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Avatar universal

Worried

Hi Doctor,
I’m a heterosexual male in the UK in a long-term relationship. On June 9th I was obliterated drunk in a bar, got chatting to a girl of African origin (can’t remember where from or how long she’d been in the UK) who asked me ‘back to hers’. Stupidly I agreed, however never got there as I didn’t have cash on me for the cab and got out and went home alone. The next morning I woke up ultra paranoid that something may have happened (sex) from the walk from the bar to finding a cab, down a back road or something, as this period was completely blank.

Due to my paranoia, on June 24th  (15 days later) I went to my GUM clinic who swabbed me and said there was inflammation, took a urine sample & gave me 1g of azithromycin. My Chlamydia and Ghonnoreah result was negative. I’d barely had any symptoms at this point, if any, I think just a very brief few seconds of tingling in my urethra.

Then on 13 July,19 days after taking azithromycin, I had some pain in my testicle, went to my GP who did a urinalysis, puss cells were present and prescribed me 7 days of doxycycline. It was at this point that symptoms started but cleared over a couple of weeks. I haven’t had sex with my partner since being diagnosed initially and she has been treated with Azithromycin.

Importantly, I’d previously had non-chlamydial NSU in October last year which was from a one night stand (during relationship issues). I then had NSU symptoms in I think in Feb of this year (tingling, burning but no discharge) but after swab was told there were no white cells so wasn't treated and symptoms quickly went.

Question:
- Given the unlikelyhood of anything happening with the girl I met in the bar on the street that I have no recollection of at all, is it conceivable that the NSU diagnosed was a ‘reoccurrence’ from my previous episode at the end of 2012 and should be put down to simply a coincidence? I've read on your site that reoccurring NSU is common?

8 Responses
300980 tn?1194933000
MEDICAL PROFESSIONAL
Welcome to our Forum.  I'll be glad to comment on your interesting question.  You are correct, recurrent NGU is rather common and it appears to be more common among persons who have NGU with negative tests for chlamydia than those with chlamydia.  The management of non-chlamydial recurrent  NGU can be challenging.  I agree that there is really little chance that your symptoms noted after your episode on June 9 were related to an un-remembered sexual encounter and thus may be a reflection of non-chlamydial NGU or some other process.  Thus, I have the following recommendations:

1.  While possibly not related to your genital symptoms, it sounds like you have a drinking problem.  If you drink to the point of not remembering events, your life is being effected by alcohol.  I suggest you deal with this.  Often professional help is needed to address such problems.

2.   The possibility of recurring NGU needs to be addressed over time with one health care provider.  By going to different providers, each one is forced to start from the beginning.  There are very good GUM specialists all over the UK, I suggest you find a clinic and explain the problem and seek to work with one, knowledgeable provider.  Such experts may be able to do special tests for other bacteria related to recurrent NGU such a Mycoplasma genitalium.

3.  Consider other, non-STD causes of your symptoms.  It sounds as though you have partial responses and this may be a manifestation of something other than NGU such as prostatitis.  

4.  If this indeed recurrent NGU, something that is a diagnosis of exclusion (i.e. you need to have negative tests, be sure your partner is treated before you have sex again and then watch to see if the inflammation recurs), the good news is that it is not clear that recurring NGU represents a process that leads to complications for affected persons or their partners.  Before this assumption can be made however, you need to rule out the possibility of infection, make sure your partner is treated (perhaps again) and then demonstrate (preferably to the same health care provider) that your inflammation has recurred.

Please note that what I suggest above is not an event but a process which needs to take place over time.

I hope these comments are helpful.  EWH
Avatar universal
Thanks Doctor. Extremely useful. Rest assured this drunken night was a one off, a celebration that got out of hand. A couple of follow up questions if I may, and some additional info to give you the background. These two incidents occurred when my partner and I were going through some difficulties. She has never been unfaithful so can not have picked any bacteria up from anybody else - please assume this to be fact in your response.

September 2011: Received unprotected fellatio
December 2011: Had unprotected vaginal intercourse

Tested after both of these incidents for all common STDs and all were negative. Had unprotected sex with my partner between September and December 211 and then condom protected between December 2011 to June 2012 (largely as a result of waiting for HIV tests). I read about Mycoplasma Genitalium and Ureaplasma Urealyctum and tested at Freedom Health in the September – both were negative. I was then diagnosed with non-chlamydial NSU in November 2012 following very mild urethral tingling. Both my girlfriend and I were treated with 1g of Azithromycin and my symptoms cleared up over a couple of weeks (quite severe burning etc whilst on antibiotics).

I then tested again privately for a full host of STIs and the only ones that I tested positive for were Ureaplasma and Bacterial Vaginosis – I didn’t treat myself for these as I’d read that both were ‘normal’.

Re. the original infection, the only assumption I can come to is that I must have picked up an infection from either of these two incidents at the end of 2011 and either didn’t have noticeable symptoms until almost a year later or passed an infection to my partner between September – December 2011 and then pickied it up again to cause symptoms in October 2012 following several months of unprotected sex June 2012 to November 2012).

The NHS state however that NSU in the UK is broken down with the following percentages – 50% Chlamydia, 25% Mycoplasma Genitalium and 10% Ureaplasma.

Given the additional info I’ve provided and working off the NHS % figures:

- Would you still be confident that my recent NSU diagnosis would be much more likely due to a reoccurrence of my previous NSU at the end of last year (8 months later) than any drunken sexual incident I have no recollection of due to alcohol and I shouldn’t eat myself up over a theoretical possibility?
- If Ureaplasma is thought to cause 10% of NSU why is it advised not to treat for it?
- If my symptoms don’t come back would what I have had still be classed as ‘reoccuring NSU’ and I can just assume that the doxycycline was effective?
- Finally I'm concerned that if I did have sex that I don't remember I could have exposed myself to syphilis (she was African and potentially therefore high risk) and given I had unprotected sex with my partner between day 3-14 after this theoretical encounter I could have passed an infection to her that I would have cured myself of from the doxycycline I took so can't test. I didn't notice any chancres but I don't check the underside of my shaft so am concerned I might have missed something that could have been there - when my nurse swabbed me for NSU she also didn't examine me thoroughly, I even held my penis whilst she took the swab so she wouldn't have noticed any chancres on my shaft. Given the information I've provided is this an unrealistic worry and not of concern?

Apologies but as you can tell I am extremely anxious about this.

Thanks for this follow up Doctor, it's very much appreciated.
300980 tn?1194933000
MEDICAL PROFESSIONAL
Responses will be limited as we have limited time/space for this purpose.

No change in my assessment or advice.  I still suspect your recent episode was recurrent rather than acquired recently.

Ureaplasma is normal flora and need not be treated, thus even testing for it is a waste of time.  Recommended treatment may reduce the amount present but it typically recurs following "treatment"

If my symptoms don’t come back would what I have had still be classed as ‘reoccuring NSU’ and I can just assume that the doxycycline was effective?   Yes.

Your concerns about an unremembered exposure and syphilis are unwarranted.

Time to get over your anxiety and move on. EWH
Avatar universal
Thank you very much Doctor, you’ve been a great help. To end this thread (you have my word) It would be really appreciated if you could just answer the below for me – I don’t need any detail, just yes or no is fine as I know I’ve had my money’s worth but I need to check my understanding for my anxieties to be put to rest:

1.In your syphilis risk assessment you included the fact that this girl I may have had unremembered sex with was African and a recent immigrant?

2.In your syphilis risk assessment you didn’t take into account the fact my regular partner had taken 1g of Azithromycin for my NSU as she didn’t take this until 6 weeks after having sex weeks with me for the first time after my possible encounter with the African girl and so it would have been too long a period to be effective against syphilis anyway?

3. Coincidentally, my regular partner told me yesterday that she has rash patches on her leg and chest that she’s had for approx. 3 weeks – this raised my concerns about syphilis. It’s been very hot in the UK and she’d put it down to this. However, if the earliest onset of a chancre is 10 days, my partners rash would have appeared only 3 weeks and 2 days from the first opportunity of her coming into contact with a chancre on me and also she says the rash has been slightly itchy at times. From the reading I’ve done, it would seem extremely unlikely for a rash to appear within 3.2 weeks of first coming into contact with a chancre and that syphilis rashes do not itch usually. Would you agree again, that my anxiety is getting the better of me and the risk of this rash being due to syphilis is exceedingly low, all things considered?

Thanks again Doctor and you have my word these are my final clarification questions.
300980 tn?1194933000
MEDICAL PROFESSIONAL
Final answer.  Nothing you have said suggests any need for concern that you have syphilis. There will be no further answers.  EWH
Avatar universal
Thanks Doctor. Your advice is very much appreciated.

Enjoy the weekend.
Avatar universal
Apologies Doctor, can you just confirm with a yes or no that you did read my final 3 questions? Many thanks
300980 tn?1194933000
MEDICAL PROFESSIONAL
Since I provided an answer, you should assume I read your questions before answering them.  You are being entirely too paranoid.  EWH
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