NGU or what?

[coffeehouse]

To: DR Hook or DR Hunter
Dr

Sorry to bother you again , have been on the Cipro for thirty days now  and no relief,still a dull pain at the tip of my penis as well as discomfort,  and increases before and after urination.no discharge though. I am getting worried about this and need your advice , just to recap my situation un protected oral 28 feb, negative Cl/gon and no wbc in U/A , treatment so far:

1)       One dose Zithormax and shot of rocephin

2)       Six weeks Dox and thirty days CIPRO

I have been avoiding going home after eight months over seas because I am afraid to transfer something to my wife, nor do I want to tell her what happened, However I am fearful of a NGU infection,or something transferable to my wife. I have researched  usual causes of NGU other than Claymidia do you agree with these assessments

1)       Mycoplasma genitalium Is not known to transfer from oral and Dox is the recommended trteatment

2)       Mycroplasma Hominus is known to transfer orally and the recommended treatment is erthomycin

I am sure there is other bacteria and causes I am just so confused with the diagnose of NGU, since most of the liteturre is not mentioning how to test. some say the U/A is un reliable

My questions

1) Is the strip test which was used on me which changes color if WBC is present adequate to confirm a NGU infection or should I request a different U/A maybe one that checks these micoplasma’s and more just to give me much needed peace of mind?

3)  Shouild I maybe try the erthomycin to see that helps

Please advise I could have been home six weeks ago but have delayed my return wanting to resolve this as to not infect my wife and ruin my life

Thank you so much for what you do I very much value your opinion
Was this comment helpful to you?Yes No

[Edward W Hook, MD]

I agree, your positve test result with relatively low concentrations of staph is not a concern and is certainly not an STD. EWH

[Edward W Hook, MD]

I'm sorry to hear that you have not been able to get NGU off your mind.  As I indicated earlier, there is little evidence that you have NGU, your symptoms are not typical of NGU and you have been treated to excess with the medications recommended for NGU therapy.  Further, it appears that you are searching the internet for clues, an effort that is almost certain to be misleading and to present you with unproven suggestions as to the cause and management of NGU (not that you have it) which do not reflect global expert opinion.  Your wife is not at risk and my sense is that your fears may be amplifying either normal sensations or a benign, non-STD process in a way that they are have negative effects on you and your family life.  You need to find a health care professional who you trust and work through this.  It might involve counseling or other mental health intervention as well.  Finding another doctor who is just going to "throw" antibiotics at you to calm your fears and use that as a means for getting you out of his/her office will not help.  Further, some of the information you have come up with is incorrect-
Azithromycin, not doxycycline is the preferred therapy for M. genitalium which, as you point out, is not known to be transmitted by oral sex.

In addition, there is little evidence that M. Hominis is an STD pathogen for most people. It appears that it is acquired as a colonizing organism in most people as youth (sometimes in association with sexual activity) but it is not clearly a cause of disease.

In answer to your questions:
1.  The strip test is good but not the best test. The best test for diagnosis of NGU is a stained urethral swab test with the next best test being microscopic analysis of urinate collected just as you begin to urinate.

2.  Azithromycin and erythromycin are related antibiotics which work similarly. If anything azithromycin works better and is easier to take – you’ve already taken this.  

Sorry if this seem terse but I see little evidence that you have NGU and worry that you are stuck in a rut of self-reinforcing worry and guilt.  I hope my comments are helpful.  EWH

[Edward W Hook, MD]

Nothing more to say other than a single, last comment. You need to understand that for persons with no evidence of disease, one eventual consequence of continuing to take the same, unsupported complaints to doctor after doctor is that it makes it far more likely that you will ultimately find someone who gives you a medication which causes harmful side effects or does a procedure which can cause damaging side effects.  In reading your comments, my sense is that so far you have been fortunate to have seen doctors who have been restrained in their therapy and advice to you. Thus so far this has only cost you money and time.  I would suggest that it is now time to ask one of your doctors to help you find and counselor or mental health professional who can help you to address the anxiety and guilt which are contributing to your difficulties.  this is said in concern for you.

This will end this thread. Take care.EWH

[coffeehouse]

Doctor,

I am mhome now and visited my doctor he did a microscope anyalasa ansd said know bacteria exists in my urine and did a urine culture as well which had no growth. I am seeing a uroligist whom did the same test he put me on Septra and uribel for pain. I am still having the same symptons. This all started after oral sex performed on me months ago. I believe the test results and trust my doctor's, What else could transmit orally to me that could have been missed? Candida? Thrush? a fungus of some sort? Here is a list of the treatments I had:
Zithromax, Dox, flaygel, eyrthmycin, Cipro, septra
The urolgist informed me he often has patients with a prostate issue and that anxiety often cause the typ of pain I am experiancing due to the sensitive nerve,s in the pelvic region. thanks for your advice I am very exhausted from this.

[Edward W Hook, MD]

Most people have staph present on their skin.  Precisely how it gets into urine form there is tough so say.  EWH

[coffeehouse]

DR,

Thanks for the quick response, man I was worried, I will try again to put my anxiety at ease, Am still feeling pain and discomfort, however am working hard to convince myself is nothing to worry about, How does this staph get into the urinary tract? I was so careful during the U/A to clean with the alchohol provided for me, anyway's not a concern as far as an STD so glad to hear that, so no harm if I have sex for my wife? Anyways I will stop asking you questions after this I feel like a fool being so worried after the expert opinions I have recieved, I can deal with my pain just dont want to transfer something to my dear wife and be the cause of her having a problem. Thanks again God bless you and this web sight

[coffeehouse]

DR,
I obtained my U/A culture results today,the only positive result was 1000-10,000 M/L for staphyloccus species also this test did not check for WBC'S the doc said not to worry about that,however this is the second time the last result was out of range hi. which was about twomonts ago ,that doctor also said not to worry, was probaby due to some contaimination from my skin getting in the sample. I switched from that doctor however when she told me the gen probe test tested for trich, and WBC'S which is incorrect.Also this time ensured that I wiped my urethea with the alchohol swab and they did a mid stream sample so confused as to how the staph got inmy urinary tract The current doctor seems much more knowledgable, I am not doubting her just wanted your opinion.According to her this would not transfer to my wife even if this was my problem. My flight leaves tommorow,what is your opinion, avoid sex with my wife, and maybe see a uroligist or is this a cause for concern. I know am being excessive with worry,and appreciate your help, I was on line and read that staph bacteria does cause urinary infections

[Edward W Hook, MD]

Glad to help. I think your doctor's advice was right on target. EWH

[coffeehouse]

Thanks for the quick response, I visited the same doctor I have been seeing today, and told her of my fears about transfering STD to my wife, basicaly she mirrored everyhting you said to incude that M. Hominis being no chance for concern, and that she believed without a doubt that my problem was excessive worry and their was no chance of me infecting my wife. She did however do a urine culture test, only because I requested it and ten days of erythomycin. I will see her next week for results. At the end of my appointment she told me to buy my plane ticket and go home, and put this behind me:) She was very nice and proffessional, Anyway doctor the pain is not as bad and will go away eventually. I thank you so much for your expert advice.