Could infection be caused by incident 38 days ago?

[whostoblame]

Dear Doc-  Thanks for all of your insightful answers to these hard questions. I have a dilemma that I will now explain.  Let me first start off by saying that I am in the process of getting a divorce.  Anyways, On the 4th of July, 2005, I met my current girlfriend; instant attraction.  After meeting her, I went ahead and did the whole gamut of STD tests; HIV, Syphilis, Gonorrhea, and Chlamydia.  All results came back negative.  She too, back in April, tested negative for the previously mentioned diseases.  Things were going fine until my soon to be ex-wife and I had unprotected vaginal sex on August 25th.  Well, I conferred with my ex before hand if she had been with other guys in my absence; she said she had, but had used a condom;  To tell you the truth I do not know if she performed or received oral sex from any of these encounters.   Anyways, I deemed it safe and relatively low risk.  The sex only lasted a few minutes, I withdrew and ejaculated, and after it was over I washed myself.  I felt horrible about he whole ordeal; not only because I felt my intentions could be misleading to the ex, but because I felt I had cheated.  I thought nothing if it, other than the guilt, and proceeded with my life; having unprotected vaginal  and oral sex with my girlfriend.  On October 3, 2005, something changed.  I began to have an itch inside my penis; about a centimeter into urethra; felt like it was on the underside.  It was not consistent; some days it itched a lot, others not much at all, I never had any dysuria, only the urine flow was a little restricted.  About a week later, on the 10th, I noticed a small amount of clear/white discharge (not thick)from my penis;  a few stains on my underpants.  I was devastated.  Went to my physician who performed urinalysis; everything normal.  He suggested I go to a Urologist (after reading this site, I now see the errors in my ways).  Took urine sample for cultures; I am awaiting the results.  I guess my question is, would Chlamydia or gonorrhea wait 38 days to manifest itself.  Could I have gotten this from my ex, or more probably from my girlfriend (she had a questionable encounter in may).   During these 38 days my girlfriend and I have had sex numerous times.  I am looking for causes other than the obvious.  Could this be NGU without Chlamydia?  The night of October 2nd , I was looking at my penis and squeezed a few blackheads, one right by the opening of the urethra.  Also, I have been diagnosed with varicose, it has been a little sore lately, could this bacteria cause NGU?  If you have any insight, I would greatly appreciate it.  

[H. Hunter Handsfield, M.D.]

Your symptoms suggest NGU, and most such cases are due to things other than chlamydia.  Oral sex probably can cause NGU, perhaps due to bacteria that are normal in the mouth or throat but cause inflammation in the urethra.  The "varicose" (varicocele, you probably mean) is a normal anatomic variant, and certanly blackheads of the penis are not abnormal.

If your urethral symptoms--especially discharge--are continuing, consider another evaluation by a provider experienced in STDs, such as your local health department STD clinic.  And to be super-safe, perhaps your new partner also should be re-tested for common STDs.  But if your and her repeat tests for gonorrhea and chlamydia are negative--as I think they will be--you can forget about the whole thing and safely continue rewarding sex with your new partner.

Good luck-- HHH, MD

[probneurotic]

It is difficult, if not impossible, to find out who is "to blame", in addition to being fruitless.  A good course of action, though I am not yet a doctor, would be to tell both partners of the matter and have them checked for any infection.  A negative culture could come back and NGU is still possible.  Chlamydia only causes 1/3 of NGU infx's.  Your doctor will likely put you on a course of Azithromycin (better choice) or doxycycline, and your partners might be put on the same regimen.  NGU can indeed manifest itself after 32 days, in fact, some cases do not manifest with overt symptoms at all.