Standard NGU or is this Chlamydia?

[MarkFromOhio]

I had unprotected oral and vaginal sex with a friend on the 19th of August who just recently completed chemotherapy earlier this year. I was the first person she was with since her treatment and she was tested at the time for everything and was negative. She recently reconfirmed this with her doctor.

A few days later I noticed tingling in my urethra and a week later I had slight pain after urinating. I also experienced some pain in the upper portion, not the tip, of my penis on the evening of the 26th but no itching or discharge. I did "dribble" a little after urinating during that time but it was clearly urine that stained my underwear and again there was no discharge of any kind nor could I milk any discharge.

I had unprotected oral and vaginal sex with my wife on the 26th.

I was given 1G of Azithromycin on the 27th and my symptoms all but disappeared the next day. I'm still waiting on my urine tests for gonorrhea and chlamydia.

I understand that NGU can be caused by a variety of things other than chlamydia.

My friend was on a z-pack the 23rd of July for a cold which was 3 weeks prior to us being together. She did not notice a yeast infection which is common after taking antibiotics and has had a hysterectomy. Again, that was 3 weeks prior so I’m not sure if it is relevant.

1. Does this sound like standard non-chlamydia NGU considering the timing after exposure and symptoms? Lack of discharge, etc.?

2. Is the post urination dribble considered discharge or would I actually see pus of some kind?

3. I’ve read that post-urination dribble and post-urination pain are usually related to a UTI or prostate issues and not STD related, your thoughts?

4. Would chlamydia symptoms really clear up that quickly? 24 hours?

5. If I do have chlamydia could I have infected my wife in that short window? She currently has no symptoms.

Thank you for your professional opinion.

[MarkFromOhio]

Thank you doctor for your reassuring reply.

I received the results yesterday for gonorrhea and chlamydia and they are both negative. I'm also seeing a urologist who prescribed bactrim. My symptoms have returned slightly, light dribbling and urethral irritation. I likely need to lay off the copious amount coffee I drink. My angst was a result of the timing of the symptoms with regard to my potential exposure.

I still don't understand the urethral pain and the post-void burning and how either is related to a UTI or prostate issue? One commonly associates burning urination with a STD which is what I did.

Perhaps copious sex could also be to blame but I'd rather give up coffee. :)

Thanks again,

M

[Edward W Hook, MD]

Welcome to our Forum. I'll be pleased to comment.  Your partner was very low risk to have transmitted any typical STI to you- between her negative tests since the last time she had sex and that she was on azithromycin, the likelihood of any STI being present at all is miniscule.  Further, isolated tingling is not terribly suggestive of an STI (including both chlamydial and non-chlamydial NGU) and "dribbling" is not a sign of STI.  Thus, if you had an STI (and personally I doubt that you did), your symptoms would be due to non-chlamydial NGU.  There is debate as to whether non-chlamydial NGU is a risk for sexual partners.  Common practice is to treat exposed partners but it is not clear that there is really anything present that warrants treatment.  

As for your specific questions:
1. Does this sound like standard non-chlamydia NGU considering the timing after exposure and symptoms? Lack of discharge, etc.?
See above.  I am not even sure you had NGU of any sort.

2. Is the post urination dribble considered discharge or would I actually see pus of some kind?
No, dribbling is not the same as discharge.  Discharge is readily seen in most cases.

3. I’ve read that post-urination dribble and post-urination pain are usually related to a UTI or prostate issues and not STD related, your thoughts?
Certainly prostate problems are a possible cause of urinary dribbling.

4. Would chlamydia symptoms really clear up that quickly? 24 hours?
On therapy- perhaps.  

5. If I do have chlamydia could I have infected my wife in that short window? She currently has no symptoms.
If you did have chlamydia, the risk of transmitting infection to sexual partners through vaginal intercourse is about 40% per episode of intercourse.  If you did turn out to have chlamydia (I doubt that his is the case), it would be important to be sure that your wife was treated, irrespective of the presence of absence of symptoms.

I hope these comments are helpful. EWH