NGU Concerns months after unprotected encounter and testing

[concernedtim]

I've already posted a question about this encounter which Dr. HHH answered very well, but I'm now concerned about NGU:

since June I've been on 100mg doxy ONCE a day for my skin, I also had some problems with a "discharge feeling" in August after the unprotected encounter. symptoms seemed to cease for a while after neg. STD tests, but about a month ago I ran out of doxy for 3-4 days and I noticed a stain in my underwear that felt wet, I had been with a woman (just kissing) and it may have been normal leakage, but I'm not sure, I don't usually let out fluid that 'easily'. I noticed penile itching, I'm not sure if it was urethral or just the foreskin, but it wasn't intense. I got more doxy, I decided to be 100% sure by taking 2 100mg tablets per day for 9 days to  rid my body of infection. I barely noticed the itchy feeling and I haven't noticed any stains. I've resumed doxy once per day. However, whenever I retract my foreskin, I always notice scant clear mucus at the penis tip. It seems as if it forms by the hole of my penis being shut because when I 'open up' the hole, I don't see any considerable mucus, but after I void, I don't really see it, but it comes back within about 2 minutes, it seems to form when my foreskin goes back over the head and makes the head of my penis tight together again. It doesn't really seem like actual discharge, but it is some sort of substance and it's very scant I can barely get a sample of it.

Questions:
1. does this seem like NGU? With scant liquid at the tip of my penis. It's more noticeable if I push the 'hole' of my penis shut and it sort of forms from there. The liquid doesn't really drip out
2. If I had NGU originally, and the doxy seemed to improve it, could NGU still be there?
3. I had a swab done when I tested for other STDs, would this have tested for NGU? Also, with the doxy 100mg once per day, would the swab be reliable for diagnosing NGU?
4. If I have NGU, will it clear up on its own without worry?

Thanks

[Edward W Hook, MD]

Glad to help. EWH

[concernedtim]

Thanks for your reasurrance Doctor.

I occasionally feel a slight sensitive feeling in my penis, not painful at all, but I have only noticed it these past few days and I'm going to assume it's nothing of significance.

I will resume normal activities without worry. Again, thanks for all your help.

[Edward W Hook, MD]

None of these additional comments change my opinion or advice.  Normal secretions can make you feel your urethra is "stuck" at the beginning of urination.  I do think the issue is what Dr. Handsfield suggested- one of "hyper awareness". EWH

[concernedtim]

Thanks for your comments.

Following up on your view of the 'normal secretions', is the fact that sometimes my penis appears 'shut' with the scant liquid running between the opening normal also? and is occasional itching a regular occurrence which I should also not worry about?

Also, I have just checked out the website for the sexual health clinic I went to and it stated: "A urine sample is taken for Chlamydia and a small swab may be taken from the tip of the urethra (opening at the tip of the penis). This sample may be looked at under the microscope to diagnose non specific urethritis or Gonorrhoea" -- so I'm guessing it's likely they tested for it because I told them I noticed a sort of discharge. So can I also assume that the doxy wouldn't have made a difference?

My last concern is that occasionally I almost feel a leaking sensation in my penis, particularly when I'm driving. Is it likely that without significant staining of the underwear that this is just an over analysis of a normal sensation? Keeping in mind I only reallly started to notice the feeling about 2 weeks after exposure which seems like good timing for NGU? It's more a question of mental vs. physical here.

That pretty much sums up all of my concerns really. But your comments have been very comforting and helpful thus far and I am very grateful.

Cheers

[Edward W Hook, MD]

Welcome back to the Forum.  I have ready all of your earlier interactions.  My sense is that you are quite focused on the possibility of having acquired an STD through the encounter that you had in the Fall and through your vigilance what you have noticed are normal genital secretions and sensations which you probably would have not noticed or ignored were you not worried about possible STD.   As Dr. Handsfield has already told you the doxycycline that you have been taking would have almost certainly prevented you from acquiring common STDs such as gonorrhea, chlamydia or NGU.  All men have normal urethral secretions which can be observed if one looks closely enough and these secretions can be increased during periods or arousal or when a person has a bowel movement.  Your non-response to the increased dose of doxycycline you took adds further evidence that this is not NGU.

As for your specific questions:
1. does this seem like NGU? With scant liquid at the tip of my penis. It's more noticeable if I push the 'hole' of my penis shut and it sort of forms from there. The liquid doesn't really drip out.
See above- this is more suggestive of normal genital secretions than NGU.

2. If I had NGU originally, and the doxy seemed to improve it, could NGU still be there?
Unlikely.  Some might argue you should be treated with alternate therapy such as azithromycin plus metronidazole (the recommended therapy for persistent NGU) but I am doubtful this would be beneficial for you.

3. I had a swab done when I tested for other STDs, would this have tested for NGU? Also, with the doxy 100mg once per day, would the swab be reliable for diagnosing NGU?
If you had NGU it could have been detected with a swab test IF the swab was evaluated for white blood cells. Unfortunately, many clinicians do not do this.  As I said above, the chance that you had NGU is very, very low.

4. If I have NGU, will it clear up on its own without worry?
Yes.

5. Can I pass NGU onto sexual partners vaginally/orally? and does alcohol consumption affect doxy?
NGU is transmitted to others only through genital intercourse, not oral (it can however be acquired following receipt of oral sex).  Alcohol does not affect the activity of doxycycline.  Your sexual partners are not at risk at this time.

I hope these comments are helpful.  EWH

[concernedtim]

Sorry, just a few quick things I forgot to ask:

Can I pass NGU onto sexual partners vaginally/orally? and does alcohol consumption affect doxy?

Also, if Dr. Hook happens to answer this question, this may be helpful to you (a question I had previously posted about the same encounter but with largely different concerns) -- http://www.medhelp.org/posts/STDs/Where-to-go-from-here-herpes-related/show/1827406