Trying to reconcile inconsistent tests

[danny1975]

The following occurred in the following order:

1.  Received unprotected oral sex.  
2.  After worrying excessively for 3 weeks, begin feeling pain in urethra, with no discharge.  (Had not ruled out at time that it was in my head.)  
3.  Went to STD clinic.  Full range of tests, all negative.
4.  Symptoms persist.  Return to clinic 1-2 weeks later.  They took urethral swab, and 5-10 minutes later came back with diagnosis of NGU.  I was given a week's worth of doxycycline, which I took exactly as directed.
5.  Symptoms did not subside with doxycycline.  
6.  After taking doxycyline, had a fully protected sexual encounter.  Actually, a failed one, since I couldn't get it up.  Barely any vaginal pentration, in fact.
7.  Returned to clinic one week after finishing doxycycline, and several days after protected encounter.  Urethral swab taken.  5-10 later, doctor comes back with diagnosis of gonorrhea.  Given cipro and another round of doxycycline.  Told not to return for 3 months.
8.  Symptoms persist.  Desperate, I order antibiotics from companies in India and Mexico and take several courses sufficient to cure every bacterial STD several times over.  Symptoms persist for several more months, then go away.  Returned to clinic and all tests negative.
9.  About a year later, diagnosed with nonbacterial inflammatory prostatitis.  I've probably had it for several years, but dismissed the symptoms until recently.

I'm trying to reconcile the inconsistent STD tests a year ago.  At the very least, one of the first two had to be wrong.  I guess it's possible that I contracted gonorrhea from the protected encounter between the second and third.

Do you have any thoughts, Doctor?  Also, can inflammatory prostatitis cause an NGU diagnosis because of white blood cells from the prostate getting into the urethra?

Thanks in advance.

[H. Hunter Handsfield, M.D.]

The tests for NGU are inherently unreliable.  They depend on looking for white blood cells in the urethra, or in urine. Other things can cause elevated urethral WBC from time to time, and most of the time they just go away without treatment.  In my STD clinic, when a male has WBC in the urethra but no other evidence of NGU, we do not diagnose NGU.  Instead we withold treatment and reexamine the patient a week later. Half the time the WBC have gone away.

On balance, I'm pretty sure you don't have urethritis and never did.  In other words, most likely the NGU test at your second clinic visit was the wrong result.  Your initial symptoms may have psychosomatic (which you indicate was your own initial suspicion) or perhaps prostatitis.  Most such cases probably aren't due to infection at all; indeed, the newer name for chronic nonbacterial prostatitis is the "chronic pelvic pain syndrome" -- as the name implies, it isn't even clear that the prostate is involved at all. It does not respond to antibiotics.  For more information, google that term and start your reading with the excellent Wikipedia article.  I suspect you'll find a lot in common with your situation.

Finally, you obviously acquired gonorrhea from one of the later sexual encounters.  There is no way you had persistent gonorrhea all those months despite negative tests and despite multiple antibiotics.

Whatever you might have had to start, at this point you have no STD.  It probably is pointless to keep trying various antibiotics.  Find a single health care provider you trust, and who understands prostate disease and CPPS, then stick with that provider and follow his or her advice.

Perhaps most important, stop worrying about any of this.  There is no known serious health outcome from chronic prostatitis or CPPS.  You can be confident there is no important risk to your health or that of a current or future sex partner.

Best wishes--   HHH, MD

[danny1975]

Thanks, Doctor.  That makes a lot of sense and clears up some of the mystery.  Also, I stopped the antibiotics a long time ago.  May I add one clarification with respect to the gonorrhea diagnosis?  I promise to drop the thread at that point.

There were only two sexual encounters: (1) the unprotected oral that started it all, and (2) the encounter between the second and third clinic visits.  Thus, there seems to be only three possible explantions for the gonorrhea diagnosis:

1.  The first two tests missed the gonorrhea.

2.  I acquired the gonorrhea during the second encounter.

3.  The gonorrhea result was a false positive.

Based on your answer, it appears you believe that #2 is the most likely explanation.  I've had trouble accepting #2, because the second encounter seemed so low risk--I had a condom on for all contact, and I wasn't even able to penetrate deeply or for more than a few seconds.  I've always assumed #1 was correct, which has caused me to worry about other negative results being wrong also.

Could you briefly address the likelihood of #1 or #3, and then I promise not to post anything further.  Note that I got the results from all tests within 5-10 minutes, if that clarifies for you what method they used.

Thanks again.

[H. Hunter Handsfield, M.D.]

Scenario 1 isn't it.  Scenarios 2 and 3 are equally unlikely.  A false positive test probably is a bit more likely, but I really cannot select between them.