NSU, Chlamydia or Gonorrhea?

A quick overview of my history and symptoms- I am a male 35 yrs hetero

5 months ago unprotected oral and vaginal (one night stand)
5 weeks ago received unprotected oral sex from prostitute and ejaculated in mouth
2 weeks ago received intense unprotected oral sex from prostitute (twice within one hour)-no ejaculation in mouth

36 hours after my last encounter I started to feel a tingling in my penis head and the glans (glands) was slightly red.  Then aound 5 days later noticed first small cloudy discharge (small amounts). Only one morning did I wake up with a drop of white discharge that was brighter and whiter than the other discharge.  Since then had only cloudy discharge in small amounts or only when milked.  No burning during urination, but painful burning and itching of glans (glands) and urethra at other times or after urination. More frequent urination and bowel movements than normal. Also feels also like my general groin area is burning.

2 days ago I went to a clinic and they took a swab and urin test.  At first the doctor said they couldn't see any bacteria in the swab or urin but then after a couple of minutes said they did see something in the urin but would have to wait a week to confirm.  The doctor explained it could be a number of bacteria but didn't want to confirm chlamydia or gono until tests came back. However when she wrote down notes in her file, I noticed first she wrote chlamydia then crossed it out then wrote gono and some other bacteria names that I didn^t recognize.  She gave me a pack Zythromax 4 pills for a total of 1g.  Took it immediately, and since then (30 hours ago) the discharge has apparently cleared up.  Pain and redness  is still there, however a little less than before.


In your opiniong

1) Do you think this is gono, chlam or NSU?  I mentally have ruled out chlam, because from what I read you cannot get it through receiving oral sex.  And since I don't have the strong yellow discharge and painful urination, I tend to believe that it is possibly not that.  However the short time between the last encounter and the tingling of penis has me worried it might be gono.

2) I have had unprotected sex with my wife during this time and she started to complain about lower abdominal pain after urination around the time of the third encounter. Would that be a symptom of any if it is the sole symptom? Assume that she has only had sexual relations with myself.

3) If it is chlamydia or NSU, how long does it take for the Zythromax to clear up the symptoms(especially the constant urethra pain)?

Again since I have to wait a week and am tremendously nervous about this situation, I would like to get an opinion on those items above.  

[H. Hunter Handsfield, M.D.]

All I can say with any assurance is that you had urethritis, i.e. gonorrhea or nongonococcal urethritis (NGU).  (NGU and NSU--"nonspecific urethritis"--are the same thing.)  You are correct that chlamydia is not a realistic possibility from oral sex.

1) You give mixed indications about the diagnosis.  Apparently your provider diagnosed gonorrhea, despite some initial uncertainty; but the treatment is not typical for gonorrhea.  (Zithromax sometimes is used, but usually at higher doses.)  Although gonorrhea tends to have a shorter incubation period and more purulent (yellower) discharge, those only are clues.  The diagnostic tests tell the story, not the symptoms.  You need to clarify this with the clinic.

2) It sounds like a good bet you transmitted gonorrhea or some other STD to your wife; her symptoms are typical.  Andominal pain may mean pelvic inflammatory disease (PID), which can block the tubes and lead to infertility.  She needs to be examined and treated immediately, preferably by the clinic where you were treated.  Do not wait the week until your test results are available.

3) Regardless of the cause, symptoms of urethritis should begin to improve in a couple of days, but it may take several days to clear up entirely.

Your use of "NSU" suggests you may be in the UK or another commonwealth country, which have tended to stick with "NSU" rather than "NGU".  If so, and you are under the care of a genitourinary medicine (GUM) clinic, you can rely on their expertise.

Good luck--  HHH, MD

[Armando1]

Item 1) clarification I meant to write ....   "since I don't have the yellow purulent discharge and pain when urinating I don^t think it is gono"

[Armando1]

OK, my wife got checked out and I did not ask the details but they prescribed her Fluomizin (Dequaliniumchlorid is the active ingredient), and from what I can gather from the package is that it is for treating candida.  
1) Could my symptoms be related or could the candida cause utheritis with discharge?
2) Would the Fluomizin clear up gono or chlamydia?

Thanks for your quick response

[H. Hunter Handsfield, M.D.]

I suppose it is possible you and your wife are sharing a yeast infection, and that your problem has nothing to do with your non-marital adventures.  But yeast doesn't usually cause urethritis or discharge.  Ask the clinic provider who examined and treated you whether yeast could explain your problem; I doubt it.

I never heard of dequalinium (Fluomizin).  On quick search, it seems to be a rather obscure drug used primarily in Germany (?) for yeast and other vaginal infections, like bacterial vaginosis.  It has not been well studied, even for those conditions.  It is not effective against gonorrhea or chlamydia.  Make certain your wife was tested for STDs in addition to yeast.  

I stand by my original advice:  You and your wife should return together for evaluation at the clinic where you were treated.  You are not going to be able to get around it:  in order to protect her health, your wife needs to know about your other sexual exposures.

HHH, MD

[who_dis]

Don't assume your wife got checked for everything.  If a married woman doesn't bring up the likelihood that she was exposed to gonorrhea, a practitioner might not test for it.  

Does she know of your episodes?

[Armando1]

Ok, I got my results today and Chlamydia and Gonorhea were negative.  I was diagnosed with Ureaplasma ureli...

What does this mean? Since I only had oral sex with others, could I have only got this from my wife?.   And from what I am reading it is not harmful to women, as this bacteria is prevelent but why is she having lower abdominal pains and why didn^t her docter give her antibiotics?

[H. Hunter Handsfield, M.D.]

Your positive test for Ureaplasma urealyticum is meaningless; it is carried normally in the urinary tract.

Ureplasma is shared sexually between partners, but most of the time causes no harm.  It is present in at least half of all sexually active persons, men and women.  The organism is a little controversial.  Some strains may cause some cases of NGU, and there tends to be more belief in Ureaplasma as something important in Europe than in the US.  But in my country, no STD clinic or public health department ever even tests people for Ureaplasma, except in the occasional research study.  And Ureaplasma is not found in the mouth--so you didn't catch it during oral sex outside your marriage.  You and your wife almost certainly share Ureaplasma as part of your normal genital bacteria.  The positive result makes no difference in my earlier opinions or advice.

Almost certainly Ureaplasma doesn't explain your wife's abdominal pain.  If she is not under the care of a physician, she needs to be seen to get a proper diagnosis.

HHH, MD