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What to do about NGU?
First, thank you for the expertise that you provide in this forum, much appreciated.
Married for about 15 yrs and pretty sure monogamous over that time. Or, at least up until I had a major lapse in judgment a couple mths ago. In Oct I received unprotected oral sex from a female stripper. The incident lasted about 15 min without completion. A few weeks after the incident I started to notice some itchiness around the tip of my penis and during urination, along with some very scant clear discharge. Since I could only see the discharge when I squeezed the head of my penis I thought at the time was probably just slight semen. Had STD testing done for Chlamydia and Gono, with both being negative.
Now within last week or two it seems that the itching, burning is becoming more pronounced (3 on scale of 1-10). This along with urge to urinate being more frequent. Visited the STD clinic yesterday for more testing. They did urine test and said pos for NGU and gave me 1G Azithromycin. Still waiting results on test.
My understanding is that NGU can potentially be from reasons other then a 3rd person STD. As you can imagine I would like to protect wifes feelings if she is not at health risk from my foolish mistake. So my questions are:
1. What is the potential this just appeared in a monogamous relationship? like something in her flora that she has passed to me? Or, the likelihood that the oral sex incident in October is the cause of NGU, the initial symptoms, and the recent flare up of symptoms? or, should I be concerned about her infidelity?
2. Does the prescription above sound like the correct protocol for my symptoms? And if so how soon after taking should I start to see improvement in symptoms? I am concerned about infection spreading to kidneys.
3. My wife had an unrelated check-up with her OGYN about three weeks after the incident. Would anything have shown during the examination if she was infected?
Many thanks for any insight.
Married for about 15 yrs and pretty sure monogamous over that time. Or, at least up until I had a major lapse in judgment a couple mths ago. In Oct I received unprotected oral sex from a female stripper. The incident lasted about 15 min without completion. A few weeks after the incident I started to notice some itchiness around the tip of my penis and during urination, along with some very scant clear discharge. Since I could only see the discharge when I squeezed the head of my penis I thought at the time was probably just slight semen. Had STD testing done for Chlamydia and Gono, with both being negative.
Now within last week or two it seems that the itching, burning is becoming more pronounced (3 on scale of 1-10). This along with urge to urinate being more frequent. Visited the STD clinic yesterday for more testing. They did urine test and said pos for NGU and gave me 1G Azithromycin. Still waiting results on test.
My understanding is that NGU can potentially be from reasons other then a 3rd person STD. As you can imagine I would like to protect wifes feelings if she is not at health risk from my foolish mistake. So my questions are:
1. What is the potential this just appeared in a monogamous relationship? like something in her flora that she has passed to me? Or, the likelihood that the oral sex incident in October is the cause of NGU, the initial symptoms, and the recent flare up of symptoms? or, should I be concerned about her infidelity?
2. Does the prescription above sound like the correct protocol for my symptoms? And if so how soon after taking should I start to see improvement in symptoms? I am concerned about infection spreading to kidneys.
3. My wife had an unrelated check-up with her OGYN about three weeks after the incident. Would anything have shown during the examination if she was infected?
Many thanks for any insight.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
As you have experienced, NGU can be acquired by oral sex; I suspect you indeed were infected during your October exposure. It is true that NGU sometimes can occur in monogamous relationships, perhaps especially from oral sex exposures. And it also is true that some cases of NGU that are so acquired probably carry little or no health risk for affected men's other (regular) sex partners. However, there are no definitive data on this; we're dealing with a situation that has never been formally studied, and you'll not I said "probable" and "probably". I cannot guarantee that your wife is not at risk for a significant health outcome.
Therefore, if you had unprotected sex with your wife any time after the October event, then she should be informed of the exposure and treated as an NGU contact. Probably you could get away with attributing your NGU to sex with your wife, either oral or vaginal, and/or with not informing her and taking a chance. Most likely nothing bad would happen. But this is against routine guidance by all STD experts and I cannot guarantee or recommend this approach. Perhaps you'll agree it would be seriously unfair to tell your wife you were the source of your infection, even if not medically harmful. Certainly if I were in your situation I would bite the bullet, tell my wife the truth, and make sure she gets medically evaluated and treated.
1) Those comments answer most of your first question: most likely you acquired this from your stripper partner, but it could have come from your wife -- whether or not she has had other partners. When one person in a relationship finds a need for outside sexual gratification, often the other partner has behaved similarly. But you know your wife and your relationship, and I do not. You're in a much better position to judge this possibility than I am.
2) Your treatment was exactly as recommended. Azithromycin 1.0 g in a single dose is one of the two standard recommended therapies. Your symptoms should clear up gradually over a few days.
3) Unless your wife's ObG tested specifically for STDs, mostly they would not be found. Most women with common STDs -- especially those that cause NGU -- have no symptoms and nothing abnormal on examination. Equally important, there are no laboratory tests for the most common causes of NGU; even if your wife had negative tests for chlamydia, gonorrhea, etc it wouldn't mean very much in this situation.
You are in a difficult position and I understand your anxieties about it and your temptation to avoid confronting the truth with your wife. You might be able to get away with the obfuscations you suggest without any serious health outcomes, but I cannot condone it.
Good luck-- HHH, MD
As you have experienced, NGU can be acquired by oral sex; I suspect you indeed were infected during your October exposure. It is true that NGU sometimes can occur in monogamous relationships, perhaps especially from oral sex exposures. And it also is true that some cases of NGU that are so acquired probably carry little or no health risk for affected men's other (regular) sex partners. However, there are no definitive data on this; we're dealing with a situation that has never been formally studied, and you'll not I said "probable" and "probably". I cannot guarantee that your wife is not at risk for a significant health outcome.
Therefore, if you had unprotected sex with your wife any time after the October event, then she should be informed of the exposure and treated as an NGU contact. Probably you could get away with attributing your NGU to sex with your wife, either oral or vaginal, and/or with not informing her and taking a chance. Most likely nothing bad would happen. But this is against routine guidance by all STD experts and I cannot guarantee or recommend this approach. Perhaps you'll agree it would be seriously unfair to tell your wife you were the source of your infection, even if not medically harmful. Certainly if I were in your situation I would bite the bullet, tell my wife the truth, and make sure she gets medically evaluated and treated.
1) Those comments answer most of your first question: most likely you acquired this from your stripper partner, but it could have come from your wife -- whether or not she has had other partners. When one person in a relationship finds a need for outside sexual gratification, often the other partner has behaved similarly. But you know your wife and your relationship, and I do not. You're in a much better position to judge this possibility than I am.
2) Your treatment was exactly as recommended. Azithromycin 1.0 g in a single dose is one of the two standard recommended therapies. Your symptoms should clear up gradually over a few days.
3) Unless your wife's ObG tested specifically for STDs, mostly they would not be found. Most women with common STDs -- especially those that cause NGU -- have no symptoms and nothing abnormal on examination. Equally important, there are no laboratory tests for the most common causes of NGU; even if your wife had negative tests for chlamydia, gonorrhea, etc it wouldn't mean very much in this situation.
You are in a difficult position and I understand your anxieties about it and your temptation to avoid confronting the truth with your wife. You might be able to get away with the obfuscations you suggest without any serious health outcomes, but I cannot condone it.
Good luck-- HHH, MD
MEDICAL PROFESSIONAL
Sigh. So now we're probably back to catching the infection in October -- which revives my original concern about the need for your wife to be treated. However, as you describe your symptoms now, I'm not at all certain you have NGU or that you ever did. Read on.
The NP and her STD clinic need to become familiar with the CDC's 2010 STD treatment guidelines, which address M. genitalium as a potential cause of NGU and the fact that moxifloxacin is a reliable treatment and therefore has a role in some cases of NGU that persists after azithromycin or doxycycline. The new guidelines were formally released only 2 weeks ago, so it's not entirely surprising they are unfamiliar.
In any case, M. genitalium is not the most likely problem here. Urine culture and senstivity implies testing for a non-STD UTI, which is unlikely. However, I also am not at all sure you still have NGU, which causes discharge but usually not the urinary symptoms you describe. This is sounding a lot like a prostate gland problem, perhaps not related to any sexual exposure at all. And "foamy" urine is irrelevant to any of this. Such urine characteristics vary with diet, fluid intake, and the like -- it's not evidence either for or against an infection of any kind.
As you are learning, all this is rather complicated. We're at the limit of what this or any online forum can offer. At this point, you might consider seeing a urologist.
The NP and her STD clinic need to become familiar with the CDC's 2010 STD treatment guidelines, which address M. genitalium as a potential cause of NGU and the fact that moxifloxacin is a reliable treatment and therefore has a role in some cases of NGU that persists after azithromycin or doxycycline. The new guidelines were formally released only 2 weeks ago, so it's not entirely surprising they are unfamiliar.
In any case, M. genitalium is not the most likely problem here. Urine culture and senstivity implies testing for a non-STD UTI, which is unlikely. However, I also am not at all sure you still have NGU, which causes discharge but usually not the urinary symptoms you describe. This is sounding a lot like a prostate gland problem, perhaps not related to any sexual exposure at all. And "foamy" urine is irrelevant to any of this. Such urine characteristics vary with diet, fluid intake, and the like -- it's not evidence either for or against an infection of any kind.
As you are learning, all this is rather complicated. We're at the limit of what this or any online forum can offer. At this point, you might consider seeing a urologist.
I believe I did have symptoms a few weeks after encounter in Oct. But symptoms faded after a couple weeks and with results of Clym and Gono being negitive wrote symptoms off as probably pertaining to anxiety.
So fast forward to now, so 5 days after 1g Azithro symptoms of frequent urge to urinate has not faded. Usually the urge/pressure starts within 15 minutes after urination and last until I urinate again. Interestingly the urge to urinate isn't near as intense when I lay down. One other thing, I have been noticing bubbles/foam in urine. the urine is clear to yellow, but just many bubbles.
After visiting the STD clinic again today, the NP feels that there is nothing else she can do. I mentioned Mycoplasma G. and although she has heard of it she said she has never seen it or know how to prescribe for it. Even after pullin gout her CDC handbook she was without any idea forward. When I mentioned moxifloxacin she had no firmiliarity with it or could not find it in her CDC handbook.
I'm a little concerned that the STD clinic isn't sure what to do next. After my pushing the matter the NP is sending my urine out for a culture and sensitivity test.
If I was to visit your clinic, what would you suggest as next steps. Your thoughts are much appreciated.
Thanks,
Randy 131
So fast forward to now, so 5 days after 1g Azithro symptoms of frequent urge to urinate has not faded. Usually the urge/pressure starts within 15 minutes after urination and last until I urinate again. Interestingly the urge to urinate isn't near as intense when I lay down. One other thing, I have been noticing bubbles/foam in urine. the urine is clear to yellow, but just many bubbles.
After visiting the STD clinic again today, the NP feels that there is nothing else she can do. I mentioned Mycoplasma G. and although she has heard of it she said she has never seen it or know how to prescribe for it. Even after pullin gout her CDC handbook she was without any idea forward. When I mentioned moxifloxacin she had no firmiliarity with it or could not find it in her CDC handbook.
I'm a little concerned that the STD clinic isn't sure what to do next. After my pushing the matter the NP is sending my urine out for a culture and sensitivity test.
If I was to visit your clinic, what would you suggest as next steps. Your thoughts are much appreciated.
Thanks,
Randy 131
MEDICAL PROFESSIONAL
You're right about the incubation period. I misread your question as meaning you started having symptoms 2-3 weeks after the October oral-genital exposure. Knowing this, I agree it is more likely your infection came from your wife; incubation periods of 2+ months may be possible, but it's quite unusual. Your wife definitely needs to be told of your diagnosis and its implications, but I do not believe you need to mention the October event.
If your wife is the source of your NGU, it doesn't necessarily mean she has had other partners; some cases of NGU may be due to bacteria that can be entirely normal in a partner's genital tract or mouth. But this issue probably will come up when you discuss your diagnosis; the main thing is to discuss it tactfully and sensitively.
Sorry I misunderstood the original question. Good luck.
If your wife is the source of your NGU, it doesn't necessarily mean she has had other partners; some cases of NGU may be due to bacteria that can be entirely normal in a partner's genital tract or mouth. But this issue probably will come up when you discuss your diagnosis; the main thing is to discuss it tactfully and sensitively.
Sorry I misunderstood the original question. Good luck.
Your thoughts are very much appreciated, and really help to put some things into prospective. Please understand that if the infection came from me and my very foolish mistake, I am inclined to come clean and tell the ugly truth. Particularly if it is regarding my partners health. I was more concerned about bringing up the incident if it was irrelevant.
I was doubtful that the exposure incident in Oct was the cause because of the incubation time of the NGU between the time of the incident and the symptoms I see now. This rationale because there was very little if any symptoms seen from when symptoms were first noticed until a week or so ago. (There is a lot of info on the web and very conflicting when it comes to window of time between exposure and symptoms of NGU). 2-3 months seemed out of the window for symptoms to show after potential NGU exposure.
Thanks again.
I was doubtful that the exposure incident in Oct was the cause because of the incubation time of the NGU between the time of the incident and the symptoms I see now. This rationale because there was very little if any symptoms seen from when symptoms were first noticed until a week or so ago. (There is a lot of info on the web and very conflicting when it comes to window of time between exposure and symptoms of NGU). 2-3 months seemed out of the window for symptoms to show after potential NGU exposure.
Thanks again.
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