You can assume your g/f is already infected, whether or not she has had symptoms. Probably it is not possible to be close enough to have sex and not transmit adenovirus. And anyway, that probably was the cause of her sore throat. At this point, you need take no precautions of any kind in your contacts with her.
Conjunctivitis is common with adenovirus, but by no means universal.
Yes, adenovirus in your urethra or anywhere else will resolve by itself, without treatment. (Have you ever had a cold that didn't go away? Infections go away just as commonly no matter where in the body they are located, urethra or anywhere else.)
Garden variety NGU cannot continue despite azithromycin, and probably amoxicillin as well. I think I already said that.
Finally, your doc is not atypical. I'll bet 90% of practicing physicians have no clue that adenovirus can cause genital infection, and most are pretty much unaware of the other causes, the roles of oral versus genital sex in transmission, etc.
Most likely your sore throat and urethritis go together, both caused by adenovirus. That's one of the common respiratory viruses responsible for colds and sore throats, and some strains (especially type 19) also cause urethritis. Adenovirus explains around 3-5% of NGU cases and can be acquired by oral sex. When it does so, the symptoms are often exactly as you describe, i.e. mostly irritation and redness with little or no discharge. Like all viruses, adenovirus does not respond to antibiotics, so or course the azithromycin (Z-pak) made no difference. (It also made no difference in the sore throat. Almost certainly that was going to get better on its own.)
You could have caught it during your oral sex adventure, but the incubation period you describe is on the long side. (If you can talk to your oral partner, and find she has had sore throat or a cold, that would nail it down.) But if oral sex is among the practices you and your regular partner enjoy, that's an equally likely source. Most likely you'll never know. If the former, then you probably were indeed the source of your girlfriend's infection--but not because you acqired it sexually. As far as you and your g/f are concerned, you're just sharing a cold virus.
While it is conceivable that you had two separate problems, just about any bacteria you could have acquired by oral sex, including gonorrhea, would have responded to the 2 separate courses of azithromycin that you received. At this point, you can expect the urethritis symptoms to settle down and resolve; if they do, I wouldn't worry about it further, and wouldn't worry about your girlfriend's health.
I think that answers all 4 of your questions. Best regards-- HHH, MD
I've done about 20 full hours of reading through threads on this board, it's has been truly eye opening. The minimal fee associated with asking you a question pales in comparison to the wealth of information existing here.
From reading I was able to really rule out most STDs - including Syph/Gon/Chly(since it can't be passed orally, or is rare anyway) and was really only left with NGU. Your reply would certainly explain why my throat is still a tiny bit swollen, not sore and no more white spots, just ever-so-slightly swollen. My throat and urethra are so close to symptom-free it's amazing.
If indeed this is adenovirus, is it passable by kissing like a normal cold? Should I not kiss my g/f until all symptoms have subsided? Should I refrain from unprotected sex with her during that time as well? My general thinking is that since it's probably a virus, it may not matter from a kissing and sex standpoint. G/F has been well this whole time, aside from her sore throat that disappeared shortly after arriving. This indicates that even if I passed NGU from adenovirus to her it is not appearing as a genital problem for her - or if so is asymptomatic? Is that correct thinking?
If that's correct than I assume once the cause of the NGU has died (adenovirus in this case) the NGU will die with it? Meaning - no more antibiotics, let everything run it's course and relax?
Thank you for your time, you do a truly wonderful service by answering questions that even my local doctor just brushed off. Probably from a lack of experience but no lack of ego to say so. I have been shocked to read these forums and learn things about STDs I never knew and was never taught - I consider myself to be educated, but my apparent lack of good knowledge was surprising.
Thanks again, and best wishes...
Minor error, I guess your first antibiotic was amoxicillin, not azithromycin. Even better; there are no STDs or other bacteria that would stand up to both those drugs. So the error doesn't change my opinion or advice.
Terrific - thank you for your additional responses. Your last sentence about my doctor makes additional sense after rethinking it... a general practitioner in an average sized town like mine (just outside Portland, OR) probably wouldn't have seen enough of adenovirus to or even NGU to have a real sense of the intricacies.
That's why you specialize!
Many thanks...
Excuse the typo : If this is correct I should tell you I have, nor has my g/f had, any conjunctivitis at all. This SHOULD read : I have NOT had, nor has my g/f had, any conjunctivitis at all.
Thanks
As a quick followup to my 2nd post I got to do even more reading on adenoviruses and it suggests that they usually come with conjunctivitis. If this is correct I should tell you I have, nor has my g/f had, any conjunctivitis at all. Unsure if this changes your answer, but it's pertinent info.
If it does change your original response, then one of my original questions might still stand: would NGU have been able to live through a full course of Amoxicillin and would my g/f have been exposed a week or so after she had finished a z-pack?