Recurrent NGU or new infection?

[bk95]

Hello,

I posted on here about a month and a half ago, believing that I had contracted chlamydia from an unprotected sexual encounter.  My doctor prescribed me 1g Azithromycin in a single dose and 400mg Suprax as well.  I took both.  About a week later, still having symptoms, although greatly reduced, another doctor put me on a 10 day course of minocycline, 100mg per day, 2x per day.  Also, I should note that my test results came back negative for chlamydia and gonorrhea, so I am assuming I had a case of NGU.  My partner at the time also tested negative, twice.  My symptoms were slight burning while urinating and I had a very small amount of pus like discharge that I observed on only 1 occasion.  I also had general irritation and discomfort in my urethra.  I had 3 seperate urine tests and there were no white blood cells either.  After my symptoms were completely gone, I assumed I was cured.
Now I have a new partner and we have only had protected sex.  However, she has given me unprotected oral sex.  After our first encounter I kind of felt a little bit of irritation down there, but nothing major.  Now, about a week later, there is a very small amount of irritation and I noticed a very very tiny amount of clear discharge yesterday.  It was only a single drop, maybe less.  I had to milk my penis a little bit to get it to come out.  I tried the same thing today, however there was no visible discharge.  I still have some general irritation though, but none while urinating.  I should note that I have been very run down and dehydrated lately as well, due to long hours at work and lack of sleep, not sure if that makes a difference.


1.  Could any infection have survived the 3 antibiotics that I took initially?
2.  Do you think I have contracted another STD from my new partner?  Seems unlikely to me, however you are the expert.
3.  Should I go and get more antibiotics or do you think this is just a recurrent case of NGU?  If so, can i spread infection to my partner?

[Edward W Hook, MD]

AS you may know, Dr. Handsfield and I share the site. This time you got me. I have reviewed your earlier exchange and will go from there.

The important facts here are:
1.  Your symptoms went away completely and appeared to stay away until you were exposed to your new partner.
2.  The antibiotics you took for your last episode (the azithromycin and minocycline) are both highly effective for treatment of chlamydial infection or NGU.  The only thing they wouldn’t have cured is trichomonas which is sometimes a cause of NGU.  In your case however, it is more likely that this is due to your recent encounter.  The timing works better.
3.  Non-chlamydial NGU is well described as occurring after receipt of oral sex.

In this business our first goal is to make sure that both you and your partner are safe. Thus, my advice would be to not take antibiotics again (yet) but instead to go get tested.  the best time to be tested is first thing in the morning, preferable before you have urinated or, if that is not possible, at least 2 hours after urination.  While you should probably be tested for chlamydial infection and gonorrhea, the most likely problem is non-chlamydial NGU.  If there are abnormalities in the test, then both you and your new partner should both be treated with the same medications.  This is the safest approach for you both.  As for your specific questions:

1.  No, any initial infection would have been cured.
2.  Common things are common.  You may well have gotten non-chlamydial NGU.  Whether this is a risk to you or your partner is not clear but I would imagine you would prefer to err on the side of safety.
3.  See above.  I very much doubt that this is recurrent NGU although if it is, your treatment should include metronidazole because a small proportion of NGU is caused by trich. Whatever you receive should also be received by your partner.

Hope this helps.  EWH

[bk95]

Thank you for the quick reply.  Your information is very helpful.  Interestingly enough, today my symptoms have lessened substantially.  The discharge has been gone for 2 days now and the irritation that I was experiencing before has substantially lessened.  The only irritation that I am experiencing now is right at the opening of the urethra.  There is no burning during urination.  I have also had a bit of a sore throat and just an overall feeling of not being well through this whole thing which seems to be going away as well...not sure if that is relevant or not.  I slept for quite a while last night, whereas before I was only sleeping a few hours per night...not sure if this would boost my immune system perhaps?  Also, is it possible to have urethral irritation from being extremely dehydrated, as the urine is more concentrated?  Or do symptoms for NGU come and go like that?

[Edward W Hook, MD]

NGU symptoms, in general do not come and go quickly.  They  can gradually evolve to either get better or get worse over time (days).   On the other hand, dehydration can lead to a little initial irritation when beginning to void.  I'm not sure if this explains what was going on with you or not.  There may still be some benefit to getting yourself checked out.  EWH

[bk95]

So I went and got checked out...the doctor would not give me any more antibiotics and instead, like you said,  wanted me to get tested again first.  I gave a urine test for chlamydia and gonorrhea.  I also asked to be tested for trich as well but they said that if the other test came back negative and i was still having symptoms.  I still have a very slight burning in my urethra but no discharge.  It seems to get better each day, but as I understand, the symptoms of trich disappear after a while, but the infection remains. So I do not understand the logic of waiting to see if my symptoms get better.  
1.  Since my previous test for chlamydia and gonnorhea was negative, could I have had trich all along?  Would the symptoms disappear and then reappear a month and a half later?

2.  Also, should I go to a different clinic and ask for metronidazole?  I do not understand why they would not test or treat me for trich when I am obviously having symptoms and my other tests were negative...and that i have had no unprotected sex since then.  

I dont want to go for another week or two waiting for my results, knowing that something is wrong.....part of the reason they didnt want to give me antibiotics is because i took a lot of them last month.  What would you recommend?

[Edward W Hook, MD]

I agree in principle with not giving antibiotics for symptoms alone.  Symptms in and ovf themself are a poor indicator of infection and you have been treated for the most common infections consistent with the symptoms you experienced.  If you do not have objective findings suggestive of infection, I would not treat you either.  So, in my mind, the question is, did your urine test have increased numbers of white blood cells?  If it did, I would pursue the metronidazole,  If it did not, I would not becasue the chances that you have an infection would be very, very low..

I have no doubt that if you ask enough docotrs you can find someone who will give you antibiotics. I am not sure that is in your best interest however.  EWH

[bk95]

Thank you again for the information.  I have had 3 separate urine tests that have not shown increased levels of white blood cells and my symptoms have now subsided.  These were done for a possible UTI.  I still have this nagging feeling though that I could have something still....am I just paranoid?  Do the symptoms of trachomonas not come and go like this?  Also, just to let you know your advice has been valuable to me...

[Edward W Hook, MD]

Without objective findings such as increased white blood cells, an STD of any sort is very unlikely to be the cause of your symptoms.  I think you have been focused on the possibility of having an STD and, under such circumstances, it is likely that you are noting normal sensations and attributing them to a possible STD.  If you had trich or any other STD, the symptoms would not come and go.  I would urge you to try to not worry.  EWH