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Persistent Non-Chlamydial, Non-Gonococcal Urethritis

I am a 26-year old male. On May 23 I lost my virginity to a CSW in the red-light district in Amsterdam. I had both protected oral and protected vaginal sex. The condom was in the CSW's mouth before being placed on my penis - so my penis may have been exposed to her saliva as a result. Tested for Gonorrhea and Chlamydia at 5 and 18 days after the incident - results were negative. Tested for Herpes I/II at 23 days after the incident - results were negative. No blisters/lesions. Since this incident, I've been encountering pain in urination (on a scale of 1 to 10, the pain is about 2/3) and intermittent pain in left testicle that has recently gone up to a level 4/5. Last week, I had trouble sleeping at night because of the pain.

Here are the medications I have take so far:
- May 28 - 250mg of Rocephin (injection) and 2g of Azithromycin (single dose) - these were prescribed to treat Gonorrhea and Chlamydia (just in case) before I got the results of the tests
- June 16 - One week of Doxycycline - 100mg tablets (twice per day) - prescribed to treat possible NGU
- July 12 - 2g of Metronidazole (single dose) - prescribed to treat possible Gardnerella/Trichomoniasis infections

I have been to a couple of urologists and every time I provide my urine sample I am told that WBC levels look normal. However, last week, I decided to get the AZO test strips, and with all three test strips provided, the result was clearly positive for Leukocytes.

1. What could be causing my symptoms?
2. In the US, STD tests do no include Mycoplasma/Ureaplasma, Trichomonas or Gardnerella. In your opinion, should I ask my urologist to order these tests for me?
3. Is it possible that I have been exposed to a bacterial infection that is resistant to all the anti-biotics I've taken?
4. I read that Cipro is recommended for UTI infections. Would your recommend this?
5. Is it possible that I have non-bacterial prostatitis? Why would I get these symptoms right after my first sexual exposure?
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Avatar universal
Hey Dr. Cummings. Thank you so much for the detailed response. I have a couple of follow up questions if you don't mind.

I actually went to a new urologist yesterday and was diagnosed with prostatitis. The prostate exam did in fact confirm an inflamed prostate and during the prostate massage the tip of my penis was burning and felt like it was on fire. I just wish that my previous urologist had done this exam in the beginning. I was prescribed two weeks of Levaquin. I hope that resolves the issue - although I read online sources that suggest taking antibiotics for at least 6 weeks to avoid relapses.

1. Do you think 2 weeks of antibiotics is sufficient or should I just trust my urologist on this one?
2. On the STD forum, Dr. Hook definitively ruled out STD's (including bacteria causing NGU's) as possible causes for prostatitis. However I have read many online sources that suggest otherwise - including this one (http://www.netdoctor.co.uk/menshealth/facts/prostatitis.htm). I'm just not convinced that it's just pure coincidence that right after my first sexual exposure I would get prostatitis. Any opinions on this?

Thanks again for all your help.
Helpful - 0
936016 tn?1332765604
MEDICAL PROFESSIONAL
Hello

I've repeated your questions beneath with my answers in CAPITALS to identify them.

1. What could be causing my symptoms?

YOU NEED TO RETURN TO THE UROLOGIST / DOCTOR YOU FELT COMFORTABLE WITH AND DISCUSS FULLY. THE STRIPS ARE NOTORIOUSLY SENSITIVE AND THE LABORATORY TESTS ARE THE GOLD STANDARD - IF THE LAB TESTS ARE NEGATIVE THEN THERE IS NO REAL EVIDENCE OF A NGU.

2. In the US, STD tests do no include Mycoplasma/Ureaplasma, Trichomonas or Gardnerella. In your opinion, should I ask my urologist to order these tests for me?

YOU COULD CERTAINLY DO THAT. THE SINGLE MASSIVE DOSE OF METRONIDAZOLE IS LIKELY TO IMPACT NEGATIVELY ON THE LIKELIHOOD OF GETTING A PROPER TEST RESULT

3. Is it possible that I have been exposed to a bacterial infection that is resistant to all the anti-biotics I've taken?

EVERY THING IS POSSIBLE BUT I WOULD HAVE DIFFICULTY BELIEVING IT

4. I read that Cipro is recommended for UTI infections. Would your recommend this?

I'M NOT ABLE TO RECOMMEND SPECIFIC TREATMENTS FOR PATIENTS I HAVEN'T SEEN - THIS FORUM IS INTENDED FOR GENERAL ADVICE ONLY - NOT TREATMENT ADVICE

5. Is it possible that I have non-bacterial prostatitis? Why would I get these symptoms right after my first sexual exposure?

IT ACTUALLY SEEMS LIKELY THAT YOU DON'T HAVE ANYTHING AT ALL. YOU IDENTIFY A "SENSATION SCORE" OF 2 OUT OF 10. I CAN'T CONVINCE MYSELF THAT I WOULD NOTICE A CHANGE OF THAT SMALL SCALE MYSELF. YOU COULD HAVE A NON BACTERIAL PROSTATITIS BUT AGAIN I WOULD ENCOURAGE YOU TO GO BACK TO YOUR PREFERRED PROVIDER AND DISCUSS WITH THEM.

Best wishes, Sean
Helpful - 0

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