continuing ngu and fears

I seem to suffer from NGU every year in the spring/summer after a diagnosis of prostatitis a number of years ago. This year it seemed to start in May.  My last exposure was receiving unprotected oral in Feb, brief unprotected vaginal in Sept or Oct.  In May, urination was uncomfortable towards base of penis, clear stcky liquid present only when milking the penis.  Went to 3 different places and got 3 painful swab tests, all 3 neg. for chlamydia.  At least 1, possibly 2 were for GC as well and negative.  Was given 2g zithromax, 2g metronidazole, and a week of doxycycline. I also became obsessed with milking my penis to see what was there.  About a month (beg. June) later I began to notice flakes around my urethra and what I milked out became cloudy.  Doc suggested urologist which I can't afford, said GC and CT passes easily with oral. Gave me 30 days of levaquin 500mg and said stop milking, and even masterbating (masturbating) can cause it.  I stopped and it seemed to work.  But now about 2 weeks after finishing antibiotics, sometimes when I urinate I have a split stream for a moment, or the flow goes down until it "breaks through".  No visible discharge ever, and no real discomfort with urination.  Unfortunately have started milking again, though gentler and less often.  Only thing ever there is watery substance which may be left over after urinating?  And rarely a small amount of sticky, mucous-like stuff.  Very small amount.  Any ideas?  Am I causing this myself through masterbation (masturbation) or milking?  Dirty hands?  Shouldn't the antibiotics have worked?  I'm convinced CT no matter the treatme

[H. Hunter Handsfield, M.D.]

The cause(s) of persistent or recurrent NGU are not well understood.  It is either a persistent infection, perhaps due to an organism not even yet identified or discovered; or may be an immunological reaction, i.e. no infection at all.  (Personally, I favor the immunological explanation, but the data are not clear.)  A third possibility is that it is a physiologic event, i.e. exaggertion of normal urethral mucus production.  Finally, perhaps it is possible that you indeed are contributing to the problem by repeatedly massaging the urethra looking for discharge.  You can be sure you don't have chlamydia, especially after the treatment you have received.

Most important, there are no known serious health consequences for either affected men or their sex partners:  no urethral stricture, no epididymitis, no infertility, no known disease of any kind in partners.  You need not take any precautions about transmission, and you can relax about any harm coming. I suggest just living with it.  And totally stop milking your penis; since this isn't important or serious, there is no reason to keep looking for discharge.

Good luck--  HHH, MD

[blechysmart]

Sorry for the continuation.  I have irrational ct fear regardless of negative tests and all that treatment.  I drink a lot of water so I can't tell about frequency, but at times feels more than normal.  I just want to be sure I have nothing communicable since I'm in a rut and can't start relationships anymore.

[blechysmart]

Thanks doctor.  I guess part of me realizes I've probably been overtreated.  But there is a part of me that is convinced I have some strain that is resistent to those antibiotics.  Its just really effecting me.  This morning, probably about an hour after my first urination I looked and there was some stuff dried on the bottom part of my urethra, and I milked it (I know, I need to stop) and some white stuff came out.  I guess it could be semen from sleeping or whatever.  But it probably won't be back for the rest of the day.  So you don't recommend any further testing or treatment?  I want to be 110% sure I don't have GC or CT.

[H. Hunter Handsfield, M.D.]

It sounds like your persisting symptoms are real.  Often it's hard to tell from online descriptions.  For many people with continuing urethral/prostate symptoms, those symptoms are probably just anxiety magnifying normal body sensations.  In your case I have little doubt you have continuing inflammation.

You say you can't afford a urologist, but seeing one would be a logical next step.  You may

[blechysmart]

Thanks again doctor.  I will see what I can do about seeing a urologist somehow.  I appreciate your advice, though I find it a bit worrying.  Are you saying that I could still have chlamydia?  Even after my 3 negative tests and the 2g of zithromax, 1 week of doxycycline, and one month of levaquin?  Is that possible?  Have you heard of that?  Or are you saying that I should move my mind past chlamydia and find out what is really going on?  I very much appreciate your advice, I've been a wreck.

[blechysmart]

Please doctor, this is my last follow up I promise.  I'm confused as to what you mean by "no harm to a partner if I just sit tight".  Does that mean wait until it goes away?

Is it even remotely possible that I have chlamydia after 3 negative tests and all that treatment?

Can having slight hypospadia contribute to this at all?

Can milking the penis increase mucous production?

Thank you for your time and this great service.

[H. Hunter Handsfield, M.D.]

Repeat questions are not appropriate as new threads, which blocks others from starting new topics.  I deleted your new question.  This is the main reason that in a few days MedHelp is going to start charging $10.00 for new questions on the STD Forum.

No, there is no way you can have chlamydia, unless you acquired it after the last negative test.  Hypospadia may increase the risk of non-sexually-acquired urethritis.  Milking the penis vigorously and frequently probably can increase mucus production.

HHH, MD