Aa
NSU for 7months
24yr old male, UK. In otherwise perfect health.
Dear Doctor,
Jan 2010 I had unprotected vaginal sex with a woman. 2days afterwards I developed redness around the urethra and severe internal itching and discomfort. No discharge.
Feb I went to STD clinic and had a blood test (hiv and syphilis), urine test and urethra swab test. The urine test was positive for NGU/NSU (a sufficient amount of white blood cells) and I was prescribed Azithromycin (Chlamydia dose-two tablets at once). This stopped the itching but the discomfort and redness remained.
March I had a negative urine test (immediate and culture). I was prescribed 1weeks dose of Azithromycin and Metronidazole. This did nothing to improve my symptoms. About this time I noticed an odour-but not one I could classify as fishy or yeasty.
Same in April. Again negative. I was also told my original test had been labelled “possibly contaminated” and prescribed Clotrimazole for imflammation and possible thrush. I went again in May/June to be simply handed another tube of Clotrimazole and told to be patient.
The odour, discomfort, increased urination and redness has never improved. No discharge. I am 100% certain my symptons are a result of the sex and not external factors (irritation, chemical, over-inspection etc). I have had no sexual activity since Jan so no chance of re-infection.
I have just seen my GP. I was prescribed Doxycycline for 2weeks (I have yet to take this). I asked could this make a possible yeast infection worse and was told no-however thrush is listed as a side-effect. I have another appointment with the STD clinic in 2 weeks.
Possibility of a yeast/thrush infection? Should I be asking for a test to confirm? I do not want to be handed another tube of cream.
Possibility of a persistent bacterial infection with so many negative tests? I know tests in the UK are limited in scope. Should I trust my GP and take the Doxycycline?
Should I have been prescribed Clotrimazole for so long?
Many thanks.
Dear Doctor,
Jan 2010 I had unprotected vaginal sex with a woman. 2days afterwards I developed redness around the urethra and severe internal itching and discomfort. No discharge.
Feb I went to STD clinic and had a blood test (hiv and syphilis), urine test and urethra swab test. The urine test was positive for NGU/NSU (a sufficient amount of white blood cells) and I was prescribed Azithromycin (Chlamydia dose-two tablets at once). This stopped the itching but the discomfort and redness remained.
March I had a negative urine test (immediate and culture). I was prescribed 1weeks dose of Azithromycin and Metronidazole. This did nothing to improve my symptoms. About this time I noticed an odour-but not one I could classify as fishy or yeasty.
Same in April. Again negative. I was also told my original test had been labelled “possibly contaminated” and prescribed Clotrimazole for imflammation and possible thrush. I went again in May/June to be simply handed another tube of Clotrimazole and told to be patient.
The odour, discomfort, increased urination and redness has never improved. No discharge. I am 100% certain my symptons are a result of the sex and not external factors (irritation, chemical, over-inspection etc). I have had no sexual activity since Jan so no chance of re-infection.
I have just seen my GP. I was prescribed Doxycycline for 2weeks (I have yet to take this). I asked could this make a possible yeast infection worse and was told no-however thrush is listed as a side-effect. I have another appointment with the STD clinic in 2 weeks.
Possibility of a yeast/thrush infection? Should I be asking for a test to confirm? I do not want to be handed another tube of cream.
Possibility of a persistent bacterial infection with so many negative tests? I know tests in the UK are limited in scope. Should I trust my GP and take the Doxycycline?
Should I have been prescribed Clotrimazole for so long?
Many thanks.
MEDICAL PROFESSIONAL
If you try doxy, 7 days should be sufficient. I see no need for 2 weeks treatment.
Sure I will do. Bit new at navigating this site is all. Be assured I take all advice with a healthy degree of scepticism :) hence my reluctance at taking that Doxycycline.
MEDICAL PROFESSIONAL
Please take the dialog about ureaplasmas, mycoplasma etc elsewhere, e.g. the community forum. Their role in urethritis is controversial, not established; and in any case, it is unlikely you have urethritis. I do not believe any additional testing along those lines, or treatment with additional antibiotics, is likely to make any difference in your symptoms.
Agreed. All I am really trying to do is educate myself as I prefer my own reassurance. But any reassurance is welcome reassurance! I think I will go discover a cure for AIDS now so I can afford that private GUM consultation!
No problem though. Thanks.
No problem though. Thanks.
MEDICAL PROFESSIONAL
I really have nothing more to offer. While I accept that many GUM clinics might seem to blow off concerns like yours with reassurance, this usually occurs because they are convinced -- as I am -- that there are no sexually transmitted conditions, bacteria, or viruses that are plausible explanations for your symptoms. Sometimes people have to just live with symptoms that can be tolerated well once it is clear nothing dangerous is going on. And sometimes the most useful advice is to stop hoping for, looking for, or spending lots of time and money to identify treatable causes that are not likely to exist. Your "Good news, Sir" scenario may seem cavalier, but it might be just the right approach.
Having said that, perhaps a private GUM consultation would come up with an idea that I and the GUM clinic, and your GP, have missed -- if you are suitably insured or can afford the cost.
Sorry I can't help further. Good luck.
Having said that, perhaps a private GUM consultation would come up with an idea that I and the GUM clinic, and your GP, have missed -- if you are suitably insured or can afford the cost.
Sorry I can't help further. Good luck.
Thankyou kindly for your reply. 7months of "NSU" or whatever does seem to affect my state of mind as much as the state of my penis!
When I mentioned visiting an STD clinic for tests I did indeed mean my local NHS GUM clinic. I separately visited my GP as there is not as long a wait and I wanted an additional opinion. It is an NHS GUM clinic I will be visiting in 2weeks time.
My GP cannot do tests only the clinic-hence the GPs advice for DOXY was not based on evidence of inflammation other than visual observation of the redness which is what concerned me and why I sought advice before/if taking the DOXY.
I ruled out viral infection as the symptoms do not fluctuate and have been present for 7months. I agree bacterial infection seems unlikely after the week of Antibiotics I took and I shall take your advice a yeast infection is also unlikely. I assume you hint that Clotrimazole is not a sure cure for a yeast infection if I even had any? I think based on your advice I will hold out taking the DOXY until I have been to the clinic again. The GP also put me down for a diabetes bloodtest in 2weeks incase this is fuelling a yeast infection or explains my symptoms-though with no family history and a healthy diet I am again dubious of the need.
It is my unfortunate opinion of my country's medical system that I feel put repeatedly through routine tests designed to ensure I do not suffer from the "big bads" yet would like more help with a perhaps lesser condition not more urine tests!
Im am certain I actually caught something due to the timing so is it possible I simply have trauma from an infection that has already been cured? If so would there be treatments more suited to trauma than Clotrimazole? If you have any questions or comments you feel I should be making at the clinic to ensure I do not recieve the standard "good news sir you are not infectious now be on your way" reply it would be appreciated. If you feel you have said everything no problem.
Many thanks.
When I mentioned visiting an STD clinic for tests I did indeed mean my local NHS GUM clinic. I separately visited my GP as there is not as long a wait and I wanted an additional opinion. It is an NHS GUM clinic I will be visiting in 2weeks time.
My GP cannot do tests only the clinic-hence the GPs advice for DOXY was not based on evidence of inflammation other than visual observation of the redness which is what concerned me and why I sought advice before/if taking the DOXY.
I ruled out viral infection as the symptoms do not fluctuate and have been present for 7months. I agree bacterial infection seems unlikely after the week of Antibiotics I took and I shall take your advice a yeast infection is also unlikely. I assume you hint that Clotrimazole is not a sure cure for a yeast infection if I even had any? I think based on your advice I will hold out taking the DOXY until I have been to the clinic again. The GP also put me down for a diabetes bloodtest in 2weeks incase this is fuelling a yeast infection or explains my symptoms-though with no family history and a healthy diet I am again dubious of the need.
It is my unfortunate opinion of my country's medical system that I feel put repeatedly through routine tests designed to ensure I do not suffer from the "big bads" yet would like more help with a perhaps lesser condition not more urine tests!
Im am certain I actually caught something due to the timing so is it possible I simply have trauma from an infection that has already been cured? If so would there be treatments more suited to trauma than Clotrimazole? If you have any questions or comments you feel I should be making at the clinic to ensure I do not recieve the standard "good news sir you are not infectious now be on your way" reply it would be appreciated. If you feel you have said everything no problem.
Many thanks.
MEDICAL PROFESSIONAL
Welcome to the STD forum. No online expert provides direct health care -- that is, I will not try to diagnose your problem or recommend treatment.
You seem aware that NGU and NSU are differen terms for the same thing. Recurrent or persistent NGU is a common problem, and often difficult to manage. Happily, it appears not to be dangerous, with no long term consequences -- no infertility, no cancer, no danger to sex partners. It's an issue of comfort, not a serious health problem.
That said, I am not convinced you have continuing urethritis at all. Few if any cases of bacterial (or trichomonal) NGU would not respond to the drugs you have had. Odor is not a symptom of urethritis; if you are uncircumcised, I would be inclined to ascribe that to simple bacterial overgrowth. Thrush (yeast infection) does not generally cause odor, and also is not a common cause of urethritis. Trials of antifungal drugs like clotrimazole are tried more often in your country than in the US, but I'm not surprised it didn't help.
Given the treatments you have had, If your GP has definitely documented urethritis -- i.e. if there is evidence of inflammation in your urethra, best documented by examining urethral material (obtained by swab) under a microscope for white blood cells -- then a trial of doxycycline may be warranted.
However, my preference is that you see a GUM specialist. Undoubtedly you are aware of the NHS GUM clinics, which are quite plentiful -- several in London and one or more in most major metropolitan areas. Collectively, the UK GUM clinics are among the world's best STD/HIV clinic systems. Or if you prefer the private sector, your GP should be able to refer you to a GUM specialist.
I hope this helps put things in context for you, even if I can't give specific treatment advice. Good luck-- HHH, MD
You seem aware that NGU and NSU are differen terms for the same thing. Recurrent or persistent NGU is a common problem, and often difficult to manage. Happily, it appears not to be dangerous, with no long term consequences -- no infertility, no cancer, no danger to sex partners. It's an issue of comfort, not a serious health problem.
That said, I am not convinced you have continuing urethritis at all. Few if any cases of bacterial (or trichomonal) NGU would not respond to the drugs you have had. Odor is not a symptom of urethritis; if you are uncircumcised, I would be inclined to ascribe that to simple bacterial overgrowth. Thrush (yeast infection) does not generally cause odor, and also is not a common cause of urethritis. Trials of antifungal drugs like clotrimazole are tried more often in your country than in the US, but I'm not surprised it didn't help.
Given the treatments you have had, If your GP has definitely documented urethritis -- i.e. if there is evidence of inflammation in your urethra, best documented by examining urethral material (obtained by swab) under a microscope for white blood cells -- then a trial of doxycycline may be warranted.
However, my preference is that you see a GUM specialist. Undoubtedly you are aware of the NHS GUM clinics, which are quite plentiful -- several in London and one or more in most major metropolitan areas. Collectively, the UK GUM clinics are among the world's best STD/HIV clinic systems. Or if you prefer the private sector, your GP should be able to refer you to a GUM specialist.
I hope this helps put things in context for you, even if I can't give specific treatment advice. Good luck-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
