ngu questions

[allentg]

Hi docs,
I've tried to enter a question here a couple times. I click 'post question', but nothing happens...
Is it possible what i wrote had too many characters? If this gets through, I guess that's a possibility...
Thanks!

[allentg]

Thanks Dr. Hook,
When you mention that infection is unlikely for my long term partner, what infections are you referring to? Is chlamydia a possibility, or trich, or some other NGU-related bacteria?
I guess trich is the only remaining possibility, as an explanation of my persistent symptoms, and for me being an infection vector to my girlfriend?
Again, thanks

[Edward W Hook, MD]

1.  Your long term partner is probably not at risk but you might want to be sure.  for her to be infected is unlikely
2.  The persisitence of symtpms is troublesome and suggests trich. I would not test again. just treat empirically with Flagyl
3.  I would not test for ureaplasma or mycoplasma.  the treatment you have had would have cured them and the tests are expensive and hard to do.  If you did them, we would probably not know what to do with the result.

EWH

[allentg]

Thanks Dr. Hook.
So even though i continue to have NGU symptoms (small amount of cloudy discharge in morning, frequent/urgent urination), my long term partner was/is not at risk of anything because of my initial azithromycin and ceftriaxone treatment?
I'm on day 5 of the doxy treatment, and my symptoms still are not clearing up. Does this point to trich as the cause?
Do you recommend getting tested for trich again, or for ureaplasma and mycoplasma, both to find out the cause of my (seemingly) continuing NGU, and also to prevent infecting my partner?
Thanks for your help...

[Edward W Hook, MD]

I agree with the advice your doctor has given you. the treatment you have taken (azithromycin, ceftriaxone) will have cured all usual STDs, thus your partner is not at risk.  Before I go on to your questions however, have you been in communication with your partner from Hong King.  If not, you should be for two reasons -first she should be evaluated.  If she has something, it may be a clue to what is going on with you. Secondly, for her own safety she should also be treated with azithromycin/ceftriaxone) to protect her.  Trich is easier to diagnose I women than men too. Now for your questions

1.  Se above,  Your long term partner is not at risk.
2. The trich test detect about 80% of infections, thus they could miss something.  some would give an empiric dose of flagyl in this situation.
3.  A lot of NGU is caused by organisms not typically tested for.  These include ureaplasmas and mycoplasma genitalium. If you had these however the treatment you've received should work.
4.  doxy is  a broad spectrum antibiotic that cures lots of infections including chlamydia.
5.  They are just not that common and the treatment you've received would work for mycoplasmas.  
6.  Anal leakage.   Not clear,  could you have picked up something form something you ate while traveling?

EWH

[allentg]

Hi Doc, great forum.
I had unprotected hetero sex (vaginal and oral both ways) with a female friend about a month ago, on business in hong kong. She also briefly performed oral-to-anal on me. She is not a sex worker.
I was diagnosed a few days later with NGU. My symptoms were painful urination, cloudy discharge, urgent need to urinate, epididymis, flu symptoms, etc. I also had whitish discharge from my anus occasionally. I tested negative for chlamydia and gonorrhea, by both swab and urine. I was given azithromycin 1000mg and ceftriaxone IM 250 mg. The symptoms subsided after a few days, or at least I perceived them to. After waiting an additional week, I decided it was safe to continue to have unprotected sex with my long-term girlfriend (unaware of my infidelity), and was advised that it was ok to do so by my doctor.
Soon, I realized that my symptoms were not gone at all. They seemed to worsen. I still have cloudy urethral discharge (mostly when I wake up), burning, somewhat difficult urination, a sensitive meatus, and the frequent/urgent need to urinate. My testicles are somewhat painful. My urologist gave me the 10 day course of doxycycline. I'm now on day 5. I also tested negative for a trich swab test.
My docs told me because I tested negative for chlamydia, gonorrhea, and trich, the NGU should have been effectively treated by the initial azithromycin 1000mg and ceftriaxone IM 250 mg. The symptoms I continue to have (one month after infection) they say are most likely a residual effect.
1) Is it likely I infected my long-term partner with NGU or with something else? Sex was well after the azithromycin, but before my current 10 day course of doxycycline.
2) How reliable is a trich swab test? One doct I saw claimed it isn't reliable at all.
3) If I don't have the infections usually associated with causing NGU, what has caused this? And what exactly could I have passed to my girlfriend if I still had NGU symptoms when we had sex?
4) What does doxy treat exactly? If it works now, does that mean I was actually infected with chlamydia/mycoplasma/ureaplasma when I was advised it was ok to continue to have unprotected sex with my girlfriend?
5) Trich and mycoplasma/ureaplasma seem to be under-considered infections in general. Why is that?
6) I continue to have some clear anal leakage. Thoughts on that? A rectal infection?
Thanks Doc

[Edward W Hook, MD]

Yes, there is a character limit on the site.  you should be able to post your question using 1500 characters.  We will not read longer questions as they are either filled with unnecessary detail and anxiety or are too complex a question to be addressed on this site.  Feel free to post your question below,-succinctly.  EWH