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Avatar universal

Post NGU tretment symptoms

On a recent trip to Bangkok, Thailand I unfortunately was exposed to unprotected oral contact (her mouth, my penis) from a bar girl before I could get a condom on (I did not ejaculate).  Within 2 days I developed STD symptoms (slight urethra burning, penis & testicular skin redness & irritation, later swelling of the lower right side abdomen). The burning intensified in a couple of days. Concerned with my symptoms and being a long way away from US medical resources, I cut my trip short, returned 2 days early. Upon landing I went directly to a well know STD clinic (6 days after exposure). I was tested for UA, Chlamydia, Gonneria, HSV, RPD, HIV1/2, Syphilis all tests were negative.

The Doctor diagnosed me with NGU and prescribed (14) 100mg Doxycycline Hyclate and (14) 500mg Ciproflonacin. I completed the prescription on this past Monday Night (its Thursday afternoon). The symptoms have cleared up….except for an odd/uncomfortable feeling in the urethra.  I have a slight continuous feeling that I need to urinate (feels like it's wet) and slight irritation (however no discharge and no other symptoms) what should I do?

What should I do about my remaining symptoms? Go back to the STD Doctor (or call his office)? See my GP? See my Urologist? ….Should I be concerned that I might have something else (Syphilis?) or that the NGU infection still remains?

Also, the Doctor indicated that I could have been exposed (it’s been about 15 days since exposure) to HIV (which has me really concerned) suggested re-testing in 3 months with my GP. What are the odds that I could HIV? How concerned should I be? Should I have another HIV test now?

I have not had any further sexual encounters, however I am concerned about disease transmission to my long term female partner (we use condoms for vaginal sex) any recommendations? Should I refrain from unprotected encounters?
3 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
From your initial description, I would have had low suspicion for any STD, including NGU, first, because the exposure was oral (low risk, although not zero); second, because your symptoms came on too soon, since NGU symptoms typically start after 1-2 weeks, rarely if ever as soon as 2 days; and third because NGU typically causes discharge without burning, not the opposite.  In any case, NGU acquired by oral sex has never been known to cause any kind of complicaiton or long term health consequence, either for the patient or his sex partners; and highly expert, Western STD care is readily available in Bangkok.  It was a pretty major overreaction to return to the US for care.

That said, the opinion of an STD clinic provider -- perhaps especially a "well known" clinic -- has to be taken seriously.  But did they definitively diagnose NGU?  Or perhaps conclude that as the best bet, even though they didn't actually find definite evidence of it?  If you did have NGU, most likely you caught it during a sexual exposure sometime before the oral sex event you describe.

As to your continuing symptoms, I doubt they are due to persistent infection, if you ever had one.  The vague sort of symptoms you describe could just be residual feelings that can continue after cure.  (People who sprain their ankles often have continuing milder pain or discomfort for months after the sprain has healed.  Similarly, a genital tract infection can have mild symptoms long after the initial problem is gone.)  If you remain concerned, return to the STD clinic.  If they find no evidence of continuing inflammation or infection, nothing more need be done.  I certainly do not recommend running off to urologists or other specialists.

Whatever is going on, you can be sure it is nothing that will ever harm you or yoru regular partner.  I see no reason to alter your sex life at this point or to use condoms.  Even if you had NGU, at this point you can be sure you have nothing that could possibly harm her.

Finally, HIV is not a serious concern from oral sex, especially given the brevity of your exposure.  Scan some threads in the HIV prevention forum about the essentially zero risk of HIV from receiving oral sex, even if your partner had HIV -- which is unlikely, since HIV now is rare in commercial sex workers in Thailand, due to a very effective national control program.

I hope this helps.  Best wishes---  HHH, MD
Avatar universal
Thank you for your professional response. While in asia I did take arithromicin from the local pharmacist. The initial overnight dose helped with the burning however the other symptoms continued to escalate. I went back to the Pharmacist and was given additional arithromicin but no reduction in symptoms. By the time I reached the US, the genital area skin was inflamed (sore like a sunburn) and right side abdomen/lymph nodes were swollen (at this point, post treatment swelling about 90% gone).  It might have been an overreaction to comeback sooner, however worsening symptoms, foreign country, traveling alone, etc…it was the decision I made. By the time I noticed the symptoms, I had left Bangkok and was in another part of the country.

As far as your question “..did they definitively diagnose NGU?” That is what I was told from the MD. It is my understanding that if tests for Chlamydia, Gonneria come back negative, the conclusion is NGU.

I am a little confused….it seems as you suspect that I did not actually have NGU…if that is the case, what would suspect that I actually contracted that would have these symptoms?...and would the treatment that I received be sufficient clear that up?

Thank you
239123 tn?1267647614
MEDICAL PROFESSIONAL
Diagnosing NGU requires more than eliminating gonorrhea, chlamydia, etc.  The standard criteria used by most experts are absence of gonorrhea plus the presence of at least 2 of the following 3 abnormalties:  symptoms of urethritis, abnormal urethral discharge seen on examination, and evidence under the microscope of increased white blood cells in the urethra.  Your symptoms were not typical, and certainly NGU does not cause inflamed skin or lymph node inflammation in the groin.  So call that one borderline at best.  You don't say anything about visible discharge or urethral WBC.  The other reason for skepticism is that azithromycin is highly effective; it is unusual for NGU symptoms to persist after such treatment.  Some STD specialists would treat for possible NGU if someone had less than the formal criteria, but without necessarily making the diagnosis.

While I didn't think it through in my initial response, the rapid onset of symptoms plus the obvious skin irritation suggest some sort of chemical or allergic reaction, e.g. to latex, spermicide, lubricant -- or especially to an antiseptic or strong soap, especially if you washed vigorously after the exposure.  But certainly not any sexually acquired infection.

Most likely you'll never know just what the original problem was, but I don't see that it matters.  Any infection that could have caused the symptoms you describe that that might have risked harm for you or your partner would have been effectively treated by the multiple antibiotics you have had.  So I suggest you just go on with your life, confident nothing bad is going to happen and that your minor residual symptoms will eventually fade.  If you find this reassurance inadequate, all I can suggest is that you return to the STD clinic for further assessment.  But don't get your hopes up for any more clarity than you now have.
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