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Non-specific urethritis misdiagnosis?
Hello Dr. Handsfield. I've been following your posts for several weeks now and greatly value your opinion. I'm hoping you can offer some insight into my urological problem. About three weeks ago I started experience a variety of symptoms: strong, near constant urge to urinate, even right after going. Mild naseau & chills. Discomfort at tip of penis and in area between penis & rectum. Low back pain on right side (although I assumed this was unrelated and from stress from weight lifting). Some weight loss in a short period of time. No discharge from penis, however.
I was concerned I might have prostatitis, or perhaps even an STD. I'm in a committed relationship, but had unprotected sex with another woman about 7 weeks earlier. I went to an urgent care clinic, where I was diagnosed with non-specific urethritis. My Chlymidia/Gonorrhea test came back negative, although the doctor actually had me do the urethral swab myself, which I found quite odd (and painful).
Anway, I was prescribed doxycycline (200mg for 10 days) and the symptoms went away almost immediatley. I've been off the antibiotics for about four days, and I've noticed the urge to urinate has returned, albeit in much, much milder form. Also, I've found periodically a gathering of clear, sticky fluid at the tip of my penis, which appears to be seminal fluid (or precum). I experience no discomfort when urinating, although my stream doesn't appear to be as strong as in the past and not as much comes out as perhaps expected. In many of these instances where fluid is discovered, which sometimes are several times a day, there has been no sexual arousal whatsoever.
I'm thinking I may still have some sort of prostate issue that the doxycycline did not eradicate. And in my paranoid mode, I'm worried it may be Herpes, even though I show none of the usual symptoms associated with it like open sores. Any opinions/advice you can offer would be greatly appreciated.
I was concerned I might have prostatitis, or perhaps even an STD. I'm in a committed relationship, but had unprotected sex with another woman about 7 weeks earlier. I went to an urgent care clinic, where I was diagnosed with non-specific urethritis. My Chlymidia/Gonorrhea test came back negative, although the doctor actually had me do the urethral swab myself, which I found quite odd (and painful).
Anway, I was prescribed doxycycline (200mg for 10 days) and the symptoms went away almost immediatley. I've been off the antibiotics for about four days, and I've noticed the urge to urinate has returned, albeit in much, much milder form. Also, I've found periodically a gathering of clear, sticky fluid at the tip of my penis, which appears to be seminal fluid (or precum). I experience no discomfort when urinating, although my stream doesn't appear to be as strong as in the past and not as much comes out as perhaps expected. In many of these instances where fluid is discovered, which sometimes are several times a day, there has been no sexual arousal whatsoever.
I'm thinking I may still have some sort of prostate issue that the doxycycline did not eradicate. And in my paranoid mode, I'm worried it may be Herpes, even though I show none of the usual symptoms associated with it like open sores. Any opinions/advice you can offer would be greatly appreciated.
Many, many thanks Dr. Hook. This forum run by you & Dr. Handsfield is truly a blessing and the information you provide is invaluable.
MEDICAL PROFESSIONAL
Unless your doctor told you they were doing a herpes test, I suspect yoru swab test was only for gonorrhea and chlamydia.
As for herpes, there is nothing in your history to suggest you need herpes testing. when peole have external lesions present, the best test is a PCR test which is taken in the same way as a culture (i.e. using a swab) but is more sensitive and is present through most labs. The lesions do not need to be "wet" or blister like to be tested. BUT, because healing herpes lesions may have negative swab tests, a negative test does not guarantee that you do not have HSV. On the other hand, a blood test tells us whether or not you have ever had herpes but does not link test results to symptoms. Your symptoms do not suggest you need testing for HSV.
EWH
As for herpes, there is nothing in your history to suggest you need herpes testing. when peole have external lesions present, the best test is a PCR test which is taken in the same way as a culture (i.e. using a swab) but is more sensitive and is present through most labs. The lesions do not need to be "wet" or blister like to be tested. BUT, because healing herpes lesions may have negative swab tests, a negative test does not guarantee that you do not have HSV. On the other hand, a blood test tells us whether or not you have ever had herpes but does not link test results to symptoms. Your symptoms do not suggest you need testing for HSV.
EWH
Hello Dr. Hook. Could you please answer one more, very brief question, if only for my peace of mind? Would the urethral swab I had performed have revealed the presence of Herpes or would that only have been concluded by a blood test (which I did not receive)? This final bit of information would be greatly appreciated, as all my symptoms have nearly vanished. Many thanks!
MEDICAL PROFESSIONAL
Sorry, perhaps I accidentally deleted part of my response. Some of your other symptoms including urinary urgency, discomfort between your penis and anus and chills are more compatible with prostatitis than with NGU. I still think there might be some benefit might be derrived from seeking the evaluation of a urologist, particularly if your symptoms are still present.
If you have abstained from sex since your other exposure (not since the onset of your symptoms), your partner does not need therapy. On the other hand, had you had sex with your regular partner in the interval beween your casual encounter and the onset of symptoms, it would be appropriate for her to be treated. EWH
If you have abstained from sex since your other exposure (not since the onset of your symptoms), your partner does not need therapy. On the other hand, had you had sex with your regular partner in the interval beween your casual encounter and the onset of symptoms, it would be appropriate for her to be treated. EWH
Many thanks for the prompt reply Dr. Hook. I hope I may be afforded a follow up question or two. In the second paragraph of your response, you said some of my history has aspects which suggest NGU, while others are more indicative of something else that you don't specify. Can you please shine a little more light on that? I'm hopeful you were eluding to prostatitis and not Herpes...
In closing, I want to mention that I have abstained from having sex with my regular partner from the point of original diagnosis, thru treatment, and to this very day. I'm terribly worried about infecting her with something, which is why I think some of my symptoms may be caused by a guilty conscience. And to further clarify, my need to urinate is not so much an "urgency" as it was before, but a regular feeling of "nature calling," as if my bladder if full even if not all that much comes out.
Again, thanks for your expertise, Dr. Hook. Any additional insight you can offer would be greatly appreciated and possibly help put my mind at ease.
In closing, I want to mention that I have abstained from having sex with my regular partner from the point of original diagnosis, thru treatment, and to this very day. I'm terribly worried about infecting her with something, which is why I think some of my symptoms may be caused by a guilty conscience. And to further clarify, my need to urinate is not so much an "urgency" as it was before, but a regular feeling of "nature calling," as if my bladder if full even if not all that much comes out.
Again, thanks for your expertise, Dr. Hook. Any additional insight you can offer would be greatly appreciated and possibly help put my mind at ease.
MEDICAL PROFESSIONAL
Dr. Handsfield and I share the forum. You got me. FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.
Your history has some aspects which suggest NGU and others (particularly the pain between your penis and the rectum, as well as your chills) In addition, it is rather unusual for NGU to occur so long after a sexual encounter.
Doxycycline is the recommended therapy for NGU and is very efficacious if you took all of your medication. I presume that either your regular partner has also been treated with the same medication and/or you have abstained from sex with her since you began the doxycycline. When one member of a couple is treated for an STD (such as NGU), the other partners should always be treated as well.
It is not at all uncommon for men to have modest amounts of seminal fluid detectable in their penis from time to time and my guess is that since all this has transpired, you are paying closer attention to your genital symptoms than you did in the past. It does not concern me. The urinary urgency however is a bit concerning.
At this time, your situation is getting beyond where my advice over the internet will not be much help. You need some additional testing and to work this through with a knowledgeable clinician. My advice would be as follows:
1. I would seek repeat evaluation at some point in the near future. The testing should include evaluation for white blood cells and will give you the best information if the test is taken at least one hour after you have last voided.
2. If your symptoms continue, I would seek the evaluation by a urologist as things will, at that time, be sounding more and more like prostatitis rather than an STD.
Hope this helps. EWH
Your history has some aspects which suggest NGU and others (particularly the pain between your penis and the rectum, as well as your chills) In addition, it is rather unusual for NGU to occur so long after a sexual encounter.
Doxycycline is the recommended therapy for NGU and is very efficacious if you took all of your medication. I presume that either your regular partner has also been treated with the same medication and/or you have abstained from sex with her since you began the doxycycline. When one member of a couple is treated for an STD (such as NGU), the other partners should always be treated as well.
It is not at all uncommon for men to have modest amounts of seminal fluid detectable in their penis from time to time and my guess is that since all this has transpired, you are paying closer attention to your genital symptoms than you did in the past. It does not concern me. The urinary urgency however is a bit concerning.
At this time, your situation is getting beyond where my advice over the internet will not be much help. You need some additional testing and to work this through with a knowledgeable clinician. My advice would be as follows:
1. I would seek repeat evaluation at some point in the near future. The testing should include evaluation for white blood cells and will give you the best information if the test is taken at least one hour after you have last voided.
2. If your symptoms continue, I would seek the evaluation by a urologist as things will, at that time, be sounding more and more like prostatitis rather than an STD.
Hope this helps. EWH
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.
