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NSU & Mycoplasma Genitalium
Dr,
I am wondering at what stage NSU is no longer a risk. I ask because I have recurring NSU for a number of yrs. My GUM clinic has reassured me there is no reason to be concerned at this stage. I attended them numerous occasions. Some times there has >5 WBCs, on other occasions there was no NSU (i.e. <5 WBCs). No Gon or Chl found in any tests. In summary:
1st visit: NSU - Took 1g zithromax - wasn't called back.
2nd visit: 6 weeks later - No NSU
3rd visit: 16weeks later - NSU - Took 1g Zithromax.
4th visit: Returned 8 weeks later - No NSU.
5th visit: 7 weeks later - NSU - Took Metronidozole & Doxy for 1 week
6th visit: 30weeks later - NSU - Took 1g Zithromax & doxy
7th visit: 2weeks later - Still NSU - Took doxy & metronidozole for 1week
8th visit: Last October - No NSU.
It is something which has been physcological now for some time as you can see from above. I think it is raising its head again (last October) as I have had the same partner all this time & have recently started having unprotected sex & am worried I may pass something onto her.
Can you please advise:
1) In your medical view is there any reason for concern, i.e. could mycoplasma genitalium still be an issue after the original medication & if so at what stage would it have been eliminated?
2) After the initial medication (1g zithromax) I had unprotected oral sex with my partner but this was after the GUM clinic said there was nothing to worry about (even though i wasn't called back by them). Would there be any danger to my partner from this? All sex since then was protected.
3) I attended a urologist & was diagnosed with non bacterial prostatitis during the 5th & 6th visit above. He carried out a cystoscopy to confirm same. Could this be "mistaken" for NSU or how are the two linked? My GUM seem to think it is a prostate issue & my urologist also.
In summary I am concerned for my partner, especially after the unprotected oral, even though this was a number of years ago.
I am wondering at what stage NSU is no longer a risk. I ask because I have recurring NSU for a number of yrs. My GUM clinic has reassured me there is no reason to be concerned at this stage. I attended them numerous occasions. Some times there has >5 WBCs, on other occasions there was no NSU (i.e. <5 WBCs). No Gon or Chl found in any tests. In summary:
1st visit: NSU - Took 1g zithromax - wasn't called back.
2nd visit: 6 weeks later - No NSU
3rd visit: 16weeks later - NSU - Took 1g Zithromax.
4th visit: Returned 8 weeks later - No NSU.
5th visit: 7 weeks later - NSU - Took Metronidozole & Doxy for 1 week
6th visit: 30weeks later - NSU - Took 1g Zithromax & doxy
7th visit: 2weeks later - Still NSU - Took doxy & metronidozole for 1week
8th visit: Last October - No NSU.
It is something which has been physcological now for some time as you can see from above. I think it is raising its head again (last October) as I have had the same partner all this time & have recently started having unprotected sex & am worried I may pass something onto her.
Can you please advise:
1) In your medical view is there any reason for concern, i.e. could mycoplasma genitalium still be an issue after the original medication & if so at what stage would it have been eliminated?
2) After the initial medication (1g zithromax) I had unprotected oral sex with my partner but this was after the GUM clinic said there was nothing to worry about (even though i wasn't called back by them). Would there be any danger to my partner from this? All sex since then was protected.
3) I attended a urologist & was diagnosed with non bacterial prostatitis during the 5th & 6th visit above. He carried out a cystoscopy to confirm same. Could this be "mistaken" for NSU or how are the two linked? My GUM seem to think it is a prostate issue & my urologist also.
In summary I am concerned for my partner, especially after the unprotected oral, even though this was a number of years ago.
MEDICAL PROFESSIONAL
Azithromcin (Zithromax) indeed is standard therapy for NGU. Your GUM clinician may have been referring to Mycoplasma hominis, long recognized to inhabit the genital tract. Also, the general term "mycoplasmas" is often considered to include Ureaplasma. The more recently recognized organism, M. genitalium, was first thought to be covered well by azithromycin. However, research in the past 3-4 years has shown azithromycin is not reliable after all, but moxilactam is. For this reason, standard STD treatment guidelines in the US call for moxilactam if NGU has not responded adequately to azithromycin or doxycycline.
1) I doubt you were tested for M. genitalium. Tests currently are available only in a research setting, althoug commercial tests may be starting to appear in some countries and laboratories.
2) I already answered this. Except for chlamydia, it is likely that no harm would come to your partner, whether by oral or genital sex, and regardless of whether M. genitalium or other mycoplasmas were present.
3) I agree exactly with your urologist.
Don't get me wrong about M. genitalium. I doubt it explains your problem, and I doubt treatment with moxilactam would make any difference in your symptoms. But you still could discuss this with your urologist and/or the GUM clinic, then trust their advice about additional treatment.
1) I doubt you were tested for M. genitalium. Tests currently are available only in a research setting, althoug commercial tests may be starting to appear in some countries and laboratories.
2) I already answered this. Except for chlamydia, it is likely that no harm would come to your partner, whether by oral or genital sex, and regardless of whether M. genitalium or other mycoplasmas were present.
3) I agree exactly with your urologist.
Don't get me wrong about M. genitalium. I doubt it explains your problem, and I doubt treatment with moxilactam would make any difference in your symptoms. But you still could discuss this with your urologist and/or the GUM clinic, then trust their advice about additional treatment.
Thank you for your help doctor.
This is my last post on this issue.
Just regarding the issue on what you said above above about the medication for mycoplasma genitalium. When I asked the GUM clinic at the time what Zithromax covered they informed me it covered "Chlamydia even though your culture was negative & the other possible main causes of NSU for which we don't have conventional tests for, such as mycoplasma & ureaplasma". Also the urologist, when he checked my GUM results/chart he said "I don't see any testing for mycoplasma but the zithromax would have dealt with it". I also asked a private consultant & he briefly mentioned that zithromax should be effective. Is it not the standard medication used?? The medication you mentioned was never discussed with me as they said Zithromax was "the standard for NSU".
1. Also if I had one test that was clear only for it to return but gone again after more zithromax/doxy would that not indicate mycoplasma was not the issue as it would never have gone away in the first place without moxifloxacin?
2. If after the 1st dose of Zithromax, the mycoplasma (if still present) would there have been any danger to my partner from giving me unprotected oral sex? Everything since then has been protected & I wouldn't even have done oral in the first place only for the GUM clinic saying it was safe to do so. But how could they fully know that without having a test for mycoplasma?
3. As said the urologist diagnosed an inflammed prostate & although he said his knowledge of STDs wasn't extensive he said he didn't know of any that would cause an inflamed prostate (except perhaps Gon.). Would this be an accurate statement in your view?
Thank you again doctor.
This is my last post on this issue.
Just regarding the issue on what you said above above about the medication for mycoplasma genitalium. When I asked the GUM clinic at the time what Zithromax covered they informed me it covered "Chlamydia even though your culture was negative & the other possible main causes of NSU for which we don't have conventional tests for, such as mycoplasma & ureaplasma". Also the urologist, when he checked my GUM results/chart he said "I don't see any testing for mycoplasma but the zithromax would have dealt with it". I also asked a private consultant & he briefly mentioned that zithromax should be effective. Is it not the standard medication used?? The medication you mentioned was never discussed with me as they said Zithromax was "the standard for NSU".
1. Also if I had one test that was clear only for it to return but gone again after more zithromax/doxy would that not indicate mycoplasma was not the issue as it would never have gone away in the first place without moxifloxacin?
2. If after the 1st dose of Zithromax, the mycoplasma (if still present) would there have been any danger to my partner from giving me unprotected oral sex? Everything since then has been protected & I wouldn't even have done oral in the first place only for the GUM clinic saying it was safe to do so. But how could they fully know that without having a test for mycoplasma?
3. As said the urologist diagnosed an inflammed prostate & although he said his knowledge of STDs wasn't extensive he said he didn't know of any that would cause an inflamed prostate (except perhaps Gon.). Would this be an accurate statement in your view?
Thank you again doctor.
MEDICAL PROFESSIONAL
Welcome to the forum and thanks for your question.
I agree exactly with your GUM that "...there is no reason to be concerned at this stage". Indeed, maybe not at any stage. Nongonococcal urethritis -- or as it is commonly called in the UK, nonspecific urethritis (NGU or NSU, same thing) -- has never been shown to cause serious health outcomes in either affected men or their sex partners, as long as it isn't caused by chlamydia. Other proved or potential causes -- Mycoplasma genitalium, some strains of Ureaplasma urealyticum, occasional Trichomoas vaginalis -- have not been clearly linked with infertility, urethral stricture, pelvic inflammatory disease in women, or any other important long term outcome. This seems to be an especially safe conclusion for those NGU cases, about 40% of the total, in which the cause is entirely unknown.
To your specific questions:
1) You apparently have not been treated with any drugs that are reliably effective against M. genitalium, e.g. moxifloxacin (trade name Avelox in the US). You might mention it to the GUM clinic. However, as implied by my opening comments, I'm not sure it matters.
2) I agree there is no known danger to your partner, either by vaginal, anal, or oral sex.
3) There is overlap between NGU and prostatis, both in symptoms and in diagnosis. Even with the best methods in the most expert hands, it isn't always possible to distinguish them. But I'm pretty sure this doesn't matter either. Nonbacterial prostatitis appears to be an inconvenience, not particularly harmful for either men or their sex partners. Indeed, some experts recommend that men with prostatitis have regular sexual activity, believing it beneifts the symptoms.
So my advice is to look at this as a nuisance condition, not a serious health threat for either you or your partner. I'll bet both your urologist and your GUM clinicians would agree with this perspective.
I hope this has helped. Best wishes-- HHH, MD
I agree exactly with your GUM that "...there is no reason to be concerned at this stage". Indeed, maybe not at any stage. Nongonococcal urethritis -- or as it is commonly called in the UK, nonspecific urethritis (NGU or NSU, same thing) -- has never been shown to cause serious health outcomes in either affected men or their sex partners, as long as it isn't caused by chlamydia. Other proved or potential causes -- Mycoplasma genitalium, some strains of Ureaplasma urealyticum, occasional Trichomoas vaginalis -- have not been clearly linked with infertility, urethral stricture, pelvic inflammatory disease in women, or any other important long term outcome. This seems to be an especially safe conclusion for those NGU cases, about 40% of the total, in which the cause is entirely unknown.
To your specific questions:
1) You apparently have not been treated with any drugs that are reliably effective against M. genitalium, e.g. moxifloxacin (trade name Avelox in the US). You might mention it to the GUM clinic. However, as implied by my opening comments, I'm not sure it matters.
2) I agree there is no known danger to your partner, either by vaginal, anal, or oral sex.
3) There is overlap between NGU and prostatis, both in symptoms and in diagnosis. Even with the best methods in the most expert hands, it isn't always possible to distinguish them. But I'm pretty sure this doesn't matter either. Nonbacterial prostatitis appears to be an inconvenience, not particularly harmful for either men or their sex partners. Indeed, some experts recommend that men with prostatitis have regular sexual activity, believing it beneifts the symptoms.
So my advice is to look at this as a nuisance condition, not a serious health threat for either you or your partner. I'll bet both your urologist and your GUM clinicians would agree with this perspective.
I hope this has helped. Best wishes-- HHH, MD
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Herpes spreads by oral, vaginal and anal sex.
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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.
