Please Help...Possible NGU or worse...

[diddybop351]

I'm a 25 y.o. male. On May 10 I received unprotected oral sex from a woman I don't know so well (can't say much about her status). That was followed by intercourse w/ condom. Afterward, I noticed a small bit of blood on the condom.

On the evening of May 14, I noticed a very slight burning sensation close to the tip of my penis after I urinated. Other than the urge to urinate frequently, there were no other issues (no other pain, no noticeable discharge, no sores, etc.).

On the morning of May 15 I visited my family doctor. A urine sample revealed nothing alarming. I was treated for a UTI and prescribed a three day course of ciprofloxacin (250mg twice daily). They also took blood samples for a full panel of tests.

I returned to my doctor on May 17, as the Cipro appeared to have no impact. Burning sensation intensified significantly, but still no sign of discharge or other symptoms. Doctor prescribed a seven day course of doxycycline (100mg twice daily), and a shot (1g of a drug whose name begins with an R?).

Awoke on May 18, to find that the treatment must have had a positive effect. Burning during urination had decreased, although it was still present. Still no other visible symptoms. Only exception is considerable tenderness on the left and right side in the area just above my penis - swollen lymph nodes, I suspected. This pain has since subsided.

My research led me to believe I have NGU of some sort. Is my reasoning and/or minimally informed diagnosis off? Honestly, is it too soon to know what the real problem is?

Second, am I wrong to expect my symptoms to disappear as quickly as they came? What exactly is the nature of recovery once an effective treatment appears to have been identified?

Third, in light of the symptoms I've noted, what's the liklihood that I've actually contracted a viral illness?

The results of my blood work won't be back until the coming Friday or Monday.

I truly do appreciate your taking time to offer me some advice.

[Edward W Hook, MD]

There is no evidence that longer treatment has any impact on the response of NGU to treatment.  If you have not responded by the time you complete your therapy, it is most unlikely htat you have an sexually transmitted NGU and you should talk with your doctor about further evaluation.  Taking additional ceftriaxone or doxycycline would not be expected to have an effect.

It is likely that your diarrhea is a side effect of the antibiotics you ahve takend.  EWH

[Edward W Hook, MD]

The sequence of events and symptoms you describe do suggest that you may have gotten NGU, most likely from receipt of oral sex.  Your condom protected genital sex was safe sex.  NGU following oral sex is thought to be most often caused by bacteria from the mouth which get into the urethra to cause the irritation that it sounds like you experienced.  Short courses of ciprofloxacin often are not effective for NGU and the subsequent therapy you receive (doxycycline and rocephin [ceftriaxone] are the recommended therapy for both gonorrhea and NGU, the two most likely causes of your symptoms.  You should let your partner know that you experiences these symptoms.  While it is unlikely that she has an STD, she should know and discuss the matter with her own doctor.  Many doctors would treat her in the same way you were treated just to be on the safe side of things.

Your response to therapy is typical of NGU.  The symptoms do respond quickly with therapy. You should complete the doxycycline even though the symptoms have resolved.

Given the circumstances and your response to antibacterial therapy, this is unlikely to be a viral illness.

I anticipate your blood tests will be normal.  They usually are in persons with NGU.

Hope this helps. You have been appropriately treated and have little to worry about at this time.  Take care.  EWH

[Edward W Hook, MD]

Assume that the antibiotics are causing the symptoms you report.,  I would check with your docotr and see if they want to give you an alternate drug.  I suspect they will.  EWH

[diddybop351]

At this point, I think the symptoms from the antibiotics are more troubling than my initial issue. Slowly but surely, they do seem to be working on the infection, though.

I just want to be sure I'm not doing more harm to myself in the process. I do have nausea, a headache, fatigue, and am just generally in a daze for a bit after I take it.

My digestive system is a mess. Nothing stays down long, and it comes out liquified.

1) Can I be assured that at least the antibiotic is remaining in my system and not going    straight through me?

2) Are there any alternative supplements you might suggest to help my digestive system in the mean time? Probiotics?

[diddybop351]

Thank you. That does make me feel better.

Although, I should clarify...my symptoms got noticeably better after the first day of the subsequent treatment, but have not improved since then. It has now been 2-3 days, and I have been very much on top of my regimen. Lymph node pain has decreased, but is still also present.

In addition, as of last night, I appear to be having somewhat frequent loose bowel movements. The only thing I've done differently is to drink a fairly significant amount of cranberry juice (16-20 oz. of the real stuff, not ocean spray). Could this be related to my infection or is it likely a result of the juice? The cranberry juice eliminated the burning sensation when urinating while it was in my system, by the way...though I could still tell the infection was present.

I have a strong feeling that (at this rate) symptoms will not clear completely by the end of my course of doxy. And that without it, the full blown infection will return. Should I ask for an extension of my prescription to perhaps 15 days or even 3-4 weeks? Is there a stronger dosage of doxy that can be given right now to be sure we knock this out before the bacteria can potentially become unresponsive? Another shot of rocephin, perhaps?

Thanks again!