Thank you, Doctor, for the very well-written clear explanation. I feel a little better. Am I understanding correctly that symptoms--including discharge--can be caused by inflammation/irritation without any bacterial cause? I'll take your advice re. sticking with my PCP and condoms for oral sex for a few months.
I'll try to help. Your question is a good opportunity for another primer on urethritis, oral sex, and related issues.
Your doc is right; oral sex often results in nongonocccal urethritis (NGU) or gonorrhea. Otherwise normal bacteria from the mouth apparently can sometimes cause inflammation in the urethra. Overall, about 30-40% of NGU is due to chlamydia; for the most part, the specific causes of the remainder are unknown. Other known causes include a bacteria called Mycoplasma genitalium, and a few cases are caused by herpes and other viruses. But the specific causes are pretty much unknown for around half of all cases of NGU.
Gonorrhea certainly can be acquired by fellatio, and is particuarly common in gay men. Chlamydia rarely infects the throat and mouth, and therefore NGU from oral sex is rarely if ever caused by chlamydia.
Gonorrhea testing of the throat is imprecise and many cases are easily missed with starndard testing. Their negative tests do not prove your partners were not infected. They should have been treated against gonorrhea, based on exposure to you and regardless of their test results.
Recurrent NGU is a common and vexing problem, for both patients and their providers; it almost never is due to chlamydia. However, I cannot tell whether your recurrent problem represents recurrences or new infections. At leat one episode, the gonorrhea, was a new infection; gonorrhea treatment failure is rare.
It isn't clear that all NGU recurrences mean infection, or just inflammation/irritation. In any case, recurrent NGU appears not to be dangerous in any way. There is no evidence it ever leads to urethral stricture, epididymitis, infertility, or any other complication in men, and no evidence that it causes disease of any kind in a person's sex partners.
You would be wiser to stick with a single provider, preferably your PCP. It sounds like he is pretty knowledgeable about STDs, and therefore will understand the issues about recurrent NGU--and thus will understand it doesn't imply you are being untruthful about your safe sex practices.
That answers several of your questions. To the others:
4) Levaquin is active against chlamydia and gonorrhea, but at this time you probably have neither of those. The drug also is active against most NGU of unknown cause.
5) Theoretically, your symptoms could reflect prostatitis. But that is a grossly over-diagnosed condition; it is a "wastebasket" diagnosis, that is a name many providers attach to otherwise unexplained urethral discharge, including recurrent NGU. True prostatitis probably is not a common explanation.
6) Non-penetrating penile-anal contact carries a very low risk, but I cannot say it is zero.
7) I doubt spermicide is a cause. But you should stop using condoms with spermicide. Nonoxynol-9 and other spermicides tend to increase STD/HIV risk, not decrease it.
8) Conceivably some people's urethras indeed are more susceptible to symptoms from oral bacteria. This has never been studied.
The last thing I will add is that you might consider using condoms, even for oral sex, for several months. Perhaps you are in a cycle that might be broken if you stopped allowing the potential for urethral infection. In addition, although the risk of catching HIV is low, in the presence of urethritis your risk undoubtedly is higher than it otherwise would be. You should be sure you know your partners are HIV negative, especially if you continue to have unprotected exposures.
Good luck-- HHH, MD