NGU

[frank706]

Following one count of unprotected oral, I suffered from the following day with some mild dysuria (more noticeable in morning and if sitting down). This has lasted for 2 weeks or so and is still present (although my impression is that this is declining in intensity and frequency). No other symptoms are or have been present. I have been tested for chlamydia and gonorrhea and both tests have been  negative. Could this be a case of NGU and should I take antibiotics (and which? 1000mg of azitromicin?) or is it likely to be 1) related to stress/worry or 2) something that will pass on its own accord (i have been taking cranberry supplements and uva ursi but not sure if they have made a difference)?

thanks

[Edward W Hook, MD]

Welcome to the Forum.  Following receipt of unprotected oral sex it is possible that you acquired what we call non-chlamydial NGU.  Typically with this problem, increased numbers of white blood cells are also detectable in either a urine specimen collected just as you begin to urinate or on a swab test taken from the penis.  Your symptoms are consistent with this problem.  Non chlamydial NGU is treated with a single, 1gram dose of azithromycin.

It sounds to me as though it is likely that you have non-chlamydial NGU.  EWH

[Edward W Hook, MD]

I cannot say whether or not you ever had NGU and, since you've been treated and have negative tests, this is immaterial.

As for resuming regular relations with your regular sex partner, absolutely.

And with this, this thread will end.  EWH

[frank706]

Dear Doctor Hook,

Thanks for this. Despite feeling some mild symptoms after urination, I think I share your explanation and I am inclined to believe that this is a somatization issue.

Just two small questions before i bring this to a close and thank you for your invaluable help. Is it then possible that I never had NGU (and didn't need treatment after all)? Am I safe to resume regular relations with my regular partner? Many thanks in advance.

[Edward W Hook, MD]

Adenovirus is an occasional cause of NGU but most typically it would have resolved by this time.

My suspicion is that your mild symptoms are due to your looking carefully for symptoms.  When person focus on the possiblity of symptoms in one part of the body, they tend to notice normal sensations they would not otherwise be aware of.  I suspect this is occurring for you.  your tests should that you do not have an STI of concern and suggest that you further treatment, or concern, is needed.  EWH

[frank706]

Dear Dr Hook

I am sorry to write again as it means that my symptoms (dysuria) are persisting. These are maybe somewhat reduced (it was never painful more like  a discomfort) but this has lasted quite some time now (1 month or so) despite medication, which is  a bit troubling

Following your advice I have gone to the local clinic, who given my negative result for chlamidia and gohnorrea, treated this as Non chlamydia NGU and prescribed a 5 day combination course of metronidazole and azithromycin. This was taken correctly and no re-infection could have take place after the treatment, yet 10 days after completion the dysuria persists as described above.

The clinic Has now tested my for herpes and I am awaiting for results ( but although the appearance of symptoms was very wick less than 1 day, given the absence of other symptoms I expect these to be negative. But maybe this is not a reasonable assumption?)

There is the possibility of adrenovirus, but I understand this is uncommon and we do not test for this where I am. Is adrenovirus a possibility?

However, their working assumption is that treatment was probably effective but that inflammation can persist sometimes for several weeks after successful treatment. Would you agree with this? They suggest I should take some ibropufen to address inflammation (this after 2 days doesn't seem to have  made much of a difference) and if symptoms persist to be tested for signs of infection in 3 weeks or so (i.e one month after the last course of antibiotics). This will be a generic test looking for signs of inflammation rather than for specific pathogens (uroplasma or myoplasma) as my clinic does not offer this service and in their view is not needed (is this an issue in your view? should I be tested specifically for these? Other providers may offer this service). They also suspect that there may be some somatization involved

Now I would be very much interested in your views on this course of action and on the questions above.

Also could it be that my two tests for stds (12 and 15 days after exposure) were both false negatives?

Is it possible that the antibiotics haven't worked? Are there resistant strains of bacteria that could be responsible?

Is a virus possible?

Could it simply be a case of somatization and/or symptoms persisting for quite a while after treatment?

Or could this simply not be NGU but another medical problem?

I am so sorry for all these question and really thankful for any advice. Hopefully this will help me to see things more in perspective

I thank you in advance for your expertise

frank

[Edward W Hook, MD]

Your improvement of symptoms should be taken as indication of a response to therapy. EWH

[frank706]

Dear Doctor,

Sorry to write again but this email will probably conclude our exchange. About 7/8 days after having taken the treatment (1g  azithromycin) sympthoms seem to have finally receded. Is this likely to be evidence the treatment having worked and the infection having cleared and no further action being required ? Or could have the sympthoms simply become latent whilst the infection is still present (and can still be transmitted)? I am asking as my local clinic does not test for non specific NGU and there seems no obvious way to establish this. As I said sorry for my persistence but your reply should probably bring this exchange to a final close. many thanks. frank

[Edward W Hook, MD]

If you have persistent discomfort on urination, rather than self medicating, my suggestion would be for you to seek the input of a trained health care provider.  EWH

[frank706]

Dear Doctor

Sorry to write again. I took the 1 gram single dose of azithromycin,on thursday evening. Whilst i thought that sympthoms were receding, I had quite a bit of dysuria last night and this morning (so approx 72/80 hours after treatment). This are less frequent than in past but still present (no other sympthom is or was ever present).

What should I do? Is it just a case of waiting a bit longer for the treatment to work? Should I be retested (or considering that I was negative for std tests) tested for something else? Should I consider further treatment?

I thank you for you advice.

[frank706]

Great. that is helpful. I will proceed as suggested. Many thanks.

[Edward W Hook, MD]

As I said, the recommended therapy is azithromycin, 1.0 gram as a single dose.  The addition of metronidazole is recommended only for the very small proportion of persons who fail recommended therapy. EWH

[frank706]

Thank you doctor. Suspecting clamydia infection I purchased the standard treatment which is the same as for non chlamydial NGU (1 gram of azithromycin) which you have suggested baove but have not taken this yet. The lab which has provided me with my negative tests from chlamydia and gohnorrea is suggesting a 5 day treatment course of both metronidazole and azithromycin. Now this is longer, more interventionist and expensive than the single treatment of  azithromycin you suggested. Is there any reason for choosing this combination treatment of the single dose of azithromycin or would the latter be just as effective? My preference would of course be for the single dose of azithromycin  if this is just as effective. thanks again for your advice. f