NGU / Chlamydia - Female Symptoms / Transmission Questions

[Sane_but_concerned]

Hi Doc,

Some straightforward questions for you:

1. Can NGU which is not caused by chlamydia cause symptoms in women? If yes, what kinds of symptoms are usually caused?

2. I know this is a gut question, but would like some general guidelines: What is the risk for contracting chlamydia or NGU with non-penetrative genital to genital contact? How about penis-anal contact between a man and a woman?

3. Can NGU in men be recurring from the same female partner? Can long periods of no relations followed by sex trigger the NGU again?

4. My partner often complains of pain in urination immediately after sex. Also sometimes pain during sex if there is a lack of foreplay. Additionally, she used to suffer from frequent yeast infections. This has happened for 4 years but she has never tested positive for an STD. What kinds of other explanations could there be?

Thank you in advance for your advice and guidance.

[Sane_but_concerned]

Thanks, again, for the reply Doctor.

My previous question arose because my wife mentioned that she had a burning sensation during urination a few mornings ago. She had mentioned the same thing once or twice about a week before that but did not have any symptoms in between and the pain was there at times and not there at other times (I asked repeatedly and sometimes was with her while she urinated). She has now come down with a few flu-like symptoms - slight fever & cold/cough but is up and about.  She has not had itching or any unusual discharge (though she always has a little bit of non-odorous discharge from her vagina due to her pill)

I get my results back tomorrow morning and will obviously tell her immediately if I am positive for anything.

In the interim I've been concerned that she may have chlamydia or another STD. Do you have any thoughts on the above symptoms and their indication of any STD?

I know I promised to keep quiet before and I assure you I will after this response (particularly since I get my results tomorrow morning).

Many thanks again for this one last question.

[H. Hunter Handsfield, M.D.]

There are no data, but my impression is that such symptoms due to STD usually don't come and go.  That pattern in a woman is more suggestive of non-sexually transmitted problems like yeast or urinary tract infection.

HHH, MD

[Sane_but_concerned]

Hi Doc,

I don't know if you are still checking this thread but I am currently awaiting my STD results.

I wanted to know if, in women, STD symptoms such as burning during urination can be intermittent - come for a few days, go for more than a week, and then return.

Thank in advance.

[H. Hunter Handsfield, M.D.]

Recurrent NGU symptoms are more common after treatment of nonchlamydial NGU, but it sometimes happens with chlamydia.  Chlamydia almost always is absent when it happens--either just persistent inflammation without infection, or some patients may have been infected from the start with chlamydia plus something else.

Urethral discharge varies widely in amount, sometimes overt, other times just noticed by milking the penis.  But men worried about dischage should milk the penis gently and infrequently, no more than once a day; more vigorous attempts can cause symptoms all by themselves.

HHH, MD

[Sane_but_concerned]

Hi Doctor,

Thanks for the clear answers. Two (short) final questions for you that I forgot to add in the last post:

(5) Can a prior infection with chlamydia that was successfully treated change any recurrent symptoms upon reinfection or should they be treated as entirely isolated events with your regular answers applying?

(6) When looking for penile discharge (and recognizing that first thing in the morning is more easy to spot) would one expect to have to milk the penis or should discharge be seeping out?

Thanks in advance - and I promise to keep quiet from now on...

[Sane_but_concerned]

Thank you Monkeyflower, your comment was clear and helpful. I do appreciate the emotional as well as physiological benefits of foreplay and rarely do we 'jump right in'. I had not, however, appreciated the movement of bacteria caused by penetrative sex and the potential results for UTIs. The responses are much appreciated.

Best,

[monkeyflower]

I think I can answer #4.

Regarding discomfort during intercourse when there's been no foreplay: It could be from dryness, or it could be that you're bumping her cervix (does she complain of crampy pain, or more superficial pain?). There's a physiological reason for this. During arousal, not only do women produce lubrication, making intercourse far more comfortable and pleasurable, but the inner two-thirds of their vaginas "balloon", turning potential space into actual space. That has the benefit of lifting the cervix up and out of the way, allowing for deeper comfortable penetration.

Generally women need some sort of attention in order to become fully aroused, before just leaping into intercourse. If your partner is complaining of discomfort during intercourse during those times, you're rushing things. Slow down. Spend some time appreciating each others' bodies--give each other oral, use toys, manual stimulation, whatever you both like. Give her time to get fully turned on before even considering intercourse. Some women like to come first. You'll both appreciate it far more :-)

As for discomfort peeing after intercourse, intercourse basically massages the bacteria normally on her vulva (usually e. coli) into her urethra. That's how most women get UTIs. She might not be getting a UTI every time (although some women do), but dry intercourse will exacerbate this friction and make urinating pretty uncomfortable.

Yeast infections are simply an overgrowth of the yeast normally found in the vagina. Antibiotics, the pill, any number of things can trigger this.

[H. Hunter Handsfield, M.D.]

1) The causes of NGU other than chlamydia are varied.  The recently recognized bacteria called Mycoplasma genitalium, which clearly causes some NGU (probably 10-20% of cases, on average), also might be associated with some cases of tubal infection or cervicitis in women.  However, no research has ever documented specific health problems in women who are the sex partners of men with nonchlamydial NGU.  In some cases, NGU appears to be caused by entirely normal oral bacteria, acquired by fellatio.  Female partners of men with NGU should be treated, however, because 1) chlamydia may be present, in which case it isn't wise to wait several days for the guy's test result; 2) M. genitalium might be a problem; and 3) treating the woman may help prevent reinfection of her male partner.

2) Chlamydia or NGU are not known to be acquired by genital contact without penetration, or by external penile-anal contact.  Chlamydia and NGU are transmitted by anal intercourse, however.

3) The causes of recurrent NGU in men aren't clear.  Some cases probably result from reinfection (usually with unknown organisms) from an untreated partner.  Sex per se cannot cause NGU, although it might be that sex can make symptoms more prominent.  This also has not been studied.

4) Genital pain or discomfort associated with sex, or immediately afterward, doesn't suggest any STD.  Monkeyflower's comments before me (below) are more expert than my own; I have nothing to add to them.

Good luck--  HHH, MD