persistent/recurring NGU and scrotal pain

[allentg]

hi, great forum,
I'm a 32 yr old male. I was diagnosed with NGU about 5 weeks ago after unprotected sex with A. tested negative for gonn and chlamydia, given azithromycin 1g and a shot of ceftraxione. i had bad testicle pain at this point, in addition to some cloudy discharge, painful urination, etc...
the symptoms subsided after a few days, and a week later i resumed unprotected sex with B, my wife, the recommendation of my doc.
a few days later, my symptoms  came back.
i'm about to complete a 10 day doxy treatment and i took 2g of flagyl 2 days ago. there is still discharge in the morning and a frequent need to pee. most alarmingly, the pain in the back of testicles has come back, and it's bad. my wife took flagyl too because trich is the only thing she could have been exposed to, according to doc.
so, if i'm free of infection as my doc told me i was, what do i have? the infections which cause epididymitis i had covered by antibiotics, so why the pain, why now? ive had some clear rectal discharge, is this related?
is my wife still at risk of anything? does my epididymitis suggest an infection remains? should the flagyl treat it (i took it only 2 days ago?) could i have a resistant strain of chlamydia or trich? I did acquire my infection from A who is from Hong Kong.
much thanks

[Edward W Hook, MD]

It does not concern me that your cultures are negative although it does indicate that you do not have chlamydia.  Even with extensive microbiological testing about 30-40% of NGU has negative cultures yet responds to antibiotics.  

As for trich.  A single dose is typically curative.  EWH

[allentg]

Thanks Doc,
I've tested negative 3 times for chlamydia, by urine and swab 4 days after exposure, then i took azithromycin 1g, then tested negative again 3 days later. Is it possible chlamydia was actually there and wasn't cured, hence my recurrent symptoms? I also tested negative for the presence of mycoplasma and ureaplasma 2 weeks after the initial azithromycin.
Assuming trich is covered by the flagyl, what transmissible bacteria exactly would additional antibiotics be treating? I guess I'm confused why I still might be infected with something, and why epididymitis has developed, considering my tests and treatment.
How soon should flagyl start to work after taking it?
Thanks for your help doc

[Edward W Hook, MD]

You acquired NGU is associated with both chlamydial infection and trich but can be caused by many other organisms.  No matter what the cause, the current recommendation for treatment is that sexual partners should be treated with the same therapy before commencing sex, even if tests are negative.  I cannot say if your recurrent symptoms are due to re-exposure to your wife of not but I can say that at this point, presuming that you respond to the doxy, your wife should be treated with at least 7 days of the same infection.  If your symptoms do not improve on the doxy, then I would re-treat both you and your wife with azithromycin since it appears that you responded to this treatment.  Given the fact that you have the testicular pain, I would also consider treating you a bit longer than the regular course of therapy, using either 14 total days of doxy, if you respond to that, or azithromycin, 1.0g given twice a week apart.

Finally, should these steps not help, I would suggest you seek the advice of a urologist to explore for other, more uncommon caused of your discharge and/or testicular pain

Hope this helps.  Take care EWH