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penile discharge but neg Chlamydia/Gonorrhea
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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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penile discharge but neg Chlamydia/Gonorrhea

Hi Doctor,
Two weekends back on a Saturday i had sex with a guy i sometimes see (im a guy too). We have safe anal intercourse (no condom breakage) but oral without a condom. On the following Monday i noticed a slight discharge when I woke up. It's white/greenish but only a little amount. It does not really come out on it's own, i have to milk it out. However, if i had a long nights sleep there seems a bit more discharge has been build up then a short nights sleep. During the day there is no discharge at all, but sometimes maybe a slight burning sensation during urination. However, the next morning (after a nights sleep without urination) the little bit of greenish discharge is there again.

7 days after that last contact and 5 days after the discharge started i went to the urologist. He checked my urine and my prostate and bladder. all were fine. He also sent some morning urine the a lab. Last Monday i got the results. Negative for both Chlamydia & Gonorrhea! I was very surprised. On the paper it says: BD ProbeTec (TM) ET Chlamydia trachomatis and Neisseria gonorrhoeae Amplified DNA Assays. My Urologist said i should not worry, but i still notice some discharge in the morning when i wake up and milk my penis.

My questions:
1. Was i maybe to early to do the urine test?
2. was my test a modern reliable one?
3. would they also automaticly detect NGU when they examined my urine.
4. what could be another reason for my discharge, could it be Trichomoniasis?
5. should I be retested or just wait and see if it will disappear on it's own?

6. And a side question: They say a lot of NGU cases are due to Chlamydia. So, why not just call those cases Chlamydia instead of NGU? Just wondering.

Thank you for the reply
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Welcome to the STD forum.

You had (or have) nongonococcal urethritis, or NGU.  Chlamydia causes about 30% of NGU cases overall, but is rarely if ever acquired by oral sex.  In contrast to chlamydia, gonorrhea can be acuqired by oral sex, but the gonorrhea tests are quite reliable.  Thus, no surprise that you have NGU with negative tests for both chlamydia and gonorrhea.  The causes of NGU in men having sex with men have not been carefully studied, but some (many? most?) probably are caused by oral bacteria that are entirely normal in the mouth but cause inflammation in the urethra.  For the same reason, NGU sometimes follows oral sex in monogamous heterosexual couples.

As to your urologist's advice "not to worry", I have a bit of a problem with that.  On one hand, he may be right -- NGU not caused by chlamydia appears to be harmless, an inconvenience more than a serious health threat.  On the other hand, we really don't know that, and the standard approach is to treat with antibiotics such as azithromycin or doxycycline.  To your specific questions:

1) The urine tests for gonorrhea and chlamydia are reliable within 3-4 days of exposure, and always are reliable if symptoms like discharge are present.  Your tests were not done too early.

2) Only the most reliable modern tests are possible on urine.  The older tests require urethral swabs.

3) Diagnosis of NGU is based on direct examination, i.e. seeing the urethral discharge.  A urine test may help confirm the diagnosis by finding elevated white blood cells, but there is no actual urine test for NGU.

4) Trichomonas is not carried in the mouth and therefore not transmitted by oral sex.

5) You should be treated with azithromycin or doxycycline.  Either discuss these options with your urologist, or find a provider more knowledgeable about STDs.  (I know it seems illogical, but many urologists have little or no training or expertise in STD.)  I recommend you visit your local health department STD clinic or, if you're in the UK, your local NHS GUM clinic.  Or its equivalent, wherever you are.

6) It's just an issue of habit, based on history. Until relatively recently, chlamydia testing wasn't widely available or it was expensive, whereas gonorrhea testing has always been easy and cheap.  Logically, we would classify urethritis exactly as you suggest:  gonorrhea, chlamydia, and NCNGU (nonchlamydial, nongonococcal urethritis).

Let me know what develops after you discuss this with your urologist and/or visit an STD or GUM clinic.  But in the meantime, don't be overly worried.  As I said above, nonchlamydial NGU generally is not serious and has few if any long-term health consequences.

Regards--  HHH, MD
Thank you for the comments Doctor.

I went again and got Doxycycline.

You said: "caused by oral bacteria that are entirely normal in the mouth but cause inflammation in the urethra". Does this mean that person I got it from does not have to be treated as well, because it's just normal bacteria that will be in his mouth again after a treatment?
I was also wondering if the likelihood of getting a NGH is higher when one gets a "deepthroat" instead of normal mouth oral because the penis goes deeper inside the body?  
And if not treated, would NGU, and it's symptoms go away on it's own?

I'm glad to hear you're on treatment.  Did you have to talk the urologist into it, or did he readily agree?

There are no data on varying risks of NGU or any other STD according to depthor vigor of oral sex.  I'm inclined to believe it makes no difference.

It is standard practice to treat the partners of men with NGU, regardless of the mechanism of transmission.  Your reasoning makes sense, and my guess it often isn't necessary.  But the causes of NGU in this situation actually aren't known; the normal oral bacteria idea is just a theory, and I recommend your partner be treated -- just because it us normal practice under the better safe than sorry principle.
The natural course of NGU hasn't been studied.  Here too, my best guess is that it would clear up on its own, with little or no risk of long-term health problems.  But without data, I would not recommend taking that chance.
I told him i was not comfortable still seeing mild discharge symptoms, so then he gave me the doxycycline. It was not a long meeting.

Ok, I will tell him to get treated too.

Thanks for all the answers and information doc!
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University of Washington
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