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STD tests negative but some symptoms persist
Hi Doc,
Three weeks ago, I had sex with an escort. I received unprotected fellatio and had protected intercourse. Two weeks after this encounter, I noticed a tight stinging feeling around the tip of my penis when I urinated. Also, when I woke up at night and in the morning, I had a cloudy to gray discharge. It wasn't a lot of discharge, but enough to worry me. I went to an urgent care center last Sunday. They took my urine and then did a swab test with the q-tip in my urethra to test for gonorrhea and chlamydia. They gave me a shot to treat the gonorrhea (I'm sorry, I don't know what the shot was) and they gave me a week's supply of doxycycline (2 a day for seven days) as a preemptive measure while we waited for the tests to come back. I did not have any more discharge after the doctor's visit and the shot. The burning persisted for a day and has now gone away EXCEPT for the mornings, when it still stings substantially when I take my morning pee. The doctor called with my test results on Wednesday and both were negative. I'm writing because I'm concerned that I had these symptoms (and continue to have the intense morning sting) but the doctor doesn't know what the problem was. He said it was probably just an "irritation" and he offered to give me some cream for the tip of my penis. Do you think there's any chance this is some other STD that I need to get tested for, like mycoplasma or ureaplasma? I've been avoiding sex with my wife since the encounter with the escort and I admit I'm worried sick about everything. But the discharge was what got me worried to begin with and I don't know if it's a good or a bad thing that I only experienced the discharge for a couple nights. Should I be concerned that it still stings when I pee in the morning, despite the negative gonorrhea and chlamydia?
Three weeks ago, I had sex with an escort. I received unprotected fellatio and had protected intercourse. Two weeks after this encounter, I noticed a tight stinging feeling around the tip of my penis when I urinated. Also, when I woke up at night and in the morning, I had a cloudy to gray discharge. It wasn't a lot of discharge, but enough to worry me. I went to an urgent care center last Sunday. They took my urine and then did a swab test with the q-tip in my urethra to test for gonorrhea and chlamydia. They gave me a shot to treat the gonorrhea (I'm sorry, I don't know what the shot was) and they gave me a week's supply of doxycycline (2 a day for seven days) as a preemptive measure while we waited for the tests to come back. I did not have any more discharge after the doctor's visit and the shot. The burning persisted for a day and has now gone away EXCEPT for the mornings, when it still stings substantially when I take my morning pee. The doctor called with my test results on Wednesday and both were negative. I'm writing because I'm concerned that I had these symptoms (and continue to have the intense morning sting) but the doctor doesn't know what the problem was. He said it was probably just an "irritation" and he offered to give me some cream for the tip of my penis. Do you think there's any chance this is some other STD that I need to get tested for, like mycoplasma or ureaplasma? I've been avoiding sex with my wife since the encounter with the escort and I admit I'm worried sick about everything. But the discharge was what got me worried to begin with and I don't know if it's a good or a bad thing that I only experienced the discharge for a couple nights. Should I be concerned that it still stings when I pee in the morning, despite the negative gonorrhea and chlamydia?
MEDICAL PROFESSIONAL
1. Just tell her what you know: you have NGU, you had to have caught it from her, and treatment is recommended. That's all you really need to say, but if she asks further quesitons you can say that like most cases of NGU, the exact cause isn't known; she may or may not have an infection that could harm her or future clients; and that standard practice is for partners to be treated.
2. I also said that your continuing symptoms indicate that you might need additional treatment, if there is evidence of urethrits on examination. You should see a provider and follow his or her advice about it. Even without additional treatment, your sympotms probably will clear up but I can't say how fast.
3. Resolution of symptoms generally means the infection is gone.
There is a lot that isn't known about NGU of unknown cause. However, as I said above, serious long term health outcomes appear to be rare.
2. I also said that your continuing symptoms indicate that you might need additional treatment, if there is evidence of urethrits on examination. You should see a provider and follow his or her advice about it. Even without additional treatment, your sympotms probably will clear up but I can't say how fast.
3. Resolution of symptoms generally means the infection is gone.
There is a lot that isn't known about NGU of unknown cause. However, as I said above, serious long term health outcomes appear to be rare.
Thanks for the prompt reply! I appreciate it. I hope you don't mind that your answer brought a few questions to mind:
1. What is the diagnosis I should share with the escort? It's not even clear to me what she gave me other than general NGU. Is that accurate?
2. You say the symptoms will likely clear up on their own even without further antiobioitics. How long will that take and is there anything I can do to expedite this, like drinking cranberry juice or eating yogurt?
3. How will I know that the infection is gone? Is it gone when the symptoms subside? Or in other words, how will I know when it's likely that I can't pass it on to my wife?
MEDICAL PROFESSIONAL
Thanks, but your age makes no important difference.
One sentence in my reply might be confusing. It should read "And although NGU often is caused by chlamydia, chlamydia is not transmitted by oral sex."
One sentence in my reply might be confusing. It should read "And although NGU often is caused by chlamydia, chlamydia is not transmitted by oral sex."
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
Your symptoms are typcial for urethritis, i.e. infection/inflammtion of the urine passage. The discharge is the strongest evidence, but discomfort at the tip of the penis often is present as well. It sounds like the urgent care center did the correct evaluation and gave you the correct treatments.
Since the vaginal sex was condom-protected, you can be sure you were infected by the oral exposure. Even before the lab test results, I would have expected both the gonorrhea and chlamydia tests to be negative, as they were. Gonorrhea usually causes symptoms within 2-5 days, whereas NGU usually takes 1-2 weeks. And although NGU often is caused by chlamydia, it is not transmitted by oral sex. A certain kind of mycoplasma (M. genitalium) is one cause of NGU; the role of Ureaplasma is controversial. But this doesn't really matter, since there are no tests available for either of these except in special situations, like in research. Some cases of NGU may be caused by entirely normal oral bacteria -- in other words, the escort might not have any detectable STD at all.
Your urgent care provider obviously knows the standard treatment recommendations from CDC and other agencies. The shot was ceftriaxone (for possible gonorrhea) and doxycycline twice a day for a week is the correct treatment for NGU. However, your comments suggest he isn't completely up to speed on NGU. In over two thirds of cases, the exact cause doesn't show up on routine testing -- so your situation is typical. There is no such thing as "irritation" that causes NGU.
NGU responds to doxycycline about 90% of the time. Persisting discomfort on urination suggests you might be in the 10% who need additional treatment. You should return to the doc, or to your local health department STD clinic. If persistent urethritis is found on exam, you might need addtional treatment. In that case, the usual approach would be to prescribe a single dose of azithromycin. (If azithromycin had been used initially, the repeat treatment would be with doxycycline.)
Until your symptoms clear up entirely, it is best to continue to avoid sex with your wife or at least to use condoms consistently. But even a slip-up might not be harmful. NGU not due to chlamydia may not have important health implications for female partners, especially if due to normal bacteria from the escort's mouth.
You should contact the escort and tell her of your diagnosis, if you haven't yet done so. Even though oral sex was the likely source of your infection, she deserves to have to opportunity to see her provider to consider treatment, to protect both her health and that of her other partners.
Nonchlamydial NGU rarely is dangerous. With or without additional treatment, it will clear up with no long term effects on your health. And as discussed above, your wife is at low if any risk for important health problems.
I hope this helps. Best wishes-- HHH, MD
Your symptoms are typcial for urethritis, i.e. infection/inflammtion of the urine passage. The discharge is the strongest evidence, but discomfort at the tip of the penis often is present as well. It sounds like the urgent care center did the correct evaluation and gave you the correct treatments.
Since the vaginal sex was condom-protected, you can be sure you were infected by the oral exposure. Even before the lab test results, I would have expected both the gonorrhea and chlamydia tests to be negative, as they were. Gonorrhea usually causes symptoms within 2-5 days, whereas NGU usually takes 1-2 weeks. And although NGU often is caused by chlamydia, it is not transmitted by oral sex. A certain kind of mycoplasma (M. genitalium) is one cause of NGU; the role of Ureaplasma is controversial. But this doesn't really matter, since there are no tests available for either of these except in special situations, like in research. Some cases of NGU may be caused by entirely normal oral bacteria -- in other words, the escort might not have any detectable STD at all.
Your urgent care provider obviously knows the standard treatment recommendations from CDC and other agencies. The shot was ceftriaxone (for possible gonorrhea) and doxycycline twice a day for a week is the correct treatment for NGU. However, your comments suggest he isn't completely up to speed on NGU. In over two thirds of cases, the exact cause doesn't show up on routine testing -- so your situation is typical. There is no such thing as "irritation" that causes NGU.
NGU responds to doxycycline about 90% of the time. Persisting discomfort on urination suggests you might be in the 10% who need additional treatment. You should return to the doc, or to your local health department STD clinic. If persistent urethritis is found on exam, you might need addtional treatment. In that case, the usual approach would be to prescribe a single dose of azithromycin. (If azithromycin had been used initially, the repeat treatment would be with doxycycline.)
Until your symptoms clear up entirely, it is best to continue to avoid sex with your wife or at least to use condoms consistently. But even a slip-up might not be harmful. NGU not due to chlamydia may not have important health implications for female partners, especially if due to normal bacteria from the escort's mouth.
You should contact the escort and tell her of your diagnosis, if you haven't yet done so. Even though oral sex was the likely source of your infection, she deserves to have to opportunity to see her provider to consider treatment, to protect both her health and that of her other partners.
Nonchlamydial NGU rarely is dangerous. With or without additional treatment, it will clear up with no long term effects on your health. And as discussed above, your wife is at low if any risk for important health problems.
I hope this helps. Best wishes-- HHH, MD
I'm 35.
You are reading content posted in the STDs Forum
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