Prolonged Urethritis

[Attraction]

Diagnosed with NSU October 15th, treated 1g Azithromycin. Had sex twice, using condoms, with wife a week later. -ve Chlamydia, Gonnorhoea, Syphillis, HIV. 31st Oct discharge returned. Treated 1 week Doxycycline. 2 days after last tablet discharge returned. Can't get appointment at clinic till Moday and know I will be facing longer antibiotic treatment and no sex (haven't had any sexual contact with wife for nearly 3 weeks).
Any ideas what I have?
Will masturbation exacerbate my urethritis? Wife is also getting very frustrated. Can I safely perform oral sex on my wife or could I have an infection which is transmissible from mouth to vagina?

[Edward W Hook, MD]

First, my thanks to jedispider for catching my typo.  The recommended dose of doxycycline is 100 mg twice daily, tetracycline dose have the same effect and is recommended in a dose of 500 mg four times daily.  Sorry if my mis-statement has contributed to confusion.

The fact of the matter is, that if your wife is on low doses of tetracycline, this may reduce her likelyhood of infection., the operative word of course being MAY.

Finally, while you and I both suspect that your initial infection was related to stepping outside of your marital relationship, it is possible that what is going on now is no longer directly related to an infection that can be passed on.  We do occasionally see these "post-infectious syndromes" that are not fully understood.  Address the metronidazole issue mentioned above.  At the same time, given the complexity of the situation (as well as in general) more open communications are appropriate and ultimately best for all.

Hope this helps.  EWH

[Attraction]

Many thanks. It isn't fun but I think I understand the situation. The fact is that, although I have told my wife that I have urethritis and she has gone to the GP, I haven't spelled it out to her that this must have come from some extramarital activity. Strangely, her GP hasn't treated her specifically and she, in her naivity, hasn't realised that I have been unfaithful. I know I am gambling a bit with her health and that is really tough but I am weighing the chances of her being infected while on long term tetracyclines (albeit at a low dose) against the future of my marriage. I will return to the clinic and, if infection is still present, try to impress on my wife that she should get the same treatment as me, just to be sure.

[jedispider]

oh **** im sorry doctor u just put in  a typo, but i just wanted to explain to attraction what the doctor told me i mean i dunno its totally wierd his opinion is different from yours.

[jedispider]

tetracycline isnt doxycline, tetracycline is the medicine that is given to people that are allergic to penicillin. Doxy only comes in 50mg or 100mg, and tetra comes in 300-500 forms. Tetra doesnt treat chlamidia or ghonorrea that well. Reccomended is cipro or somethin else

[Edward W Hook, MD]

The dose of doxycycline your wife was on was far less than that which is recommended by the CDC for NGU  (500mg 4 times daily for 7 days).

Nonetheless, assuming that she is not infected and/or that she will now be treated with recommended therapy, see no. 1 above (treatment for trichomonas).  Also, there are a small number of persons who do experience persistent/recurrent urethritis despite doing all the correct things we've discussed.  Once the trichomonas issue is ressolved, you enter an area where there are no good data, only experience.  In this situation, one approach is to take the antibiotic which seemed to give you the best (quickest, most longstanding) response and take it for two weeks rather than one.  After that, for the very small group who are still having problems, we tend to tell them to observe the problem over time but also reassure them that after proper and repeated treatment of both them and their partners, the likelyhood that this is an STD which must be treated to prevent complications is very small.

A difficult situation.   I hope this helps.  EWH

[Attraction]

At the time when I first developed symptoms, and for 10 days afterwards, my wife was on tetracyclines (tetralysal 300 once per day since April) for another problem. She has been to her GP, examined and swabbed, but not given any other treatment. I have had no sexual contact with her since.
I wish you were right about my anxiety and over examination of my penis (I certainly have been in that sort of state) but my swab was positive between treatments, the discharge disappears when on antibiotics and returns afterwards, and it is visibly purulent.

[Edward W Hook, MD]

A question and several comments:

Question 1rst.  Was your wife treated at the same time you were either time? This is quite important.  There is a chance that she is infected as well.  For instance, you could have gotten it from her or, you could have given it to her before you developed your symptoms.  We often have problems of this sort come up because folks are trying to guess when they became infected and from whom.  Many people guess wrong.

Comments.  
1.  The CDC recommends that persons with recurrent NGU be treated with azithromycin or doxycycline PLUS metronidazole.  Trichomonas may cause persistent/recurrent urethritis.

2.  When anxious about response to therapy, some people focus on their penises so much that they notice symptoms that, in fact, are not really abnormal but are normal urethral secretions and/or sensations.  

3.  There is no information to suggest that masterbation has any effect on urethritis.

4.  Oral sex should not put your wife at risk.

Hope this helps.  Be sure your partners have all been treated.  EWH