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urethral discharge
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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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urethral discharge

I developed urethral discharge after receiving unprotected oral sex from my wife 7 and 10 days prior to symptoms. Last unprotected vaginal intercourse was 3 weeks ago with my wife. Discharge is clear to slightly discolored, mild discomfort after urinating. Saw an MD; UA showed leukocytes at 1-5 wbcs. Prostate slightly tender on exam. MD diagnosed probable NGU and possibly prostatis. Urine culture and urine GC/CT sent off. Treated with zithromax 1 g and cipro 500 mg BID for 3 weeks to cover possible prostate.

Concerned about a possible encounter the first week of August (>7 weeks ago). I was drinking, memories are foggy from the night. Was in a quiet bar late night; a woman asked me to go into bathroom with her to have sex. I declined but things somewhat blurry after. Remember leaving alone and the ride home. Immediately went to bed. Woke the next morning with blurry memories though concerned about possible encounter that I couldn't recall. No overt symptoms but likely anxiety driven urethral irritation without discharge or dysuria for 1-2 weeks. Resumed normal sexual activity with my wife. Inquiring about possibilty of contracting gonorrhea without symptoms, passing it to my wife then becoming reinfected after latest oral exposure. I would presume I would remember any sexual activity but with the recent onset of symptoms I am concerned.

Hope all is anxiety driven and symptoms are in fact NGU related to recent oral exposure. My wife and children all currently have URI's as well so possible adenovirus etiology.
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239123_tn?1267651214
Welcome to the forum.

NGU can be acquired during oral sex, and it is believed many such cases are due to entirely normal oral bacteria -- i.e. not to an STD in the usual sense.  For that reason, NGU can follow oral sex in monogamous couples.  The timing of your symptoms suggests that's what is going on in your case.  However, I agree with your doctor that prostatitis could be the problem instead.

Of course I have no way of judging your fuzzy memory about your "hot August night" (from an old Neil Diamond song), but most likely you would have recmembered if you had had vaginal or oral sex.  Even if you did, if you had caught an STD you likely would have had symptoms within 2 weeks not several weeks later.  I doubt that event has anything to do with the current problem.  Assuming your urine GC/CT test results are negative, you can dismiss that event.

Your treatment was appropriate and I expect your symptoms to clear up.  The main uncertainty is whether or not your wife should be treated.  Standard advice says yes, i.e. all partners of men with NGU should be treated.  However, there has never been research on the value of treating partners in this specific situation, i.e. if the problem is likely entirely normal bacteria in your wife's mouth, treating her might make no difference.  On the other hand, it probably wouldn't hurt and if you were my patient, I would treat her with a single 1.0 g dose of azithromycin.  You might discuss this with your doctor for his advice, and with your wife.  (In speaking with your wife, you need not mention your "hot August night".)

I hope this helps.  Best wishes--  HHH, MD
9 Comments
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Avatar_m_tn
Symptoms developed 3 days ago, last oral encounter 7 and 10 days prior.
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Avatar_m_tn
Thanks for your response. I may never be able to listen to Neil Diamond the same again. I had previously dismissed the August event as well though with recent symptoms had to think it through. Even if an act occurred, the risk of the female having an STD and then me contracting it are low. I presume I would recall such an event as well. I clearly am not a good drinker (fortunately it is a rare occurrence) and would not do well as an unfaithful spouse.

How long should I anticipate urethral discharge and discomfort? I took zithro last night and have had 3 doses of Cipro.

Also, my wife developed a sore throat within days of the last oral event 7 days ago. Could this make adeno a possible culprit?
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239123_tn?1267651214
Your symptoms should start to improve in 2-3 days and clear up entirely over a week or so.

However, your wife's sore throat may be significant, for exactly the reason you suggest:  adenovirus.  (You're done your homework -- thanks!)  If that's the cause, your symptoms may take longer to clear up.  Antibiotics have no effect on viral infections, so the azithromycin and cipro would have no effect.
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Avatar_m_tn
All laboratory testing (UC, GC/CT) was negative. Still on Cipro. Symptoms mostly resolved by 7-10 days. Mild irritation persists though no noticeable discharge. My treating physician recommended against treating my wife; wasn't certain what he would be treating and stated he didn't want to disrupt her normal oral flora even if it was the offending agent. Stated it could have been adenovirus or normal oral flora versus prostatitis. Does prostatitis cause urethral discharge?

Stated if symptoms recur after resuming sexual activity with my wife to consider treatment for both of us at that time. Does this seem reasonable? When can I safely resume unprotected sex?
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239123_tn?1267651214
Although standard advice is for routine treatment of the sex partners of men with NGU, in this case it is unlikely your wife has a treatable infection.  Your doctor's recommendations are reasonable.
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Avatar_m_tn
My wife was treated with Zithromax 500 mg a day for 3 days for a respiratory infection. Would this be considered adequate treatment considering my possible diagnosis of NGU despite the recommendation of 1g of Zithromax?
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Avatar_m_tn
This is not the standard treatment regime, but could possibly be adequate.  However, based on your story and that lack of symptoms in your wife, it doesn't sound like she ever had anything to begin with.  Did your symtoms (symptoms) recur after resuming sex with your wife?  
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239123_tn?1267651214
As discussed above, probably your wife did not have a sexually transmissible infection responsible for your apparent NGU.  But if she did, that treatment would be adequate.

That should end this thread.  Follow your doctor's advice from here on out.  I don't think you have anything to be worried about.
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