What to do next

[Attraction]

Mid September had unprotected sex with a (girl) friend while abroad on business. Had sex with my wife a few days later and one week after that she started to experience some discomfort. Diagnosed as thrush and, apparently, successfully treated. 5 weeks after my extramarital encounter I developed a slight purulent discharge. Went to STD clinic 3 days ago, diagnosed as NSU and treated with 1g Azithromycin. Told my wife that I had a problem, that I had gone to hospital, that I had been diagnosed with 'urethritis' and that she was to go to her doctor or a clinic (I was away again and went to a clinic in another city). I did not elaborate on the type or source of infection. She has been to her GP yesterday and has had swabs taken but it seems she has only been treated for thrush again (just ointment). 3 days after treatment, my discharge has reduced but is still present. The head of my penis has a 'blotchy' appearance.I have a follow up appointment in two weeks. When should the discharge stop if diagnosis and treatment were correct? When will they have a bacterial type on the swabs taken (mine and hers)? If my wife's swabs are +ve, will her GP just treat her or will she investigate the source? If they are -ve, are we in the clear?

[H. Hunter Handsfield, M.D.]

You're not going to want to hear this, but your NGU (nongonococcal urethritis, same thing as nonspecific urthritis/NSU) is an STD; and you need to level with your wife and assure that she receives proper treatment, i.e. azithromycin or a drug of the tetracycline class.  She also needs to have diagnostic tests for gonorrhea and chlamydia, even if your own tests were negative.  Otherwise you may be taking a serious risk for her health.  Whether or not your wife also had a yeast infection (thrush), I cannot say; but if so, that clearly not the only problem here.  However, if indeed she had a yeast infection, that might explain the "blotchy" rash on your penis.

As far as your symptoms are concerned, azithromycin is usually effective, but persistent symptoms are a problem fairly frequently, up to 10% of patients.  The usual recommendation is to switch to a second drug, usually doxycycline, which is taken twice daily for a week.

Your use of NSU (instead of NGU) and other issues of terminology suggest to me you are in the UK.  I urge you and your partner to visit a genitourinary medicine (GUM) clinic together for expert advice and management.  While many GPs provide excellent STD management, in general a GUM clinic is a better option.

Best wishes--  HHH, MD

[Attraction]

I realise I may need to post a further question for further answers but I'll try here first. You're right, that wasn't what I wanted to hear but I'm sure you're used to that and, anyway, I have no one else to blame.
However, it seems my infection is atypical in that it took 5 weeks to surface and is not, immediately, responsive to Azithromycin. Could it be something else? Could I be wrecking my marriage and further hurting my wife by suggesting I introduced an infection when I didn't?
If I can get her to accompany me to the STD clinic, is there still a chance that this will turn out to be unrelated to my infidelity?
Why, in the unlikely event that my tests were to prove negative, must we still assume I have an STD?

[H. Hunter Handsfield, M.D.]

Yeast infections are not a common cause of urethritis, but it might explain a few cases; and you are correct that a 5 week delay is longer than usual for appearance of NGU.  And yeast doesn't respond to azithromycin.  However, that your discharge improves suggests the drug had some effect, even if incomplete.

Perhaps the best approach is for you to be evaluated by a GUM clinic or other specialist, then rely on that person's judgment before discussiing the situation with your wife.  However, the cat may already be out of the bag.  The sort of subterfuge you and your GP have already followed with your wife was pretty transparent, unless she is very naive.  Most women know or at least suspect it's an STD when she and her husband both need treatment for a simumtaneous genital infection.

HHH, MD

[Attraction]

It is extremely good of you to come back to me. I think my wife is rather naive on these matters and very trusting (I know it will break her heart to tell her) but I don't think the GP was practising subterfuge. I'm sure my wife will have mislead her into thinking that I too have been diagnosed with a yeast infection. She probably forgot that I had told her urethritis.
I have already been to the GU clinic so, following your first reply, I had decided to contact the clinic for results of my swabs and: 1) if positive for Chlamydia or Gonnorhoea I must tell all immediately and get my wife treated, 2) if positive for another bacterial infection, tell my wife that it is bacteria, not fungus, and ask her to accompany me to our local GU clinic (still in the hope that there is another source of infection), 3) if, by a  miracle, my tests are negative, or only positive for yeast, seek further advice from the clinic I visited and/or our GP.
Is that half reasonable? I'll keep the delays to a minimum.

[H. Hunter Handsfield, M.D.]

I will have no further comments, including no comment on the various scenarios of what you tell your wife or when.  You need to work that out yourself, with the advice of your hands-on provider(s).

[Attraction]

I understand. First test back - Gonorrhoea negative. Some relief (even the word frightens me) but also just realised that it was 4 weeks and 1 day, not 5 weeks. Just outside the accepted limits. I guess the most likely scnario is that it is Chlamydia, that I was originally asymptomatic, and I have become symptomatic after reinfection from wife.