Chlamydia/Gonorrhea/NGU/Trich?

[JeffNW]

I am in a relationship with a woman. 6-8 months ago, she had a bacterial infection in her vagina, her doctor told her it could be chlamydia or some non-sexual disease, they treated her for it without testing, and I got tested for chlamydia (but not trich or NGU) and was negative and got no treatment.

In late August, I had a one-night affair: I received unprotected oral (one minute?), I gave unprotected oral (3-5 minutes?) and I got my unprotected not fully-erect penis inside her for a few minutes.

I later had unprotected sex with my girlfriend.

Two months after affair, girlfriend began a long period (month). She is 47, so they're evaluating menopause and other things. I have also learned she was screened for gonorrhea and chlamydia and came up negative in late November, so she’s clean.

14 weeks after my affair (about 10 days ago), I noticed itchiness around the back of my thighs and started to have to pee a lot. Thinking it was a fungal infection from wearing dirty jogging shorts two days in a row just before this, I used a vaginal anti-fungal cream on my thighs. A few days later, I began to feel a tingling sensation in my urethra, and had to pee a lot. Both symptoms persist but have decreased a bit now. I have noticed no discharge. I have had a host of body sores, but that could all be anxiety.

I got tested for all STDs except Trich and NGU. All results that have come back are negative; I'm waiting for chlamydia and gonorrhea. I also got a urine dipstick test and my LET was 0 and so were my nitrites.

My questions:
1. Could I have something that my girlfriend had before she got the antibiotics 6-7 months ago?
2. Is it likely I have chlamydia or gonorrhea?
3. Is it likely I have NGU or Trich?
4. If I don't have chlamydia or gonorrhea, should I get tested for NGU or Trich?
5. Do I have a chance of passing NGU or Trich to my girlfriend? Would those harm her?
6. Anything I'm missing?

Thanks.

[Edward W Hook, MD]

Final answer:

The absence of leukocytes on the urine dipstick adds further support to the idea that his is not an STI.  EWH

[JeffNW]

Thanks, Dr. Hook. Your comments just helped. Especially your comment about the 100 days thing.

I'm sorry about the verbosity. Anxiety is difficult.

Any thoughts about the urine dipstick and the 0 leukocyte score on the urine dipstick?

[Edward W Hook, MD]

Thanks for shortening your question.  It is to the point and helpful.  You are correct:
1.  NGU, while the most common NGU in men, is not particualrly common.
2.  Even most single encounters with infected partners do not lead to infection.
3.  It would be extraordinary for NGU to appear as a result of receipt of sexual exposure 100 days earlier.
4.  I'm not sure what your symptoms are but the symtoms of NGU are burning on uriation and/or a discharge from the penis.

Anxiety can cause problems such as tingling and itching.  Other sorts of problems can also casue genital symptoms.  EWH

[JeffNW]

Also, if I can add a quick note to that, does the urine dipstick test that was performed on a fresh void/first of the morning urine sample and that read 0 for leukocytes at the time while I was suffering symptoms also suggest I did not have NGU, or is that basically meaningless?

[JeffNW]

Dr. Hook,

Fair enough, sorry for the length. I feel all STIs are ruled out by testing I have taken or the other woman has except NGU.

Am I correct in assuming that (1) relatively few people have NGU in the big picture, that (2) it's somewhat low-risk to catch in one encounter, (3), I should have expected symptoms to appear within 7-10 days or maybe two weeks but that 100 days is really an outlier, and (4) that my symptoms aren't classic of NGU and so I should assume I don't have it? (My doctor treated my precautiously for Trich with Flagyl so I'm not sure if I can go in and get an NGU test or not, but I will try).

And that my symptoms are more likely due to straight-up anxiety (genitally focused anxiety), irritation with chemicals, or something else like an issue with my prostate?

Thanks.

[Edward W Hook, MD]

The length of this question, particularly as a follow-up is well outside of the limits of what is permissible on this forum.  There is a 2000 character limit on initial posts and then LIMiITED follow-ups are permitted (no follow-ups are allowed on many MedHelp forums, we choose to do so).  I will not read this follow- up.  You may ask a single, brief follow-up and I will answer it.  EWH

[JeffNW]

Dear Dr. Hook,

Thanks for the information on the trich culture tests. That has put my worries about trich to rest. I now believe I don't have that or any of the "big" STDs--HIV, herpes, syphilis, gonorrhea, or chlamydia--or trich.

That does leave non-chlamydial NGU, though. I wonder if you'd let me ask five questions about that, since I haven't before, and if you would answer them for me, even if you have to shut off my thread after this.

Hopefully you will. I'll include my timeline and my 5 questions below. Thanks in advance for your time--even for people like me who are probably suffering anxiety, your work and information are helpful and appreciated.

6 months before my incident: long-term girlfriend is told she has a bacterial infection that "might be chlamydia but might not" and is treated by doctor without test to see what it is. I am not treated. I mention this now because after having read so much, this sounds like female version of non-chlamydial NGU. Maybe it's unrelated to my issue, though. I had nothing to do with this issue, by the way--no affairs, etc, and I'm sure my girlfriend had no affairs also.

My incident--unprotected oral, unprotected vaginal, both brief

About 2 months after my incident--my girlfriend begins having long period, spotting

3 calendar months after my incident (14 weeks and 2 days)--I notice I have to pee a lot one day and then about four days after that I develop a tingle at the tip of my urethra and urinary frequency, although with maybe some of that "dribbling" people talk about. If I am discharging, I cannot notice it, and there's no burning during urination.

15 weeks after incident--I test negative for all standard STDs, including doing chlamydia and gonorrhea test twice (test done at lab, not doctor's). Also, my girlfriend's doctor had tested her for chlamydia and gonorrhea as well, and those were negative. I am not sure if she performed other tests on vaginal swabs or urine for things like BV, trich, or bacterial infection from my NGU.

15 weeks after incident--nurse at lab uses urine dipstick in my first void of morning urine and reads a perfect 0 for leukocytes and 0 for nitrites (while I am experiencing symptoms)

16 weeks after incident--I go to doctor, explain situation, he says it does look like my urethra is irritated, he gives me that one-dose Flagyl 4-pill prescription (which I take). They don't have technology to do test for trich; I ask for test for NGU, but he didn't swab me and I'm not sure he tested urine, probably because he thinks I'm just overreacting. I have written him to find out if he did look under a microscope at my urine.

16-18 weeks after incident--My symptoms get better after the flagyl within two days but then return. Those with a skeptical eye could argue that my symptoms increase when my anxiety increases (and vice-versa), but from my perspective it's a difficult "chicken and egg" issue trying to find the true casual agent of symptoms v. anxiety.

That's pretty much the whole story. There ARE two wild cards. First, my anxiety increased a great deal two days before my symptoms began because my girlfriend was taken in for an ultrasound and they found two cysts on her ovaries (no doubt unrelated to anything I've done). Second, I did a number of things that exposed my penis/urethra to chemicals and/or fungus just before my symptoms began. In two days before my first urge to pee a lot, I wore dirty jogging underwear that might have had fungus in them, I masturbated twice with lotion from a hotel that must have been poured from a large bottle into a re-usable small bottle and wasn't sanitary, and I rubbed a women's vaginal fungal infection cream all over my legs to try to address any possible fungal issue on my thighs from the jogging--so, maybe I irritated myself with chemicals?


That's my timeline. Here are my questions:

1. My symptoms only began 14 weeks after my incident. That seems really late, and I've read the other doctor on this site say anything after 2 months would be so unusual he'd expect some other form or origin of infection. Does this extended delay of original symptoms for me suggest I didn't get NGU from my incident, and if so, with what degree of certainty (how unusual would this be)?

2. I know the urine dipstick is not an approved method of testing for STDs, but how much comfort can I take from the fact that I had 0 leukocytes at the time I was experiencing symptoms? Basically no comfort, or is it a pretty good indication that I didn't have NGU even if it's not definitive or a recommended testing method?

3. Is it possible that anything I have has nothing to do with the one-night stand I had and dates back to my girlfriend's infection 9 months ago, or a recurrent version of that?

4. Is it possible that I or my girlfriend just got some new infection, and infected one another, and it has nothing to do with my one-night stand or her infection 9 months ago?

5. Specifically, is it possible that all the stuff that happened just before I began having my own symptoms (jogging in dirty underwear and possibly getting fungal infection, masturbating with probably unsanitary moisturizing lotion at hotel, possibly irritating tip of penis with anti-fungal cream) is what caused my symptoms, especially given the logical time frame of all this?

Thanks. Like I said, I realize my situation may all be anxiety. And I realize that I'm asking a lot of questions. I'm hoping you'll answer this one because it's not the same question I have asked before. I expect that if you do, you'll shut this thread down due to the length after this point--I am OK with that since non-chlamydial NGU is the last thing I could have. And again, I and everyone on this board appreciate what you do--even the "BS" stuff you have to do with anxiety/guilt cases, since it really does help the anxiety sufferers.

[JeffNW]

Yay! Thanks! Happy new year to you.

[Edward W Hook, MD]

Culture tests for trich are quite sensitive.  As for any test there are occasional false negatives but between the fact that most women do not have trich and the negative test, my advice is to believe the test and move forward.  As you already know, I think you are over reacting.  EWH

[JeffNW]

Doctor, I have tried to move on, as mentioned above, but the results were mixed at best.

Because I couldn't get a trich test, I finally got in touch with other woman and she finally had the test today.

It was a culture and the results were negative. I feel like this can put my concerns to rest-I don't have a problem trusting reliable tests.

That said, could you tell me the chances of a false negative with a culture for trich in women? Is this what is called the specificity (or rather, the opposite of specificity)?

Thanks in advance. If you tell me the chances of a false positive are low, I will be able to move on and you'll hear no more from me.

[Edward W Hook, MD]

Thank you.,  I hope my comments have been helpful.  EWH

[JeffNW]

Thanks again Dr. Hook.

I hear what you're saying here. Honestly, I hope it is paranoia, and assume it will pass.

I know you deal with anxious people like myself a lot, and we seem to bottom out into downward spirals like I have. I'm sure it's irritating at times. As I mentioned before, I do thank you for your time and consideration. Sometimes these kind of words do have calm the anxiety. I look forward to moving on with my life.

Thanks again.

[Edward W Hook, MD]

Your are being paranoid (actually, CONTINUING to be paranoid).  HPV infection does not casue heavy periods.  Further, if you and/or your GF have ever had other partners, chance are you already have or have had so called "high risk" HPV.  In addition, if she (or you have it) from a past or recent exposure, it is nearly certain that it would ressolve itself with no advierse events and, if there were problems, PAP smears would detect it.  

Just get a grip on yourself and move forward.  If you cannot, eithe confess yoru infidelity or seek counseling to help you work through it.  EWH

[JeffNW]

Understood, Dr. Hook. I appreciate your knowledge and candor.

I have tested negative for all STDs in my screening. I have also now been tested for NGU and am waiting to hear. My doctor doesn't test for Trich so I was treated yesterday. I am not sure but I feel symptoms may be leaving. They also are testing urine to look for other explanations.

I know you want to avoid hypotheticals, but I would like to ask one exception of you. I cannot test for high-risk HPV, but it is apparently something that can lead to a long, heavy period like my girlfriend began having two months after my potential exposure. She is being evaluated by her own doctor, but I believe they are not doing a Pap smear because they did one in May, months before my infidelity. I know many things are possible and few things seem definitive in these questions, but is it possible/likely that I was exposed to high- risk HPV, I infected my GF, and she reacted by beginning a heavy period two months later? How likely might something like that be and, since HPV can lead to cervical cancer but generally does so over a period of 10-20 years, how alarming of a sign would an extended period be in terms of cervical cancer (assuming that high- risk HPV were the cause and acknowledging there are other explanations, such as menopause).

I would sincerely appreciate your indulging me in this one 'what if?'. I will ask no more after this. And yes, I  suffering guilt and anxiety , and yes, my decisions and actions have been horrible. But I do care about my GF more than any other person or thing in the world.

[Edward W Hook, MD]

Welcome to our Forum.  Based on your nearly 20 recent posts to various MedHelp sites I see this has you quite worried.  I think there is little reason for this to be the case.  Your GF's problems are not necessarily due to any STI and her health care provider was just doing the right thing, being thorough, when asking about possible STI risks.  In addition, you have negative tests and symptoms which are not typical for any STI.  I would urge you not to worry.  It appears that you live in the Seattle area.  If that is the case, you can get a definitive evaluation by seeking (re-)evaluation at the Seattle-King County STD Clinic which provides state of the art sexual health care.

In answer to your specific questions:
1. Could I have something that my girlfriend had before she got the antibiotics 6-7 months ago?
Unlikely.  I'm not sure why you are assuming this is even a possibility.  Do you think your GF has an STI?

2. Is it likely I have chlamydia or gonorrhea?
No. I anticipate that your tests will be negative.

3. Is it likely I have NGU or Trich?
Also quite unlikely although slightly so since you have not been tested for these problems and you were tested for gonorrhea and chlamydia.  

4. If I don't have chlamydia or gonorrhea, should I get tested for NGU or Trich?
Clearly this is up to you. It is doubtful that you have them but if you wish to seek testing, I have mentioned where to do this above.

5. Do I have a chance of passing NGU or Trich to my girlfriend? Would those harm her?
These are "what if" questions about infections that it is unlikely that you or she has.  One step at a time.

6. Anything I'm missing?
No.  

I hope these comments are helpful. My sense is that you are being a bit paranoid, perhaps related to guilt over your own repeated infidelity.  EWH