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bacteria resistant to nsu or prostatis?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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bacteria resistant to nsu or prostatis?

Dear Doctor,

I am a male heterosexual in my 30s and have had urethritis for approx 11 weeks. I last had sex 12 weeks ago. I tested positive for nsu 10 weeks ago and again last week, although I tested negative 3 weeks ago.  All three tests were urethra swabs and the respective white blood cell counts were 6, 2 and most recently 10 per high powered field. My only certain symptom has been unchanged over the 11 weeks and is a swollen urethra. More red and blue than usual and more sore. A bit worse after urination and masturbation.
The doctors have prescribed me for nsu...week 1 azithromycin, week 3 metronidizole, week 5 low dose oxytetracycline , 6 weeks nitrofuratoin as at this visit a uti culture came back positive. A retest for a uti one week later was negative but my symptoms were unchanged throughout all treatments.  After my last positive nsu swab last week I was given ofloxacin 200g for 7 days and aciclover to cover hsv although I have no other symptoms of hsv other than an inflamed urethra.  I should also mention I have tested negative 4 weeks ago for hiv, syphilis, clamydia (chlamydia) and gonnerhea .I and I use condoms.

Please can you advise me on what I could have and what treatment options I have? I have read extensively on this site and government sites and wonder if 7 or 10 days doxycycline, 2 or 3 weeks erythromycin, cipro or a continuation of ofloxacin when my 7 days of this finishes this weekend are worth a try or a treatment not mentioned? If so, which first!? I also had a negative mycoplasma plus ureaplasma plus hsv urine sample from an online testing clinic that was ...should I rely on these results? Looking forward, if I continue to have over 5 white blood cells in swabs and hence nsu that won't clear, wmight it affect my fertility
Tags: NSU
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Welcome to the Forum.  I will try to add some perspective.  In doing so, I need to say that he clinician or clinicians who are caring for you are doing a very good job, both in terms of diagnostic testing and treatment.  You're lucky- not everyone gets evaluated this well.  

As I understand it, your last exposure, the week before this all started was condom protected -is this correct?  This would make a sexually transmitted urethral infection quite unusual.  From your descriptions however, in addition to your negative tests, you have also had very good, recommended treatment for NGU and recurring NGU.  I have just several comments which may be useful:

1. The phenomenon of recurrent NGU is uncommon but well described.  In the few studies of this syndrome extensive microbiological evaluation of persons such as yourself fails to demonstrate pathogens in either the patients themselves or their sex partners.  In these situation, the inflammation tends to gradually go away on its own  and there is no evidence that it leads to complications in the individual or their sex partners.

2.  In you think another effort at therapy is worthwhile, some of my colleagues conjecture that response rates may be better with a week of moxifloxacin than with other antibiotics. this has not been formally studied however and is only conjecture.  

I hope these comments are helpful. The amount of inflammation you report is rather small and my main recommendation would be to try to wait it out and not worry too much unless it worsens or other symptoms appear.

I hope this comment is helpful. EWH
5 Comments
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Avatar_m_tn
Thanks so much Dr Hook for your valuable advice. I realise I am lucky to receive tests and treatment, but the doctors I see are often recently trained offer differing information and idagnosis (saying it is either NSU, a UTI  or maybe prostatis), so I come to you or Dr HHH as I take your words to be best NGU expertise available to me.  I have spent weeks reading about NSU/NGU and would be v grateful if you can tell me (and others with NSU) your position on all of the remaining qns I can not seem to find answers for:

1 I used an online STI urine test that uses a well know private Laboratory, but bottled my urine at 7am and took it to the Lab myself at 11am (ie without keeping it cold). Would you consider the test results above valid despite 4 or more hours of the urine sample being at varius temperatures etc?
2 Great that you say no harm to me or partner if I have NSU long term but (my qn above was cut off) - does this extend to no harm to a baby if I were to get partner pregnant (I am hoping to have kids in a year or so)?
3 I have read Moxifloxacin side effects can be strong so would prefer to only use it as a last resort. Which course if any out of Doxy, Erythromycin, further Ofloxacin or Azithro sound worth trying? With any of these, does drinking alcohol make them less effective or only make the side effects worse (as 4 weeks with no alcohol is not easy)?
4 Is a urine test enough to pick up active HSV - and I cannot find what is the max no of years first symptoms of HSV has/could occur after catching it?
5 Is it possible Prostatis would cause only an inflamed urethra with no other symptoms? I have v occasional aches in testicles but not severe at all (so only definite symptom is my swollen urethra) and if I can rule out Prostatis I can stop taking Ofloxacin which I would like as it seems to have made an old tendon injury hurt after 5 days of Ofloxacin.
6 You are right that I have used condoms - the last time I didn't was 10 years ago, so sexual transmission of my NSU would have been oral or hand-to-genital (with hand-to-genital more likely due to the timing of first symptoms), so does this make you think that it is a uti bacteria rather than a sti bacteria that has given me urethrirtis and a high urethra wbc count (or can non bacterial urethritis also show 10 white blood cells phpf?

I realise these are difficult qns, but your answers to each would help me sooo much to a) treat the NSU and b) worry less and stop me spending hours searching online reading differing studies without getting these answers…

Thank you again. A grateful friend from across the pond.
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Avatar_m_tn
Dear Doctor,

In my effort to manage my persistent ngncu, please could you tell me a couple of extra things which have occurred to me?

A. Is there any herbal treatment that you would recommend for urethritis? Perhaps bromlean as an  anti inflammatory?
B. The urethritis is definitely worse after ejaculation for a day or two. Do you think less ejaculation would speed the healing?  I am now slightly concerned I am doing long term harm, even when I masturbate carefully...
C. Could you please reference the studies you mention above on ngncu? And is there any sense of the longest amount of time in years or months persistent ncngu can last?
D. If I want to re test, what is the max number of days I need to wait after antibiotics ? One week or more? And does a time lapse also apply to any non antibiotic herbs or non prescription painkillers?

As these are new questions that will help me with my problem, please let me know if you would prefer I write a new thread...

Thank you again for all of your great help...
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Your questions are questions which are difficult to answer. The studies are small and much of what we know about this syndrome are anecdotal.  I'll end this thread with the best answers I can provide.  

A. Is there any herbal treatment that you would recommend for urethritis? Perhaps bromlean as an  anti inflammatory?
Sorry, I have no experience with herbal therapy for STIs or any sort, including urethritis.

B. The urethritis is definitely worse after ejaculation for a day or two. Do you think less ejaculation would speed the healing?  I am now slightly concerned I am doing long term harm, even when I masturbate carefully...
I doubt that you are doing any long term harm unless there is pain related to the masturbation.

C. Could you please reference the studies you mention above on ngncu? And is there any sense of the longest amount of time in years or months persistent ncngu can last?
Sorry, I cannot provide these. There have been no systematic studies of this rare occurrence in more than a decade.

D. If I want to re test, what is the max number of days I need to wait after antibiotics ? One week or more? And does a time lapse also apply to any non antibiotic herbs or non prescription painkillers?
I would wait at least week until re-testing unless the medication you have been taking is azithromycin in which case you should wait for two weeks before testing (not that I expect these tests to be positive.  Use of painkillers should have no effect.  As for herbs, as I said before I have no idea how to counsel you. EWH
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Avatar_m_tn
Thank you for taking the time to answer these, especially on a Saturday!

Masturbation makes the area more sore, but not what I would call painful, so I am extremely relieved that I do not have to stop this or sex altogether....

Best wishes and thanks for all your kindness and expertise.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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