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NGU Risk
Doc, here is my situation. I recently had an encounter where another man and I mutually masturbated and he gave me brief unprotected oral sex (~1 min). The event took place on 4/29, on 5/3 (3.5 days after exposure) I was tested at an getstdtested.com lab for chlamydia and gonorrhea, based on the timing recommended in one of Dr. Hansfield's posts stating virtually all people show infection in 3-4 days. I was still anxious, so I made an appointment to see a doctor, he gave me a shot of Rocephin and tested me again for chlamydia and gonorrhea. Long story short, the urine sample was lost/damaged so the doctor had me test again on 5/9. When I went in for the testing on 5/9, the doc gave me a prescription for 1g of Azithromycin (2 - 500mg pills taken in one dose) since I would be out of town when the results came in. I have had no noticeable discharge, no painful urination, no redness or tenderness in my meatus. However, I felt the need to urinate frequently (with the sense that I couldn't quite get all the urine out) that was present for a few days after my shot and Azithromycin pill and then it went away. Today 5/23, I feel general discomfort in my testicles.
All my tests are negative but I'd like your professional opinions to put a few issues to rest.
1. Can a urine test detect NGU or does it have to be a swab or the urethra?
2. Since NGU is caused primarily from Chlamydia and that is not passed orally (at least very rarely) what is real risk or NGU via oral (I can't find reliable statistics)? Are Mycoplasma genitalium, Ureaplasma urealyticum, or other bacteria able survive in the mouth like gonorrhea or are they more like chlamydia?
3. Would Rocephin and Azithromycin reliably clear up bacteria infection causing NGU, there is mixed information on what the preferred method of NGU treatment is?
4. Does my symptoms sound like NGU?
5. Finally, I'd like to put this mistake behind me, can I resume sexual relations without putting my girlfriend at risk.
Thanks
All my tests are negative but I'd like your professional opinions to put a few issues to rest.
1. Can a urine test detect NGU or does it have to be a swab or the urethra?
2. Since NGU is caused primarily from Chlamydia and that is not passed orally (at least very rarely) what is real risk or NGU via oral (I can't find reliable statistics)? Are Mycoplasma genitalium, Ureaplasma urealyticum, or other bacteria able survive in the mouth like gonorrhea or are they more like chlamydia?
3. Would Rocephin and Azithromycin reliably clear up bacteria infection causing NGU, there is mixed information on what the preferred method of NGU treatment is?
4. Does my symptoms sound like NGU?
5. Finally, I'd like to put this mistake behind me, can I resume sexual relations without putting my girlfriend at risk.
Thanks
MEDICAL PROFESSIONAL
Welcome to the forum. I happened to log in to the forum just as your question came in.
You need to move on with no worries about NGU or any other STD from the encounter described. First, receiving oral sex is low risk for STDs in general. Second, the treatments you had would have aborted or eradicated any bacterial infection you might have had, which escaped diagnosis -- including gonorrnea, chlamydia, syphilis, and NGU. (There was no risk for chlamydia, which rarely causes oral infection and therefore rarely is transmitted by oral contact.) Third, your negative tests are reliable. Fourth, NGU acquired by oral sex is probably harmless, with no known serious health outcomes for either infected men or their sex partners. Finally, your symptoms do not suggest NGU, which does not cause frequent urination, especially in the absence of urethral discarhge; nor do any STDs cause such a symptom.
Those comments cover questions 3 and 4. To the others:
1) Absence of symptoms, plus the treatment you have had, are sufficient evidence to know you don't have NGU. There is no reliable test for asymptomatic NGU.
2) There are no statistics on frequency. Ureaplasma and mycoplasmas are not known to be transmitted by oral sex, but this has not been carefully studied.
5) No distant online expert can guarantee someone isn't infected. For example, I don't know what STD risks you have had other than the one described. But if I were in your situation, with my knowledge of all the issues, I would never have stopped having unprotected sex with my wife and I certainly would continue it now, with no worries for her health or safety.
I hope this helps. Best wishes-- HHH, MD
You need to move on with no worries about NGU or any other STD from the encounter described. First, receiving oral sex is low risk for STDs in general. Second, the treatments you had would have aborted or eradicated any bacterial infection you might have had, which escaped diagnosis -- including gonorrnea, chlamydia, syphilis, and NGU. (There was no risk for chlamydia, which rarely causes oral infection and therefore rarely is transmitted by oral contact.) Third, your negative tests are reliable. Fourth, NGU acquired by oral sex is probably harmless, with no known serious health outcomes for either infected men or their sex partners. Finally, your symptoms do not suggest NGU, which does not cause frequent urination, especially in the absence of urethral discarhge; nor do any STDs cause such a symptom.
Those comments cover questions 3 and 4. To the others:
1) Absence of symptoms, plus the treatment you have had, are sufficient evidence to know you don't have NGU. There is no reliable test for asymptomatic NGU.
2) There are no statistics on frequency. Ureaplasma and mycoplasmas are not known to be transmitted by oral sex, but this has not been carefully studied.
5) No distant online expert can guarantee someone isn't infected. For example, I don't know what STD risks you have had other than the one described. But if I were in your situation, with my knowledge of all the issues, I would never have stopped having unprotected sex with my wife and I certainly would continue it now, with no worries for her health or safety.
I hope this helps. Best wishes-- HHH, MD
Oh no Doctor, I do not underestimate you, that's why I prefaced my statement by saying you have years of experience and that I'm no doctor. Thank you for clarrifying, even though I posted in someone else's thread. I did not intend to sound argumentative at all, sorry about that.
No response required Doc, I just wanted to apologize. Thanks again.
No response required Doc, I just wanted to apologize. Thanks again.
MEDICAL PROFESSIONAL
With respect, you underestimate my expertise in this area. I am very familiar with the research literature on M. genitalium and of course with the female consequences of urethritis in men. Some of the lead M. gen researchers are my colleagues and personal friends. Whether the organism causes PID or cervicitis are far from clear; the data are mixed at best, and the more studies are done, the muddier the picture has become. And in any case, M genitalium has not been associated with sexual transmission between males or by oral sex -- which is veryworried's situation.
In 30+ years in the STD business -- starting long before we knew about M. genitalium or worried about treating it -- recurrent or persistent NGU has been one of the most common problems I have dealt with, and I have never seen a serious health outcome in either an infected man or his sex partner.
That will be all for this thread.
In 30+ years in the STD business -- starting long before we knew about M. genitalium or worried about treating it -- recurrent or persistent NGU has been one of the most common problems I have dealt with, and I have never seen a serious health outcome in either an infected man or his sex partner.
That will be all for this thread.
Doctor
with all due respect, I must disagree with you on one point here. I'm no doctor and you have years of hands on experience with STD's, but if Mycoplasma Genitalium is the cuase of the NGU, studies have shown there is a risk to the partner in the form of cerviticitis and PID. Both of which can cause major damage to a woman's reproductive system. Again, I'm no doctor but most of the research I have come accross indicates this.
with all due respect, I must disagree with you on one point here. I'm no doctor and you have years of hands on experience with STD's, but if Mycoplasma Genitalium is the cuase of the NGU, studies have shown there is a risk to the partner in the form of cerviticitis and PID. Both of which can cause major damage to a woman's reproductive system. Again, I'm no doctor but most of the research I have come accross indicates this.
MEDICAL PROFESSIONAL
NGU_Fool's comments are right on the mark. But I would reemphasize what I said above: there are no known serious health outcomes from recurrent or persistent NGU or chronic prostatitis. The discomfort is one thing, but don't let it keep your eyes off this central fact. If you end up having to live with it, no harm is likely either for you or any current or future sex partners.
I'm not sure what to make of your situation, but there are many men out there who have had negative test results and yet they are still experiencing symptoms. As you've read, there are bacteria that can cause this kind of stuff, but they are never identified because they are not tested for. Antibiotics are prescribed, and how a patient responds is the measuring stick used to determine sucess of treatment. When all courses of antibiotics are used, and the patient still isn't responding, the patient is written off as having urological or Psychological issues. Although the doctor is probably correct in that you have been treated for STD's and should not be worried about passing anything on to your partner, you still do not have any answers as to what's really going on with you, which is the most frustrating part. Hang in there and be persistent with your doctor. Do your own research so you can speak to him in an educated manner and bring up other possibilities. If he will not hear any of it or even consider anything you bring up, you should probably get another doctor who is will to work with you and/ or at least explain why they do not think you have a certain condition.
MEDICAL PROFESSIONAL
1) No STD. Prostate problems, probalby.
2) There is no chance you had gonorrhea, and in any case the treatments you had would have successfully treated it.
You have testicular discomfort despite the antibiotic almost certainly because you have no infection. No antibiotic is likely to help your symptoms. Please re-read all my replies above.
This forum cannot help you further. I will have no other advice.
2) There is no chance you had gonorrhea, and in any case the treatments you had would have successfully treated it.
You have testicular discomfort despite the antibiotic almost certainly because you have no infection. No antibiotic is likely to help your symptoms. Please re-read all my replies above.
This forum cannot help you further. I will have no other advice.
Thanks for your advice, a few final questions for this thread, if you wouldn't mind.
1. You mention that you see several cases like this in your practice, can you elaborate on what is often the cause.
2. I have read that the CDC recommends dual treatment for gonorrhea, sinceit is becoming for drug resistent. Would the fact that my treatment of rocephin was given one week prior to the 1g of azithromicin be of any concern to the effectiveness of treatment. Could the shot of rocephin give a false negative on my follow-up gonorrhea or is this situation of no concern.
I am now 3 days into my prescription of tetracycline and still have the same testicular discomfort. Can the amount of antibiotics I have had prescribed (possible killing of good bacteria) be a cause for the testicular discomfort, if the meds I had kill std bacteria, wouldn't it have likely killed other bacteria that would cause testicular discomfort?
Again, thank you for your help and advice.
1. You mention that you see several cases like this in your practice, can you elaborate on what is often the cause.
2. I have read that the CDC recommends dual treatment for gonorrhea, sinceit is becoming for drug resistent. Would the fact that my treatment of rocephin was given one week prior to the 1g of azithromicin be of any concern to the effectiveness of treatment. Could the shot of rocephin give a false negative on my follow-up gonorrhea or is this situation of no concern.
I am now 3 days into my prescription of tetracycline and still have the same testicular discomfort. Can the amount of antibiotics I have had prescribed (possible killing of good bacteria) be a cause for the testicular discomfort, if the meds I had kill std bacteria, wouldn't it have likely killed other bacteria that would cause testicular discomfort?
Again, thank you for your help and advice.
MEDICAL PROFESSIONAL
Situations like yours are very common in STD clinics; we have seen hundreds of patients with essentially identical complaints. I have never seen or heard of anyone having a bad outcome as a result. I doubt you had epididymitis, and my bet is your doctor didn't really think it likely. He probably treated you only as a precaution.
It seems your doctor is quite knowledgeable about STDs and problems like yours. I suggest you continue to follow his advice and wise counsel.
It seems your doctor is quite knowledgeable about STDs and problems like yours. I suggest you continue to follow his advice and wise counsel.
I had my follow up appointment today with my Doctor to review the results. As stated, he confirmed the negative tests. I told him of my testicular discomfort so he examined and said my right testicle seemed a little swollen. He reiterated your point that the meds should have cleared any std infection and concluded i might have a slight case of epididimis. He prescribed 10 500mg tetracycline pills (1 a day). I asked him about sex and he said that whatever i have isn't an std because i was absent typical symptoms (discharge, apparent urethra infection) also the meds and test results confirm its not an std. He thought I was probably just reacting to normal bacteria that my body didn't like so it should be no risk to others. With all i have read on other forums and such a low risk of STDs via oral/mutual masturbation, oral ngu being harmless, I wanted to get your thoughts. Have you seen similar situations in your practice? With 2 negative gonorrhea and chlamydia tests would you agree with my doctors assessment and prescription? Is epididimis (my testicular discomfort is mild not severe and i understand epididimis to be) a likely diagnosis? Thanks again for your advice.
MEDICAL PROFESSIONAL
You have it exactly right: the STD viruses and bacteria evolved to accommodate to the genital tract and most do not readily infect the oral cavity.
It makes sense that vigorous oral sex or deep penetration might increase the risk of STD, but no data exist; it has never been studied.
It makes sense that vigorous oral sex or deep penetration might increase the risk of STD, but no data exist; it has never been studied.
Thank you Doctor for the reassurance, I was thinking guilt/anxiety was behind my "symptoms" but your expertise and experience go along way in relieving those fears. I trust your answer (as I have not had any other risks outside my normal partner for over 7 years) and appreciate the quick response.
I am curious about one thing though, why is oral sex generally considered such low risk? Is it because the mouth isn't a conducive environment to STD bacteria or that the body can fight small amounts of bacteria that enter the urethra.
In your experience are oral infections usually linked with rough/vigorous fellatio or any common factor?
I am curious about one thing though, why is oral sex generally considered such low risk? Is it because the mouth isn't a conducive environment to STD bacteria or that the body can fight small amounts of bacteria that enter the urethra.
In your experience are oral infections usually linked with rough/vigorous fellatio or any common factor?
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
