symptoms again

[preocupado871]

In december, after a protected exposure with a very promiscuous woman and unprotected sex with my GF, I got a very slight discharge (only visible while opening urethra) and pain between rectum and scrotum, got tested for chlam, gon and tested negative but had 4-6 wbc. I took 5 days of cipro, and 1gr of zithro simultaneously. Felt somewhat better but did another urine test a week later and continued to show wbc in urine. Then took 7 days of doxy, felt better but not perfect. I told my girlfriend I had urethritis but that the cause was unkown and that the usual procedure was to be treated with antibiotics, she ended up taking 1 gr of zithro but also took cipro for another bacteria (non std) that was found by her gynecologist. For the past days I have itching and pain in my penis and pain between rectum and scrotum, also difficulty maintaining an erection and somehow erratic peeing. I have not been tested again but I am pretty sure I will have Wbc if tested. Not sure on how to proceed. Specific questions:
• Should I take more meds?
• What can be causing my discomfort? Recurrent NSU? Prostatitis?
• Should my girlfriend take more meds? (we had unprotected sex after taking the meds)
• Is there any serious health threat for any of us?
• Should I be concerned about ureaplasma and mycoplasma genitalium? How harmful are these?
• Any advice…?

Thanks,

[Edward W Hook, MD]

1. does having WBCs prove inflammation or infection? or both?
Inflammation yes, infection no. there are many possible casues of inflammation. To sort out which would take careful examination by a trained clinician.

2. can I have CPPS with WBCs in urine?
There are many causes of CPPS.  Please see the piece in Wikipedia.

3. how is NGU different from CPPS?
Again, read Wilipedia.  There is no evidenc e that you have NGU.

4. How can any of the two be properly diagnosed?
NGU is best diagnosed by a urethral swab taken from the penis.
EWH

[preocupado871]

Thank you for the answers. I asked again not because I am obsessed but because I am in pain and thought antibiotics would make me feel better. Last questions just to clarify:
1. does having WBCs prove inflammation or infection? or both?
2. can I have CPPS with WBCs in urine?
3. how is NGU different from CPPS?
4. How can any of the two be properly diagnosed?
I dont mean to ask infininte questions but local urologists seam to have scarce knowledge of CPPS and NSU.

thanks again.

[Edward W Hook, MD]

Welcome back to the Forum.  I'm sorry these problems continue to worry you.  As I indicated to you in December, there was virtually no meaningful risk of STD for your related to your encounter out of your relationship.  Your STD tests were negative and I probably would not have treated you of your GF.  Sometimes we hear from clients who continue to worry about the possibility of an STD and this causes them to focus on their genital area looking for symptoms or repeatedly examine themselves.  These practices lead to noticing normal sensations that are otherwise overlooked and to attribute them to possible STDs.  They also lead to noticing normal genital secretions and worrying that they are abnormal.  I worry that this is what you are doing. You need to stop worrying about obscure STDs, to stop repeated self examinations, and do your best to stop worrying. You do not need more testing or more antibiotics.  

As for your specific questions:
Should I take more meds?
No.

What can be causing my discomfort? Recurrent NSU? Prostatitis?
Believe your test results. The sensations you report suggest the Chronic Pelvic Pain syndrome (CPPS) which is well described in Wikipedia and does not need treatment.

Should my girlfriend take more meds? (we had unprotected sex after taking the meds)
No

• Is there any serious health threat for any of us?
No

• Should I be concerned about ureaplasma and mycoplasma genitalium? How harmful are these?
Ureaplasma is normally found in the genital tract of men and women and the role of M. genitalium remains under debate. if you had M. genitalium, azithromycin is the preferred treatment.

I hope my comments are helpful. EWH