NGU re-infection

[illyb20]

Hello,

I am a male living in Japan. On June 26th, I had  unprotected oral and vaginal sex with a woman I had just met. A week later, developed pain during urination and had clear discharge in the morning. Went to clinic, negative for Gon. And Clamd., but  urethral smear had a high WBC count, diagnosed with NCNGU. Received two weeks worth of levofloxin (100 mg 3x a day), but due to miscommunication, didn’t start treatment right away. So when I went in for the Clam. Test results,  still had high WBC’s and received a weeks worth of Cravit( generic f levofloxin, (500 mg x1day). Took one day of it, but made me feel ill so stopped, Finally ended up receiving a weeks worth  of “minopen’ (not sure of the English name, but same antibiotic family as DOXY) Finished treatment, symptoms resolved. 3 days ago, I had a normal urethral smear.  2 days ago I had  another encounter with the very same girl that gave me NGU. This time however, it was literally about a minute of receiving unprotected oral, before I came to my senses and stopped her. My questions are as follows,

1. Given the limited time of exposure, and the fact that it was just oral, what do you think my risk of re-infection is? I am concerned because this girl def gave me NGU before.(whether it was vaginally or orally I don’t know).

2. I have had some pain return on urination, not as bad as before, but still not  as comfortable as immediately after the “minopen” treatment, do you recommend I re-test? I know it is too soon to know if I am re-infected (2 days since oral) Thinking of going to clinic Sat.

3. Worse case scenario, I am re-infected, what is your opinion on NGU acquired orally? Is it of any concern for my health, any risk to the health of my future partners?

4. I still have Levo medicine untouched. I was thinking of taken it just to be safe, but thought maybe I have a resistance to it since I stopped after 1 does of the cravit. What is your opinion on this?

Thank you.

[Cj1885]

If yu took medication for ngu can drinking to much milk disrupt the healing processs..Cj22

[Edward W Hook, MD]

The timing of your test (i.e. first thing in the morning) means that htis was a good specimen.  I would not treat it.  


Your 2nd question is unanswerable.  I doubt that there is any risk to your partner.  Nothing more to say.  EWH

[illyb20]

I see. So you are saying that WBC's could still remain even though an infection is not present? I did make sure to go to the clinic in the morning, before I had urinated at all, so i would say at least 4 hours had passed from when I last urinated to when I took the evaluation. I was instructed to return after again after a week or two.

My main concern is that I am meeting a long time friend (with relationship potential) in a week, and there is a very good possibility things will get intimate. I just don't want to spread anything to her.

My last question would be, do you thing there is a possibility that I could have anything infectious to pass on? I will have at least taking a weeks worth of Cipro before meeting her, and my current evaluaiton didnt have enough WBC's to diagonse NGU. So I am not sure if i have the "green light" to have relations with someone without worrying about passing an STD to them.

Thanks again, although I am fairly proficient in the langauge here, medical situaitons are very difficult to understand, and your responses are very valuable to me. So I am very thankful for your time.

[Edward W Hook, MD]

The WBC's and irritation due to NGU do not go away immediately with treatment but may take a while to do so.  How long is difficult to say.  If you had a few WBCs on evaluation in my clinic but were below the threshold for NGU I would not treat you.  I might ask you to return for another evaluation, instructing you to not void for at least an hour befoe the sample was taken.  EWH

[illyb20]

Hello,

Just returned from my re-evaluation. There was a very small amount of WBC's found in my urethral smear, but it was not enough to be a diagonosis of NGU. None the less, I was given a two week supply of Cipro. Do you think NGU is still a possibility? Worried that even though it wasn't a high enough amount to diagonose NGU, there were still WBC's present.

Also, the night before the smear, I recieved a very rough hand job(nothing else) and ejaculation occured, not sure if that would effect the smear at all.

Thanks again for your time.

[Edward W Hook, MD]

Feel free to let us know the results of your follow-up evaluation.  I anticipate that it will not show NGU.  If that is the case I suspect the sensations you are experiencing are a reflection of paying too much attention to your genitalia, causing you to be aware of normal sensations that you would overlook or discount in other situations.  EWH

[illyb20]

I see, I suppose there are more questions than answers about nonclahmydial NGU, thank you for your first explanation.

If my testing does not show NGU, could this just be to anxiety? or to residual inflammation without persisting infection? Please allow me to check back in with you once I get the results.

Thanks again!

[Edward W Hook, MD]

I wouldn't worry about resistance.  If you have NGU it would reflect re-infection, not resistance.  IF TESTING SHOWS NGU, the minopen (which is probably minocycline) should work again.  

Please re-read my comments about nonchlamydial NGU above - Isummarized the current outlook and lack of information.  There is not more to say.  EWH

[illyb20]

Thank you doctor for your response, it was very informative. I just have a few things to follow-up with if I may. First, I have to admit the symptoms are not always present, sometimes I have discomfort somtimes I don't, and I am definetly very anxious about the whole situation. But nonetheless, I will go to re-test this Saturday, which would be 7 days from the possible re-infection.

Just a few additional questions I had from your answers,

If I am re-infected and recieve the "minopen" again, would be treated with the same antibiotic be effective? worried about resistance, but I took my "minopen" precisley.

second, I did not mean to ask if it is ok to leave NCNGU from oral untreated, rather I am very perplexed by the syndrome itself. I never knew NCNGU exisited till now, so I have done alot of reading. I have read somewhere on the forums that NCNGU usually doesnt lead to infertility and other such negative outcomes, and I remember reading somewhere that if the NCNGU has been known to be acquired orally, parnters arent usually treated. Is this accurate? I just have a general curiosity about NCNGU and would like to hear anything more you could add.

Thanks again for your time, and I will definetly go for re-evaulation this weekend.

[Edward W Hook, MD]

Welcome to our Forum.  I'll go straight to your questions:

1.  NGU following oral sex is less common than NGU following genital-genital contact but it still occurs.  In addition, the duration of exposure is certainly a factor in risk for acquiring any STD.  Thus while I certainly cannot give you a number, your risk for infection from the exposure you describe is certainly lower than following your first encounter with her.  The only way to be sure would be to have a re-evaluation with repeat testing for urethral white blood cells.

2.  The onset of symptoms at 2 days following your exposure is a bit on the early side for NGU but is possible.  Nonetheless, if you are uncomfortable when urinating, I think a re-evaluation would be wise.

3.  The significance of NGU acquired from oral sex is the subject of considerable conjecture.  It is assumed to originate from the introduction of oral bacteria into the urethra and as this would represent the introduction of "normal" bacteria into an "abnormal" place.  Non chlamydial NGU form oral sex may have somewhat less potential for long term harm, or transmission to others, than other traditional STD bacteria such as chlamydia but no one knows for sure.  If you are asking if it is OK to see if non-chlamydial NGU will just go away, the answer is no, I would treat it if I knew it was present.  Following this thought chain, again, if your symptoms are still there or worsen I would seek evaluation (intermittent symptoms on the other hand are more suggestive of heightened awareness than true infection.

4.  One levofloxacin would not cause resistance and taking it would resolve non-chlamydial NGU if present.  I would expect it to cause the same side effects as the last time you took it as well however.

Hope these answers are helpful. I suggest you go get checked again.  EWH