Persistant NGU? Or Something Else?

[nowyouknow]

Age 32: In a monogamous relationship for 2yrs. Strayed once & 3dys after began to experience the following: Tingling Sensation in the genitals (penis). Frequent urination. Mild discomfort after/during urination- light burning but not too bad. Mild flue like symptoms w/ 2-3 bouts of nausea + aching muscles. After 4 days w/ symptoms there was small amount of light clear sticky discharge from the penis, only first thing in the morning. This could be pre-ejaculate fluid from erection during sleep? It generally has to be massaged out & does not seem “leak” on its own. Not dark yellow or white or blood. Never any pain in the testicles. Mild abdominal discomfort. Small sore in the pubic area but was told it was an infected follicle (by 2 docs), not HSV. I went to an STD clinic and was tested: blood & urethra swab (gram stain?). Negative for HIV, Gonorrhea & Chlamydia. Told it could be NGU and given 7days of Doxycline (2x250mg/Day) I completed the course. The lab also sent the slide out for analysis- results were negative. Frequent need to urinate + tingling subsided, but still some residual symptoms, nearly 13dys after exposure (2-3) days after full Doxy course. I also developed a slight pain in the prostate felt during masturbation. Went to urologist who took urine sample & prostate exam. I presume the Uro inspected the urine visually- was told it was clear & free of infection. No meds or testing by urologist. Shortly after I wz still having prostate pain & slight ache in the penis. Discharge, clear as described before, but not everyday. Went back to STDclinic & took another swab- negative. Given erythromycin 2x250mg x4/day x7days. I completed this course. 34dys after symptoms began prostate pain has subsided a bit. There is still a dull ache in the penis tip with light discomfort after urination. Discharge has subsided. I have not had sex since symptoms started. Is this pain/ache in the penis normal after an infection? Could it be “trich”? Ideas? Suggest any other tests?

[H. Hunter Handsfield, M.D.]

I'm not going to be able to provide the clear answers you are hoping for.  Generally that's impossible when several providers have been involved; distant adivce from an online source, no matter how expert, generally is less definitive than driect exam.

Your symptoms are not typical for NGU and never were.  First, the dominant symptom is discharge, with little or no dysuria (uncomfortable urination).  Second, the incubation period was very short; it's usually 7-14 days or even longer.  Third, NGU almost always responds to the treatments you were given.  When the problem persists or relapes, it's generally that symptoms clear up and later return, not continued symptoms despite antibiotics.

Your "trich" (trichomonas) idea might have merit.  It is the only infectious explanation I know of that would not respond to the drugs you have taken.  But all the atypical features above still apply, about the nature of symptoms etc.  So I doubt trich is the problem, but you probably should ask your doc about it and consider a course of appropriate treatment.  The newer drug tinidazole (Tindamax) probably is more reliable in men than the old standard, metronidazole (Flagyl and generic brands).  But don't get your hopes up.

All things considered, my bet is you have the male chronic pelvic pain syndrome.  CPPS used to be considered a form of chronic nonbacterial prostatits, but the prostate itself probably isn't usually involved at all.  CPPS is increasingly believed to be the result of heightened pelvic muscle tension, often anxiety-related, which can cause a whole variety of symptoms, mostly similar to yours.  Fortunately, it appears to be a problem of comfort only, i.e. without threat of any serious outcome.  You can find loads of information if you google "chronic pelvic pain syndrome".  I suggest starting with the Wikipedia article; although Wikipedia can be spotty, the CPPS article is excellent.  Then discuss it with your urologist or other provider.

In summary, except for the slight possibility of trich, you an be sure you have no STD.  In all probability you have nothing that will ever harm you or a future sex partner.  For some men with similar symptoms, just knowing that is the starting point of recovery. Most people can live with a little discomfort if they know it's nothing serious, just as people live with chronic back pain or any number of other minor ailments.

Good luck--  HHH, MD

[nowyouknow]

Thanks for your comments. I understand you're not having all the answers given the circumstances. I will surely ask the doc about trichomonas, as a precaution. But what are the symptoms of "Trich"? Also, I would "assume" that this was something they could have seen under the microscope after the swab? But maybe they don't look for that? Also, why would the doctor give out Meds if the symptoms are not fitting? The urologist did note that my prostate was swollen...it hurt when he applied light pressure. I'll look into CPPS. The prostate problem seems to be getting better. Also, those swabs aren't exactly painless. I suppose even that could cause irritation lasting more than a few days?

Can "trich" go away on its own if Tindamax doesn't work? Or, does it usually kill the parasite, assuming that were the problem? And, when is it again safe to have unprotected in a monogamous sex without infecting a partner?

[H. Hunter Handsfield, M.D.]

Trichomonas usually is entirely asymptomatic in men.  When it causes symptoms, mostly it is the same as garden-variety NGU.  There is no good test for trich in men, swabbing, microscopic, or anything else. Your docs may or may not have looked, but probably wouldn't have found it even if present.  Special techniques (e.g., PCR) are used in research but are not available as commercial tests.  It probably usually clears up on its own, without treatment.  Tinidazole is highly reliable treatment.

No STD causes prostatitis (well, gonorrhea, but so rarely that I have never seen a case in 30+ years in the STD business).  Whether or not you had overt prostatitis, as your urologist thought, or CPPS, it wasn't due to STD.

I already said you have nothing that will ever harm a sex partner.  If you wan't to be double sure, have the trich treatment.  Aside from that, unprotected sex is fine; you have nothing to transmit to a partner.

[nowyouknow]

Once again thank you for the reply and reassurance. I did look up CPPS as suggested, but also kept finding references to STD's being linked to prostatitis. And, CPPS seems to be quite complex. So I admit, this is a bit confusing overall. All I know for sure is that there is pain and it needs to go away soon. Obviously I am not an expert and medicine isn't always an exact science. So, will talk to my doc about your comments and go from there. Thanks.

Further note: some of the sites for CPPS look like scam website or herbal drugs, etc? The wikipedia one was better...

Also:
http://findarticles.com/p/articles/mi_m3225/is_n2_v39/ai_7553271

http://www.chronicprostatitis.com/nickel.html
“A number of observations support an association between Trichomonas vaginalis and prostatitis.[71-74] In one study, the prevalence of Trichomonas exceeded 85% in men who had symptoms of prostatitis that persisted despite their receiving antibacterial therapy.[75]”

[H. Hunter Handsfield, M.D.]

I have no further comments.