Recurring NGU

[bubbafresh]

25 year old male in a relationship for 5 years except for a break for a few months last year. I had one other partner in that time, around May 20, 09.  We engaged in unprotected sex for a few minutes before stopping. By the last few days of June, I had the urge to urinate frequently, a clear discharge, and some inflammation in that area. I went to the Health Dept and I was diagnosed with NGU. Tests for Chyl, Gon, HIV, Syph were negative.

Given a 7 day dose of Doxy. Had reaction after one pill. Intense burning and itching in perineum. Mild on chest, arms,  and head.  Stopped dosage, returned to clinic a few days later. They found no signs of sores and thought it was allergic (been on Tetra family before with no prob) or fungal. Given Zithro and NGU cleared up in a week.

Symptoms returned after a few days. Much more mild. Mostly urge to urinate and dribbling. Found relief  when sleeping. 4 weeks later, the symptoms subsided (Mid Aug).

Reunited with my GF. She was tested just to be safe and was clean. End of September, received unprotected oral from her and had protected sex. The symptoms returned, again mild compared to initial infection. They found NGU and gave me Zithromax. My other tests were again clean. The symptoms cleared up within a week (early Oct).  GF was retested and negative (for Trich as well).  

Moved away to LA and had no other sexual contact. Beginning of Dec, the symptoms returned!  Very mild.  Was treated on the off chance it was Trich with Metro. Symptoms cleared in 2 weeks. 10 days later, (New Years Eve), GF visited and received unprotected oral.  Symptoms returned within a day.  Present ever since: weak stream, no discharge except for slight dribbling after urination. Unrelenting urges to urinate are most prominent at night, if at all. Ok when asleep. Since early Dec, have felt much more fatigued than normal (sleeping 10 hrs). No health insurance, working on seeing specialist.

Any chance this is rare case of HSV or some other STD?

[Edward W Hook, MD]

In general we suggest that partners be treated when they are seen but that is because we usually do not have information and test results.  In your situation, despite two negative tests, but given your persistent symptoms, it might be a good idea for BOTH of you to be re-treated at the same time.  There are some agents which are not routinely cultured for which might be treated.  A lack of response when you have both been treated would completely remove any lingering concern that this might be an STD which is "ping-ponging" back and forth between the two of you.  EWH

[bubbafresh]

Thanks Doc,

I had heard a prostate infection was a possibility so I will look into it.

One other question.  Is it advisable that my GF receives treatment or is the fact that she has been tested good enough?  Some resources say that they should be treated if her partner has been exposed to NGU.  I know that on both her visits that she made sure to specifically find out about Trich to spare me of the uncomfortable test and to also mention I had NGU, but they did not treat her as a precaution.  Of course, I was unable to find out about the other partner who I believe I acquired the infection from, but I have been treated for Trich anyways.

Thanks again!

[Edward W Hook, MD]

Welcome to this Forum.  Your detailed description makes it clear that you have been well evaluated for STDs relating to your recurring NGU.  That your tests for gonorrhea and chlamydia are negative is reassuring as is the fact that your GF has been tested and found not to have trich which is one of the important causes of recurrent NGU.  Furthermore you have been appropriately treated.  A small proportion of persons with NGU get recurrent NGU which continues to trouble them despite repeated negative tests and in the face of repeated treatment.  When this occurs there is no clear explanation of what is going on but, as long as both partners have been treated and evaluated, experience indicates that this troublesome set of symptoms is not a health risk to either the person with the recurrent NGU or their sexual partners.  Thus if this is what is going on, I doubt that there is little to be gained by further treatment or testing.  Some specialists suggest that in a small proportion of cases treatment with moxifloxacin is helpful but this reflects individual reports, not  the results of scientific study.  

In your specific case, the urinary urge and dribbling suggests to me that this may not be recurrent NGU but could be prostatitis.  This can present in the way that you describe.  A health care provider and perhaps a urologist would need to evaluate you for this and make the diagnosis. If this is prostatitis, the treatment is different that for NGU (more prolonged therapy).

There is nothing to suggest that this is an STD (including HSV) from what you tell me.   I hope this comment provides you with some direction.  EWH

p.s.  Alcoholic beverages tend to induce urination.  this is turn would make your symptoms a bit worse.  EWH

[bubbafresh]

I should add that I was retested in LA in early Dec through urine sample.  They did no slide test, but the tests came back neg for Chly, Gon, Syph, and HIV (6 month Test).  It was unclear to me whether they found evidence of NGU through this test since they mad eno mention of it.

I also mention New Years because I consumed alcohol.  I have found int he past few months that alcohol seems to aggravate it.  I have all but avoided it except for a few occassions aftera s tring of good days.  I will have a beer or two, and find that the urge to urinate starts soon after - and not in the way that alcohol normally causes this.