Recurring NSU

[79Ross]

Dr,

In Feb. 06 I suffered a blackout. I may have had a sexual encounter with a sex worker. I had a girlfriend at this time (now fiancee). We weren't having full sex at the time. (All screens came back neg. except for NSU which is recurring). Main concern is any possible damage I may cause/have caused to my fiancee.

July 06 - Tested positive for NSU (no known bacteria found). - Prescribed 1g Zithromax in a single dose. - Was not called back to GUM & was told to continue on as normal. - Girlfriend not prescribed anything.

End Aug. 06 - Rec. unprotected oral from my girlfriend.

Early Sept. 06 - Gram stain came back negative.

Dec. 06 - Attended GUM with my girlfriend. - Her screen was clear - mine showed NSU (Negative for Trich also.). - Both prescribed 1g Zithromax.

Mar. 07 - Gram stain came back neg.

Apr. 07 - Gram stain showed NSU (not chlymidia). Prescribed Doxy for 1wk & metronidozole.

June 07 - Urologist diagnosed prostatitis following cystoscopy examination. - Prescribed alpha blockers. Urologist said it was anxiety related.

Aug. 07 - Attended GUM with my girlfriend - Doctor told her nothing else they could do for me & referred for counselling.

Sept. 07 - Protected sex with girlfriend.

Dec. 07 - Diagnosed with NSU (Neg for Trich). - Prescribed 1g Zithromax & 100mg Doxy for 1 week.

Jan. 08 - Still NSU - Prescribed 100mg doxy for 1 week & metronidozole for 5 days & told not to return.

Since Mar. 08 Protected sex with my girlfriend.

Queries:
1) Would the medication from July 2006 have been sufficient for eliminating all bacteria, including Mycoplasma & Ureaplasma?
2) Any harm to my girlfriend by receiving unprotected oral sex at end August 2006?
3) Recurring NSU anything to cause concern for my fiancee or me?  
4) What could be causing my NSU?

[Edward W Hook, MD]

1.  Your GF is not in danger because she was treated just once.  Azithromycin, 1.0 gram is the recommended therapy for persons with NGU and their sexual partners.  In fact, many specialists would fault the persons who repeatedly treated you.

2.  Yes.

3.  Please see my comment above about mycoplasma.  There is no debate among specialists, just in the mind of those who are out of date of use the internet for information.  Mycoplasma hominis is not a proven pathogen.  A more recently describe mycoplasma, Mycoplasma genitalium may be an STD.  Among treatments for NGU, azithromycin is the preferred therapy for this organisms.  Some persons feel that another antibiotic, moxifloxacin may be a better therapy for this organism.  

4.  I agree with your doctor, I see no reason to abstain from unprotected sex with your fiancée as your only partner.

EWH

[79Ross]

Thank you for your reply doctor, I really appreciate it.

One or two final queries which I hope you can clarify before I leave this issue:

1) After my initial 1g of Zithromax in July 2006 (my GUM clinic didn't ask me to return to see if the NSU was gone, all other tests were negative) I had unprotected oral (received) with my girlfriend at end August 2006. It was after this that I started to worry I may have passed something onto her despite having taken my 1g of Zithromax a month earlier. Is it safe to say that oral sex was safe in this instance so? She only received 1g of Zithromax throughout the whole history (January 2007), I was treated on numerous occasions as outlined above. Would this have been sufficient for her?

2) Is it fair to say that the initial 1g of zithromax in July 2006 was sufficient to deal with the NSU & that all meds taken since that were of little or no benefit seeing as the NSU was still there on occasion despite taking them rigidly & not been exposed again?

3) There appears to be some debate about mycoplasma & ureaplasma & their health risks. Would the 1g of Zithromax have dealt with any possible hazards? If there are no conventional tests for diagnosing these "bugs" how do we know 1g of Zithromax is sufficient to deal with them. My GUM say this 1g is standard for NSU & for mycoplasma.

4) I hope to start having unprotected sex soon with my fiancee who has been with me throughout all this. My GUM have said they see no reason why I shouldn't. I just wanted to get your opinion as an outside viewer.

I hope you can clarify these queries as I won't intrude upon you again.

Thank you again for your help.

[Edward W Hook, MD]

Welcome to the Forum.  Recurrent NGU is a frustrating situation.  It sounds to me as though you and your GF have been well evaluated and treated over time.  Your experiences and the fact that neither of you have had complications related to your recurring NGU serves to validate that comments we've made here before that, fortunately for those troubled by it, recurrent urethritis does not lead to complications or progressive illness in those who suffer from it and thus is more of a nuisance than a health hazard.  At some point (and you may well be there at this time), it is appropriate to accept recurrent, previously treated NGU as the nuisance it is and to not pursue further evaluation and therapy which is costly and creates the risk of complications due to medication side effects and additional costs.  In most cases the  process gradually goes away on its own.

In answer to your specific questions:
1) Would the medication from July 2006 have been sufficient for eliminating all bacteria, including Mycoplasma & Ureaplasma?
Despite misinformation to the contrary based on older, out of date studies, for the most part Mycoplasma and ureaplasma are not pathogens but are most often normal components of genital flora.  Efforts to "treat" normal flora are typically unsuccessful and frustrating.  

2) Any harm to my girlfriend by receiving unprotected oral sex at end August 2006?
No.

3) Recurring NSU anything to cause concern for my fiancée or me?  
See above, now that you have both been repeatedly treated over the past more than 6 years, I would not worry and would consider this more of a nuisance than anything else.

4) What could be causing my NSU?
No idea.

I hope thses comments are helpful.  EWH

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