.   You remind me of me, --you know its pretty bad when you start looking inside you urethra.  Don't bother there's nothing in there but a functional lumen.


Looks like your going to be alright.   God has a sense of humor no?   I think he does.





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Avatar_m_tn
I'm sure I will be alright.  But I would like any symptoms to go away in the meantime.  Why do you say that it takes a month for symptoms to resolve?  I've read that symptoms should clear up shortly after treatment.
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101028_tn?1348750963
many things can cause burning after urination. Usually if it's a std, it's constant burning, not just after urination.

follow up with an urologist as needed.

grace
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1318465_tn?1340571541
True symptoms should resolve shortly after treatment.  Sometime between 3 days to 2 weeks is the average time it takes.

But in some people it will take longer and you and I are a perfect example of that.

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Avatar_m_tn
i am having this same problem iv been to the urologist and they have tested me for all std's and all came back negative. I have been given about 4 to 5 different  antibiotics and it shows signs of little relief and then the same symptoms reaccure. Have you found any solution to the problem or is every doctor in the word dumb found to what is going on with us.
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