Urethritis Diagnosis 3 weeks after receiving oral sex & antibiotics?

[wontdothatagain]

Feb 04, 08 I received unprotected oral sex outside of my monogamous relationship of 8 years. Beginning of 2nd week in Feb08 I awoke with a really sore throat. I went to the doctor the very next morning, was put on Amoxocillin after a visual throat exam, rapidstrep was neg.  I finished the entire course of as directed (2/day for 10 days).  Throat cleared within 6 days.  Girlfriend developed sore throat just before Valentine's Day Feb12th 08, so she was given a Z-Pack by her doc and finished it over 5 days.

At the end of the 3rd week Feb08 I noticed my urethra seemed to be a tiny bit irritated. No discharge of any kind, no real pain, just slightly irritated.  Back to the doctor a few days ago and he diagnosed 'Urethritis' after a visual exam.  Didn't see anything major just very slight irritation and put me on Zithromax, a 1G dose, no tests.  2 days later symptoms are the same, barely there at all.  Still no discharge or pain.

My g/f and I have been having condom-protected sex where we normally don't. Had sex 3 times in Feb, once a week, but not for the 7days.  The 1st 2 times with condoms.  The last time was sometime last week and was without a condom and just before my urethra was irritated.

My questions are:
1.  Being that my oral sex encounter was in the beginning of the month, the period for NGU to show up seems right.  BUT, I was on Amoxicillin during that time.  Even though Amoxicillin isn't the 1st choice drug for NGU I assume it would *probably* wipe it out - is that correct thinking?

2.  Could I have passed NGU to my g/f during our unprotected sex - with all the antibiotics we've had - is that even possible given the dates of antibiotics and treatments?

3.  If it's possible I have passed NGU to my g/f from vaginal sex : Will it clear on it's own if asymptomatic (as written in some of these threads)? Is it really undetectable by her doc?

4. Would her zpack from the previous week have protected her during our unprotected sex the following week?

Thanks!

[H. Hunter Handsfield, M.D.]

Most likely your sore throat and urethritis go together, both caused by adenovirus.  That's one of the common respiratory viruses responsible for colds and sore throats, and some strains (especially type 19) also cause urethritis.  Adenovirus explains around 3-5% of NGU cases and can be acquired by oral sex.  When it does so, the symptoms are often exactly as you describe, i.e. mostly irritation and redness with little or no discharge.  Like all viruses, adenovirus does not respond to antibiotics, so or course the azithromycin (Z-pak) made no difference.  (It also made no difference in the sore throat.  Almost certainly that was going to get better on its own.)

You could have caught it during your oral sex adventure, but the incubation period you describe is on the long side.  (If you can talk to your oral partner, and find she has had sore throat or a cold, that would nail it down.)  But if oral sex is among the practices you and your regular partner enjoy, that's an equally likely source.  Most likely you'll never know.  If the former, then you probably were indeed the source of your girlfriend's infection--but not because you acqired it sexually.  As far as you and your g/f are concerned, you're just sharing a cold virus.

While it is conceivable that you had two separate problems, just about any bacteria you could have acquired by oral sex, including gonorrhea, would have responded to the 2 separate courses of azithromycin that you received.  At this point, you can expect the urethritis symptoms to settle down and resolve; if they do, I wouldn't worry about it further, and wouldn't worry about your girlfriend's health.  

I think that answers all 4 of your questions.  Best regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Minor error, I guess your first antibiotic was amoxicillin, not azithromycin.  Even better; there are no STDs or other bacteria that would stand up to both those drugs.  So the error doesn't change my opinion or advice.

[wontdothatagain]

I've done about 20 full hours of reading through threads on this board, it's has been truly eye opening.  The minimal fee associated with asking you a question pales in comparison to the wealth of information existing here.

From reading I was able to really rule out most STDs - including Syph/Gon/Chly(since it can't be passed orally, or is rare anyway) and was really only left with NGU.  Your reply would certainly explain why my throat is still a tiny bit swollen, not sore and no more white spots, just ever-so-slightly swollen.  My throat and urethra are so close to symptom-free it's amazing.

If indeed this is adenovirus, is it passable by kissing like a normal cold?  Should I not kiss my g/f until all symptoms have subsided?  Should I refrain from unprotected sex with her during that time as well?  My general thinking is that since it's probably a virus, it may not matter from a kissing and sex standpoint.  G/F has been well this whole time, aside from her sore throat that disappeared shortly after arriving.  This indicates that even if I passed NGU from adenovirus to her it is not appearing as a genital problem for her - or if so is asymptomatic?  Is that correct thinking?

If that's correct than I assume once the cause of the NGU has died (adenovirus in this case) the NGU will die with it?  Meaning - no more antibiotics, let everything run it's course and relax?

Thank you for your time, you do a truly wonderful service by answering questions that even my local doctor just brushed off.  Probably from a lack of experience but no lack of ego to say so.  I have been shocked to read these forums and learn things about STDs I never knew and was never taught - I consider myself to be educated, but my apparent lack of good knowledge was surprising.

Thanks again, and best wishes...

[wontdothatagain]

As a quick followup to my 2nd post I got to do even more reading on adenoviruses and it suggests that they usually come with conjunctivitis.  If this is correct I should tell you I have, nor has my g/f had, any conjunctivitis at all.  Unsure if this changes your answer, but it's pertinent info.

If it does change your original response, then one of my original questions might still stand: would NGU have been able to live through a full course of Amoxicillin and would my g/f have been exposed a week or so after she had finished a z-pack?

[wontdothatagain]

Excuse the typo : If this is correct I should tell you I have, nor has my g/f had, any conjunctivitis at all.  This SHOULD read : I have NOT had, nor has my g/f had, any conjunctivitis at all.

Thanks

[H. Hunter Handsfield, M.D.]

You can assume your g/f is already infected, whether or not she has had symptoms.  Probably it is not possible to be close enough to have sex and not transmit adenovirus. And anyway, that probably was the cause of her sore throat.  At this point, you need take no precautions of any kind in your contacts with her.

Conjunctivitis is common with adenovirus, but by no means universal.

Yes, adenovirus in your urethra or anywhere else will resolve by itself, without treatment.  (Have you ever had a cold that didn't go away?  Infections go away just as commonly no matter where in the body they are located, urethra or anywhere else.)

Garden variety NGU cannot continue despite azithromycin, and probably amoxicillin as well.  I think I already said that.

Finally, your doc is not atypical. I'll bet 90% of practicing physicians have no clue that adenovirus can cause genital infection, and most are pretty much unaware of the other causes, the roles of oral versus genital sex in transmission, etc.

[wontdothatagain]

Terrific - thank you for your additional responses.  Your last sentence about my doctor makes additional sense after rethinking it... a general practitioner in an average sized town like mine (just outside Portland, OR) probably wouldn't have seen enough of adenovirus to or even NGU to have a real sense of the intricacies.

That's why you specialize!

Many thanks...