Is this normal after a NGU or it is recourrence?

[MMMM31]

31 y/o, heterosexual male.

6/9 Sex with girl A,unprotected and protected oral,and protected vaginal.The condom broke and I changed it
6/13-15 Unprotected oral and vaginal sex with my 5 years girlfriend,she had her period
6/25-30 Urethritis symptoms
6/30 Gon,Chla and Trico negatives. Sulfamethoxazole 1 week.
7/2 Rocephine shoot
7/ 5 Discharge still. DoxycyclineX2 weeks.After first dose discharge stopped,itching continues a few more days
7/12 I masturbated and seminal clear fluid still coming for a few minutes afterwards.
7/19 Finish doxycycline
7/19-25 Testicles pain and swollen scrotum (like I had worms in left side). Discharge or pee feeling in the urethra near the tip, but nothing came. After peeing urine drops still coming
7/28-31 Skating in hot days. Red and hotness in the scrotum developed. Nausea every morning
8/ 2 Many beers, next day discharge and pee feeling again, but nothing was coming. Frequently peeing
8/4 Masturbated, when ejaculation it burned at the tip of my penis

Girl A told me: in Nov 2006, 1 month after 1 night sex got one red bump outside from the vagina, it smell and burning when peeing. STD tests negatives (no viral test). Prescribed doxycyclina and flagyl, it went away. 1 month ago tested for chla,gon,mycoplasma,syphilis,HIV,Hepatitis B-C, all negatives. From a swab the doctor look in the microscope and observed something like chla, but it wasn’t .  

After 2 months I´ll meet again my girlfriend next week. She has no symptoms, but just had nausea during 2 days. She got many years ago genital HSV receiving oral sex, last time she had bumps was 4 years ago. I haven’t had genital HSV symptoms.  I have HSV 1 in my lips since many years ago.
1- Should my girlfriend take doxicycline? Can we have sex? If we, should we use condom? What about giving and receiving oral sex?
2- It is a recurrent viral NGU? It is normal to have these feelings after treatment finished?
3- My girlfriend nausea can be from urethritis?

BR,

[Edward W Hook, MD]

Read what I said about sex.  Oral sex is not recommended although, admittedly the risk is rather small.  Masturbation is fine.  Whatever you do however, she must be treated - the sooner the better.  

If you are in the US, you can go to a public STD clinic for low cost, usually thorough care

Your symptoms do not sound like prostatitis.  Some people will tell you this but it is highly unlikely  EWH

[Edward W Hook, MD]

As you point out, you had NGU and were effectively treated for it with the doxycycline that you received.  Unfortunately, you had sex with your GF in the interval between your 6/9 encounter and getting treated, thus GF is exposed.  Both of your partners must be treated and, if you have been re-exposed to either one since you took the doxycycline, you need re-treatment again.  

If that has been done (your note is hard to follow) then you have recurrent NGU.  Recommended therapy for this is 7 days of erythromycin (a single dose of azithromycin would probably work as well) PLUS 2.0 g of metronidazole in case trichomonas is there as well.

Regarding your questions.

1.  Yes.  You both need to have finished your treatment before you have sex to avoid "ping-pong infections" bouncing back and forth.  Condoms are not recommended as a substitute for abstinence in this situation but are likely to work.
2.  Viral recurrent NGU is not described.  If, after the azithromycin/metronidazole treatment you still have symptoms and you have followed my other advice, you are probably OK.
3.  Hard to say.  There is a possibility that this is related to having been exposed to your infection and is a sign that she is infected.  Hope this helps.  EWH

[MMMM31]

Thanks doctor for your quick response.

No, I haven’t been re-exposed with any girl since infection begun and treatment.  My GF has not been treated yet and we will see each other next week again just for 4 days and I wonder if un-protected oral sex (giving and receiving) can be a risk for me again? What about masturbating each other?

I am afraid that the infection that girl A had in November 2006 (which the doctor couldn’t diagnosed), is related with the chlam the doctor observed in the microscope one month ago in a sample from her.  If this is true, it means that she never was cure with Flagyl and Doxcycyclina (just symptoms went away). And that can be the reason of my urethritis,  so I am afraid that I am not completely cure yet.

Regarding Question 2: All this feeling like discharge and peeing in the urethra close to the tip of my penis (but there is no discharge), swollen scrotum and redness are they normal after the treatment have been completely or post effect of an urethritis (I could not follow you answer to question 2 completely).  I never have had prostatitis and UTI. Prostatitis can be developed from an NGU?

Sorry for my question again, but I am not at home since all this is happening, so I don’t know what to do or where to go.  I go back home in two weeks and first thing I am going to do is to visit a specialist.

Thank again.