Uncured NGU

[Amir12]

Hi
I am 45 years old gay man.
Two months ago I had unprotected sex, few weeks later I got urethral itching and irritation between voids, burning sensation and urethral pain without discharge.
I was cured with 1g of Azithromycin.
Two weeks ago, I did unprotected Oral sex (very stupid I know), Only in 2 days later the previous symptoms returned. I got again 1g of Azithromycin. This time I had only few days of some relief, however, the symptoms returned.
In both cases I have tested for chlamydia infection, general Urine test and Urine Culture .Chlamydia was not  found in both cases. In the first test Leucocytes were fond.
I am very frustrated now. The doctor said that I should repeat the Azithromycin treatment.  
1. What can be the major cause for it? can it be one of the following?  (Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium)
2. What should I do?
3. Should I take an alternative antibiotic? If yes what is recommended?
4. Should I wait before taking another course of antibiotics for full PCR test?
5. How much time is needed between last antibiotics to PCR test?
6. Is there any way to relief the pain?

Thanks a lot

[Edward W Hook, MD]

I have answered each o fthese questions and will do so once meore, then it is time for this thread to end.

Is it possible to exclude any sort of  bacterial  infection?   You already have.  Infection would most often be associated with WBCs, particularly if it was causing symptoms (the symptoms come from the inflammation, of which the WBCs are a manifestion)

Should I perform more test?  I would not


Can NGU exist without WBC?  Signs of inflammation are part of the NGU definition when it is associated with infection.  Non-infectious NGU has been described but there are no studies of definitve data.

I have found in the internet the term "Urethral syndrome". Can it be possible cause for my situation?   No, this syndrome overlaps with NGU.  EWH

[Amir12]

Thanks for your answer
Is it possible to exclude any sort of  bacterial  infection?
Should I perform more test?
Can NGU exist without WBC?
I have found in the internet the term "Urethral syndrome". Can it be possible cause for my situation?
Thanks a lot again

[Edward W Hook, MD]

I am skeptical that this is NGU- if there are no white blood cells, it is hard to make a diagnosis of NGU.  There are other causes of the sort of extreme burning you describe.  These include disease of the nerves (neuropathy) which can be due to nutrional deficits, trauma (to the back) or other processes.

You might get symptomatic relief from the burning with a medication called pyridium.  Discuss this with your doctor.  EWH

[Amir12]

Thanks a lot for your answer.
In my second test I had no WBC, actually nothing has found.
The reason I think that PCR test might be needed is to identify whether I have any kind of known NGU infection.
Most prominent symptoms is the Extreme burning sensation which I really cant stand.

[Edward W Hook, MD]

Welcome to the Forum.  As I read your post, I note that you do not mention the presence of white blood cells along with your 2nd episode.  Is this correct?

NGU following oral sex is almost never due to chlamydia. What causes it is difficult to say and in most cases is unknown. the role of the bacteria you mention is not clear, particularly in NGU following oral sex..  It is thought that NGU, as indicated by symptoms and the presence of WBCs results from the introduction of oral/throat bacteria into the urethra during oral sex.  It most often does respond to either azithromycin, given as a single 1.0 gram dose or to doxycycline, 100 mg twice daily for 7 days.  

I don't know what you would do with a PCR test.


Please let me know about the WBCs and if pain are your most prominent symptoms.  We can discuss further from there.  EWH