NSU Extremely Anxious

[caettm]

Dr

I’d exposure with someone other than my regular partner >1yr ago.

1 How soon post exposure can you be tested for NSU? Sympt can take 7-14days. Can you be tested 3days after expos? i.e. Could NSU be present directly post expos? I ask cos I tested after 3days in an std clinic follow the expos. Clinic said NSU should show up in 3days. Correct? No WBCs showed up this test.

2 Is it critical to hold urine for 1hr before swab? Clinic never said it. Is this why nothing showed up originally (see below for retests). I think I held urine for 1hr but unsure.

3 No sex contact with my partner after the expos. until post bloods. I went back after the blood test period was up & asked to retest for all stis. Swab showed >5WBCs, with no new expos. Was clinic out with 1st swab (at 3days)? i.e. If I’d gone with their 1st diag. & not asked to be retest for NSU could I have put my partner in danger if we'd sex?

4 I was treated with zithro. I told them about my regular partner & that we hadn’t any sex since my expos. so they saw no reason to treat her. I asked should I return for an all clear test. They said no.  I then started only unprotected oral with my regular partner (1month after zithro). I was still worried I’d pass something to her mouth despite treat.  

So I went for NSU retest. Result = 1yr. Sex is still fully protected.

5 Have I infected my partners mouth when unprotect oral took place after initial zithro. I took?

[caettm]

Thank you doctor. I really didn't mean to waste anyone's time if you think I did. It wasn't my intention. I just needed to be sure that we weren't at cross purposes. Thank you again for your replies & patience.

[Edward W Hook, MD]

Last answers,  No follow-ups, repeats or clarifications.  Your repetitive time lines were understood the first several times you posted them.  

1) I never got mouth swab after my expos. Any danger to my partner from unprotect oral (me on her) despite this not occuring until after 1st Zithro dose I took?
No.

2) Any damage to my partner's mouth with her giving me unprotect oral on a no. of occassions but AFTER I took initial 1g Zithro but bearing in mind that a test 5wks post zithro showed no NSU & a further test again 8-12wks later did show NSU?

No

3) Was my original 1g zithro sufficient for NSU despite it reoccuring over and over after with no new exposures except unprotect oral with reg partner?

Yes

4) Should my partner have been treated (despite oral only taking place after my initial 1g zithro)?

No.

4) What is the rec period for holding urine?

1 hour although even this is probably not needed.  

5) Can I start unprotect sex with my partner?

Yes.

6) Was there ever danger to my partner due to recurr NSU after 1st zithro failed?

No.

7) Why retreat recurr NSU if not a major concern?

Probably was not needed although many patients do not tell the truth about re-exposure and therefore many health care providers would rather re-treat than take the chance.  

8) You said above "If you have persistent problems at this time STD is not a major concern". What would be my concern at this point if any?

Anxiety, guilt or perhaps the chronic pelvic pain syndrome (see description in Wikipedia)


No further questions until at least November 2013.  EWH

[caettm]

Dr,

Can you please comment on my post when you are free. i.e. the post with the 8 questions outlined. Thank you again.  

[caettm]

Doctor, my last post above has finally submitted correctly. When you have time I would greatly appreciate if you could read through this post & offer your advice & answers to my 8 questions above (in case your advice is different to that previously given due to posts not submitting correctly). Again sorry for the miscommunication but there was a fault with my computer when submitting posts. As the above post is now clarified from my end please could you reply when you have time to do so. Thank you again & apologies again for any inconvenience.

[caettm]

Thank you doctor. My comp wouldn't post text as planned in any of above posts.Below is the final and correct account. I'm extremely worried we're at crossed wires about events till now:  

Had expos other than reg. partner
No sex with reg. partner after expos
I got tested, NSU positive only (no chlym)
I was treated with 1g Zithro, not called back to clinic
After treatment had unprotect sex with partner (her on me & me on her)
I got retested 5wks post zithro. No NSU.
Had unprotect oral with reg. partner again.
Got retested again 8-12wks later, NSU positive
I was treated with 1g zithro.
Retested 3wks later: NSU clear
Diag with prostatitis & phimosis
All sex since is protect but NSU still recurred for 1yr despite treat. & protect sex reg partner only.  

Can you please provide an answer beside each of these:

1) I never got mouth swab after my expos. Any danger to my partner from unprotect oral (me on her) despite this not occuring until after 1st Zithro dose I took?

2) Any damage to my partner's mouth with her giving me unprotect oral on a no. of occassions but AFTER I took initial 1g Zithro but bearing in mind that a test 5wks post zithro showed no NSU & a further test again 8-12wks later did show NSU?

3) Was my original 1g zithro sufficient for NSU despite it reoccuring over and over after with no new exposures except unprotect oral with reg partner?

4) Should my partner have been treated (despite oral only taking place after my initial 1g zithro)?

4) What is the rec period for holding urine?

5) Can I start unprotect sex with my partner?

6) Was there ever danger to my partner due to recurr NSU after 1st zithro failed?

7) Why retreat recurr NSU if not a major concern?

8) You said above "If you have persistent problems at this time STD is not a major concern". What would be my concern at this point if any?

thank you again, as said this is the last post.

[caettm]

Thank you doctor again. Last qns before finishing this thread. I would really appreciate your response beside each of these specific questions & it will be my very last post. I'm having trouble trying to pick through all the above posts due to muddled up text.

1) I never got a mouth swab taken after my exposure. Is there any danger to my partner from unprotected oral (me on her) after the I took the initial 1g zithro?

2) Did any harm came to my partners mouth due to the very 1st NSU reoccurance (i.e. post 1st Zithro treatment)? She wasn't treated because no contact took place with her post expos until after I took 1st Zithro & then it was oral only with my partner.

3) Am I correct to say that original 1g zithro was sufficient to cover NSU despite it reoccuring again and again after treatment with no new exposures except unprotect oral with reg partner?

4) What is the recommended period for holding urine?

5) I can recommence unprotected sex with my partner?

thank you again.

[Edward W Hook, MD]

Repetitive question.  Please re-read my response.  If you have persistent problems at this time STD is not a major concern.  EWH

[caettm]

Forgive me doc, this was a vard hard time for us both. So I just want to be fully clear. We're hoping to have kids but afraid of any unprotect sex.

Post expos, no contact with my partner until AFTER 1g Zithro.

After this 1g Zithro unprotected oral ONLY with reg. partner.

Retest 5wks post zithro. No NSU. But urine only held 1hr. Is this ok?

Continue unprotect oral ONLY with reg. partner.

Retest again & NSU shown.

I alone was given 1g Zithro 2nd time.

If 2nd NSU due to zithro failure from 1st time was my partner at risk from anything? Only oral took place with partner.

Was NSU more likely from A'dam sex worker or from unprotect oral with reg partner prior to Amsterdam? If from reg partner would it not have shown up on 1st time?  

NSU has returned since despite no new expos at all. What does this signify? I was diag. with prostatitis & phimosis also.

Thank you again.

[Edward W Hook, MD]

You posts are excessively long and difficult to follow.  Your second episode of NSU may well have been due to the introduction of mouth organisms into your urethra during receipt of oral sex.  Azithromycin treatment was the right thing to do.

Trich and M. genitalium are not transmitted by receipt of oral sex and should not be a concern for you.

You have been treated and now need to stop worrying and move forward. Your regular partner is not at risk.  EWH

[caettm]

No its still not entering correctly.

[caettm]

Sorry doctor, Again my post isn't submitting correctly. Some lines of text aren't entering correctly in 1st paragraph in my reply above. There is an error above where it reads "Approx 1 week later (i.e. 5weeks post zithro). I went for NSU retest 5WBCs." This should read "5WBC". Then the line "I was treated with 1g zithro again" should be read.

Just to clarify.

- No contact with partner after exposure before I took initial zithro.
- Clinic didn't call me back.
- 1 month post zithro started unprotected oral with partner.
- 5wks post zithro got retested. 5WBCs.
- I was treated with 1g Zithro again.

[caettm]

Dr,

The critical part of my post wasn't included for some reason. To recap:

- After non partner exposure I was fully tested. NSU >5WBCs. This took place 3-4months post exposure. Treated with 1g Zithro. I had no sexual contact with my partner after this exposure before I took the 1g Zithro.
- After I took the 1g zithro, clinic did not call me back for retest.
- 1 month after Zithro I started unprotected oral only (i.e. no other type of sex) with my partner.
- Approx 1 week later (i.e 5wks post zithro) I went for NSU retest. 5WBCs.
- I was treated with 1g Zithro again.

Therefore based on above is my partners mouth infected with UU, Mycoplasma Genitalium, Trich or other given the fact I didn't have any contact until after initial 1g Zithromax & a subsequent retest showed clear result. Very importantly though a further test showed NSU again. Was the second NSU a relapse of 1st or normal bacteria from partners mouth. If a relapse have I seriously infected my partner?
- At no stage did bloods or clym or gon show up.

- All sex since = protected & only with partner.
- I think the exposure I mention included a condom but not sure but was with sex worker in Amsterdam (window type). I had no other partner in my life apart from my own regular partner & this sex worker. Also before all this occurred I had only unprotected oral with my partner. i.e no unprotected vaginal or anal took place.

[Edward W Hook, MD]

Welcome to the forum. some parts of your post are a bit unclear.  I will try to address them however.

1 How soon post exposure can you be tested for NSU? Sympt can take 7-14days. Can you be tested 3days after expos? i.e. Could NSU be present directly post expos? I ask cos I tested after 3days in an std clinic follow the expos. Clinic said NSU should show up in 3days. Correct? No WBCs showed up this test.

Typically the symptoms of NSU begin 3-5 days after exposure.  It is difficult to say at what point all persons with NSU will have positive tests but typically a test at 3 days should be positive.

2 Is it critical to hold urine for 1hr before swab? Clinic never said it. Is this why nothing showed up originally (see below for retests). I think I held urine for 1hr but unsure.

Yes, it is best to have not urinated before the swab test. Urination washes away the signs of infection.

3 No sex contact with my partner after the expos. until post bloods. I went back after the blood test period was up & asked to retest for all stis. Swab showed >5WBCs, with no new expos. Was clinic out with 1st swab (at 3days)? i.e. If I’d gone with their 1st diag. & not asked to be retest for NSU could I have put my partner in danger if we'd sex?

From what you say, apparently the first swab was incorrect.  If you had unprotected sex with your partner without treatment there would be a risk for infection of your partner.

4 I was treated with zithro. I told them about my regular partner & that we hadn’t any sex since my expos. so they saw no reason to treat her. I asked should I return for an all clear test. They said no.  I then started only unprotected oral with my regular partner (1month after zithro). I was still worried I’d pass something to her mouth despite treat.  

If your partner was not exposed (i.e. you did not have sex with her  after your exposure to the partner outside of your relationship), she did not need treatment.  Azithromycin is the recommended therapy for NSU.  After treatment it is safe to have unprotected sex.  

So I went for NSU retest. Result = 1yr. Sex is still fully protected.

5 Have I infected my partners mouth when unprotect oral took place after initial zithro. I took?

No, her mouth would not become infected if you had unprotected sex after treatment.

I hope these answers are helpful. EWH