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Non-specific urethritis, chlamydia, or gonnarhea? Also testing questio...
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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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Non-specific urethritis, chlamydia, or gonnarhea? Also testing questions..

Last weekend, Saturday Night, I had unprotected oral and vaginal sex with a female I have known for a while.  

Tuesday morning, I woke up and had slight burning when I urinated. It wasn't extreme, but it was enough to get my attention. After I got out of the shower (I urinated in the shower) I squeezed the tip of my penis and a slight amount clear/milky fluid came out.  I looked at my bedsheets immediately and saw 5-6 dots of yellowish spotting, presumably where the leakage had occurred overnight.  Later that day when I got to work I noticed that I had a slightly white discharge from my penis if slightly squeezed.  None of the subsequent urination since that one time Tuesday morning have burned.

I went to the doctor late Tuesday afternoon, told him what happened (he did not do a physical exam of my penis), he said it sounded like chlamydia but could be urethritis from another source, and put me on 10 days of 200mg Doxycycline, and I also urinated in a cup - But since Tuesday afternoon the whitish discharge has gone and I am left with a constant watery wetness from my penis.  It's not a large amount, but enough that the opening of my penis is somewhat wet, which is not normal for me.

Friday, the nurse called me with test results, Negative for gonnarhea and chlamydia.  

I'm on day 4 of antibiotics and I still have the watery substance leaking.. any idea how long this can go on, what exactly the watery substance is, and what the mechanics of its creation are?

Question below about the STD testing procedures, and should I be retested because of this?

I'm reading testing procedures and how for these urine tests for chlamydia and gonnarhea there should be a max of 20-30ml urine in the cup.  I was not told this and I filled it up.. 120ml.  I wonder if it was too diluted to get an accurate result..  at least I knew enough to not have urinated in 2 hours and to get a first stream catch in the cup.  

Thank you very much.  I can add additional info if needed.  30yo WM
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Welcome to the forum.

This sounds like a straightforward case of nonchlamydial NGU.  The only atypical feature is the relatively rapid onset, which might have suggested gonorrhea; NGU symptoms usually start around 7-10 days, whereas gonorrhea onset is typically 2-5 days.  However, the standard tests like you had are very reliable, and I put more credence in those results than in your symptoms.  The tests are very forgiving; 10 vs 20 vs 30 ml of urine makes no difference in test reliability.  As for your symptoms, it takes up to 10 days for NGU symptoms to clear completely, and yours already have improved -- so that's not a concern.

It is important that your partner be tested for both gonorrhea and chlamydia, and treated.  As I said, the tests you had are highly reliable, but still she should be checked for both.

If your symptoms persist more than 10 days, or if before then they actually get worse again, then return to your doctor for reevaluation.  But most likely you are on your way to complete cure and nothing serious will come of this.

Regards--  HHH, MD
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Testing procedures used by this lab are:

! CHLAMYDIA TRACHOMATIS RNA, TMA
! NEISSERIA GONORRHOEAE RNA, TMA
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239123_tn?1267651214
TMA stands for transcription mediated amplification, a form of nucleic acid amplification test (NAAT).  The trade name of your test is Aptima, produced by the GenProbe company.  It's one of the gold standard tests for both chlamydia and gonorrhea.
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Thanks.  You've alleviated a lot of anxiety.  I told my partner earlier in the week about what was going on, and she was going to get tested but decided not to after I told her about my negative test results.  I will try to encourage her to go through with testing anyway.

So just out of curiosity, when you've been involved with other cases of non-chlamydical NGU, what have you found to be the causes?

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239123_tn?1267651214
NGU is just as much an STD as chlamydia and gonorrhea, and your partner definitely needs diagnostic tests, a gynecologic examination, and treatment.  This is not an issue of "encouragement", but one of insistance -- to protect her health, prevent transmission to other partners, and prevent you from becoming reinfected if you have sex with her again.

All STDs are "involved" with nonchlamydial NGU on a daily basis.  Among men attending STD clinics, it is the most common of all STDs.  A few cases are caused by an organism called Mycoplasma genitalium, some others maybe by Ureaplasma urealyticum (controversial), and infrequent cases by various viruses and trichomonas.  The cause is unknown in about half of all cases.
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Update.  Along with my negative results, her chlamydia and gonnarhea tests came back negative as well, as well as for other STDs such as HIV, syphillis (syphilis), and herpes.  So, I guess it's one of those mystery NGU's that will never be specifically diagnosed, but that antibiotics cleared up without a problem.  Her doctor elected to not treat her with antibiotics as there was no evidence of infection of any type in her urine, and no abdominal pain.

Our bodies just didn't get along, I guess.

Thanks for the information.
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239123_tn?1267651214
As I indicated above, it is standard practice, and the consistent advice of CDC, other public health agencies, and STD experts, that the female partners of men with NGU should be treated, regardless of what is found on the partners' own tests and examinations.  The purposes are to prevent potential complications in the woman and to reduce the chance of re-infecting the man with NGU.

If tests are negative for gonorrhea and chlamydia in both partners, it is probable that nothing serious usually comes from not treating the partner.  However, there is no way to know for sure, hence the expert advice in favor of treatment.

I suggest you discuss this with your partner, and that she in turn discuss it with her doctor.  Here is a link to the latest CDC recommendations, which include the advice I just outlined; she could refer her doctor to it, if he is unfamiliar:  http://www.cdc.gov/std/treatment/2010/default.htm

That will end this thread.  Good luck.
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