Oral Sex and NGU

[seattle_guy]

Hi there.

I've been in a monogamous heterosexual relationship for 9 years, but recently, for the first time, I had mutual oral sex with another man. He ejaculated, I did not. About an hour later I noticed a bit of a sore throat. Question #1: am I right in thinking this was too soon afterwards to be anything more than a coincidence?

Fast forward to today, three days later: I noticed a milky discharge from my penis and went to an STI clinic here in Seattle to be checked. The nurse told me that the cell count in my swab was over 5, and that it looked like NGU since no gonococcal cells were visible. I'm now on Doxycycline. Question #2: if no gonococcal cells were visible to the lab tech, how likely are they to turn up in the urine and blood tests? I realize those tests are more definitive, but the results are still a week away. Should I be worried about gonorrhea?

I'm in my early-50's and have had recurring NGU every 2 to 5 years or so since my late teens. Occasionally -- this time, for example -- I'm pretty sure it's a result of receiving oral sex from a new partner. But on other occasions my NGU has flared up after years of monogamy. So, question #3: other than sexual transmission, what could be causing my recurrent NGU?

Thanks in advance for your response.

[H. Hunter Handsfield, M.D.]

Directly to your questions:

1) Some sort of physical or chemical irritation, or maybe anxiety.  No STD can cause sore throat or any other symptom in less than 2 days after exposure.

2) NGU can be acquired by oral sex, but 3 days is very early; typically the incubation period is 1-2 weeks or even longer.  Bonorrhea typically shows up 2-5 days after infection.  Gonorrhea bacteria usually are visible microscopically, but there is a slight chance they were missed.  "whatisay" mentions chlamydia, but that rarely infects the throat and is not known to be acquired by oral sex.  Also, the incubation period for chlamydia is like NGU, i.e. 1-2 weeks or more.  If you have NGU or chlamydia, you probably caught it sometime other than your recent adventure with the other man. Your gonorrhea and chlamydia lab results should be available 4-5 working days after the specimen was collected, so be sure to check back with the clinic, as undoubtedly you were advised to do.

3) Oops, only now do you say you have had the NGU problem before. You might just have recurrence of a chronic problem, which might not even be infectious; the causes of recurrent NGU are not well understood, but it often has nothing to do with new infection.  Some cases probably are due to prostate gland problems.  You might consider seeing a urologist.

Good luck--  HHH, MD

[whatisay]

#1. Yes-at least from that activity you could be getting a cold form womething else.

#2. I think not, but it could be chlmydia-anyway you are on antibiotics so it will be killing that off regardless of what it is.

#3 Not sure,  wait for the doc,

[seattle_guy]

Hello again Dr. Handsfield, and thanks for your response to my first posting. I have a couple of follow-up questions, if I may.

First, I have been on Doxycycline for three days now, and the milky penile discharge seems to have completely disappeared (don't worry, I understand the importance of finishing the prescription even though the symptoms are gone!).

So, given that no Gonorrhea bacteria were visible microscopically on my swab, and given that the Doxycycline seems to have cleared up the discharge, is it fairly safe to assume this was another bout of my recurrent NGU and not Gonorrhea (and also nothing to do with my episode of oral sex with another man)? My common sense says yes, but your thoughts would be appreciated; due to the Labor Day holiday, I won't get results from the blood/urine tests for another 10 days - a long time to wait!

Second, you mention that the causes for recurrent NGU are hard to pin down, and that some cases may be due to prostate problems. I intend to see a urologist to follow this up, but in the meantime can you offer any further thoughts on recurrent NGU? One doctor told me it could be because I have a deviated septum in my penis - a little bridge of skin at the entrance to my urethra that in effect results in my having two, uh, pee-holes. Other than occasionally causing me to produce two simultaneous streams of urine (neither of which ends up where it was aimed!), or two jets of semen (much to the amazement of my ex-wife), could this extra bit of skin be harboring nasty NGU bugs as one doctor suggested? He wanted me to have it snipped - ouch!

Thanks again, Dr. Handsfield.

[H. Hunter Handsfield, M.D.]

The improvement says nothing about the specific cause.  Doxycycline isn't routinely recommended for gonorrhea, but usually it would respond.  

Infections commonly accompany such conditions, most likely because there may be internal "pockets" where bacteria can accumulate--exactly with what "one doctor" suggested, except the bugs probably are not all that "nasty".  With this, I doubt your problem has anything to do with the sexual exposure you describe or your prostate gland.   I wish you had described your anatomic anomaly first time around.  

Recurrent NGU (in people without anatomic abnormalities) is not well understood.  It is not known what proportion of recurrences are infectious or perhaps immunologic, or how often there may be a component of prostate gland infection.  It's a compex subject. You can use the search link to find other, more detailed comments.  But most of the information probably doesn't apply to your case.