Urethritis for life?

[disaster_man]

Doctors please help.
8/2011 - Unprotected oral/protected vaginal with a stripper but I'm in a longterm relationship. 10 days later I'm having discharge/frequent urination. Diagnosed with NGU from urethral swab (neg. for other STDs). Given 1g azithro, 1 week Cipro. Discharge clears and urethral swab is neg. 2 weeks later but still have burning in urethra so I'm given 2 weeks doxy and a shot of cetrifix. I still have burning despite neg. UA so given 2 weeks of metro. UA following this is neg. I avoid all sex with my parnter.

10/2011 - I feel guilty so I confess to my partner. She forgives me but requires we use condoms for oral/vaginal now. Have used them every time since.

12/2011 - Strong urge to urinate/clear discharge for 2 days. Neg. UA.

2/2012 - Strong urge to urinate/clear discharge/testicle pain for 3 days. UA neg.

4/2012 - 10 days erthromycin for sinus infection.

6/2012 - Clear discharge/testicle pain. Given PCR for m. gen.,Trich, other STDs. All neg.

7/2012 - Strong urge to urinate/clear discharge. Two-cup UA shows "weird clumpy" WBCs. Dr. says maybe urethritis and only option left is clindamycin. But there was never any unprotected sex. I go to an STD specialist and a urologist when discharge continues. Both say the discharge is clear "like a teardrop" so no need to worry and it'll fix itself. Swab, urine cultures and analysis of prostate fluid all neg. But discharge continues. Symptoms cleared up 2 weeks ago.

1. Am I infected? What's causing this? STD Dr. said "probably prostate." Uro. said "not the prostate." Can an infection from oral last this long without being cured?
2. My partner bleeds during sex alot. She had an exam 4 months ago. It was all normal?!? Did I infect her through the condom? I have been very careful with the condoms always.
3. Is this a serious problem or just an inconvenience? My Dr., the STD Dr. and the uro. say stop worrying because only cloudy discharge is bad. They say to have unprotected sex if I want. Do you agree?

[Edward W Hook, MD]

Sexually transmitted NGU is not a realistic possiblity for you at this time.  The term NGU describes a syndrome with many causes, many but not all of which are STDs.  You have been treated for the STDs which cause NGU.  You need to look elsewhere for an expanation of your symptoms.  EWH

[disaster_man]

Thank you again for your response. I have only one last clarification and I won't take up any more of your time. Is it correct to assume that no cause of NGU could survive the antibiotics I was treated with and that orally acquired NGU will typically not survive for over a year (the immune system will kill it off by then)? In the absence of unprotected oral or vaginal exposures, NGU is not a realistic probability?

Thank you again Dr. Hook for taking so much time with me. I appreciate it and will not bother you further.  

[Edward W Hook, MD]

Straight to your questions:

1. Clear discharge,strong urge to urinate and testicular pain can be a sign of prostatitis and this can happen without evidence of ongoing infection in a UA and culture?
While not typical, chrnic prostatitis might present this way.  that's why I suggested you discuss it with a 2nd urologist.  He can examine you and advise you better than I can over the internet.

2. The on again- off again pattern suggests prostatitis rather than a pattern of reinfection of urethritis from fully condom protected sex (it is almost impossible to have reinfected my partner thru an intact condom while having negative tests and then to reinfect myself thru an intact condom at some later point).
From what I can tell, you have NO objective evidence of urethritis.  Your concerns about infecting your partner are simply not realistic.  

3. A longer course of antibiotics (4 weeks) should be tried even without evidence of infection to eliminate prostatitis.
Again, I suggested this as a possiblity and would encourage you to discuss it with a urologist.  Your concerns may not warrant therapy at all.  

4. The original NGU was unlikely to be dangerous from a health perspective because it was acquired orally and was not chlamydia, gono, HIV or syphillis.
Correct.

EWH

[disaster_man]

Thank you very, very much for your reply doctor. It is very helpful.

Your summary of my problems is correct. To answer your question, it is hard to tell whether my symptoms respond to the antibiotics. My symptoms seem to come and go on their own, no clear pattern. The clindamycin did not help at all . I was not having symptoms while on erythromycin but they started a few weeks after I finished. I took zithro, doxy, cipro and metro back to back when I was first infected. They cleared up the discharge and frequency immediately and all tests were neg. but the symptoms came back two months after that (even though I only had sex with my partner three times during that time....all carefully condom protected).

If you don't mind, can you clarify the following things for me? I have learned alot by reading you and Dr. HHH on this site. It would be very helpful for my understanding of this and I will probably not get such expert advice anywhere else.

1. Clear discharge,strong urge to urinate and testicular pain can be a sign of prostatitis and this can happen without evidence of ongoing infection in a UA and culture?
2. The on again- off again pattern suggests prostatitis rather than a pattern of reinfection of urethritis from fully condom protected sex (it is almost impossible to have reinfected my partner thru an intact condom while having negative tests and then to reinfect myself thru an intact condom at some later point).
3. A longer course of antibiotics (4 weeks) should be tried even without evidence of infection to eliminate prostatitis.
4. The original NGU was unlikely to be dangerous from a health perspective because it was acquired orally and was not chlamydia, gono, HIV or syphillis.

Thank you very much again Dr. Hook for your help and advice.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be pleased to comment.  To summarize, since August of 2011 you have been troubled by occasional urethral discharge and urinary urgency and genital discomfort. Cultures and test for infection have been negative and multiple courses of antibiotics up to 2 weeks have not helped resolve the problem.

I have a question for you- when you have taken antibiotics, has there been any change at all in your symptoms or are they unchanged?  

Either way, I have two thoughts.  You may have prostatitis (which is typically NOT an STD) or a more recently described problem called the chronic pelvic pain syndrome (which is best described in Wikipedia).  If this is prostatitis, the duration of antibiotics you have taken is too brief- prostatitis typical requires up to 4 weeks or more of antibiotics and may require multiple treatments.  I would suggest you discuss your concerns with a second urologist.

In addition to this, your problems may be increased by your continuing focus and concern on your symptoms.  Focusing on a possible problem as you are doing can often increase the severity of symptoms that might be overlooked either way.

Either way, there is no evidence at this time that you have an STD and I think you need not worry about STD transmission to your partner.  I se no medical reason to continue to use condoms.

1. Am I infected? What's causing this? STD Dr. said "probably prostate." Uro. said "not the prostate." Can an infection from oral last this long without being cured?
See above.  

2. My partner bleeds during sex alot. She had an exam 4 months ago. It was all normal?!? Did I infect her through the condom? I have been very careful with the condoms always.
Bleeding following sex is not normal.  Your partner should discuss this with her GYN.  There is no evidence that you have infected her.  I suspect her bleeding is unrelated and coincidental.  She should see her GYN.

3. Is this a serious problem or just an inconvenience? My Dr., the STD Dr. and the uro. say stop worrying because only cloudy discharge is bad. They say to have unprotected sex if I want. Do you agree?
.I do agree with them.

I hope my comments are helpful.  EWH