Welcome to the forum.
Genital pain is not normally a symptom of urethritis, and I doubt your pain indicates a continuing infection with NGU, M. genitalium, or anything else. Certainly I have never had a patient with symptoms like yours who turned out to have active NGU or any other STD as the cause. In some cases, it is possible that non-infectious inflammation may be triggered by NGU, chlamydia, gonorrhea, etc -- allowing symptoms to continue long after the infection that triggered the problem has gone.
If you think about it, this concept applies to most injuries or infections anywhere in the body: the sprained ankle that still hurts months or years after the sprain has healed; the abdominal pain that can continue in women following pelvic inflammatory disease (a complication of gonorrhea or chlamydia) long after the PID has cleared up; back pain or headaches that come and go without explanation. The genitals are no different -- except for the special place the genitals may occupy in our emotions and psychology. The main thing is to understand that no serious harm is being done. There are no known complications like infertility, cancer, or anything else either in infected men or their sex partners. Once the affected patient understands that, often it becomes pretty easy to live with the discomfort, and sometimes it just clears up gradually on its own.
To your specific questions:
1) M. genitalium is not a likely cause of such symptoms, and it is not known to be acquired by oral sex. I suggest you don't waste any money, time, or emotional energy barking up that tree.
2) I agree the antibiotics would have cured a bacterial infection. I explained above why symptoms might persist, but a virus is not the likely reason. There are no known viruses that would cause continuing symptoms of this sort.
3) There are a whole bunch of reasons why herpes due to HSV-1 (or HSV-2, for that matter) is not a plausible cause of your symptoms. Don't go there either.
4) As suggested above, you can be very confident you have nothing that you can transmit to your wife. In fact, sexual activity might be good for you in this circumstance. If I were in your situation, I would be having regular unprotected sex with my wife, with no fears for her health.
This may simply boil down to a case of the male chronic pelvic pain syndrome. You might google that term and see if the symptoms match yours. The Wikipedia article is excellent as a starting point. As you will see, CPPS is an inconvenient but probably harmless condition. After you do that, consider making another appointment with your urologist; take what you learn about CPPS, and perhaps print out this discussion, as a framework for discussion. My guess is that he will give you similarly reassuring advice.
Good luck with it-- HHH, MD
This has been incredibly helpful and reassuring to me. It has given me a peace of mind I have not had in months. Thank you so much for providing perspective and expertise (and for taking the time to write such a personal reply to each of my questions).
You are absolutley correct that the genitals hold a special place in our minds and I have been admittedly overly focused on mine since this one-time mistake. I hope that you do not mind addressing one brief follow up question before I leave this dark chapter of my life behind. In your experience with NGU patients, do these kind of symptoms typically persist for a short time or are they more permanent? I can deal with the physical sensations as long as I know there is no serious health problem....I just am curious what I should expect.
Once again, thank you, from the bottom of my heart.
This is the kind of follow-up comment that we like! Thanks for the thanks; glad to have helped.
Unfortunately, it isn't possible for me to predict or even give an educated guess about symptom duration. If indeed the problem is primarily psychological -- i.e. magnification of otherwise minor discomfort or even normal body sensations -- if your confidence that it's nothing dangerous really takes hold, perhaps they will fade aware completely and quite soon (fingers crossed). But there isn't much more I can say about it.
Thank you again for your reply. I actually am skeptical that it is primarily psychological (I feel far more than an intesnification of normal sensations). I apologize, but I should have been more specific in my follow up question. I meant to ask explicitly about the redness of the meatus. Assuming that I am experiencing some inflamation as a result of the NGU infection, does this typically fade with time? My main concern has been hurting my wife. I can cope with the problems if I know I will not do that.
I will end the thread with this.Thank you again Dr. for all of your help.
I already told you there is no chance you have anything that can harm your wife. My guess is your meatus is normal. Even if not, inflammation, without infection, is not transmissible.
That indeed ends this thread. Please try to move on.