ngu

[allentg]

hi,
i was diagnosed with ngu after unprotected oral/vaginal with a woman who is not my s.o. about 3 months ago. tested neg for every testable std at the time. took 1g azith and cetrifaxione.
symptoms cleared up (or i thought they did), 2 weeks later resumed unprotected sex with s.o.
in the last 6 weeks, my symptoms have recurred. tested neg for everything again (including inpouch trich test). no wbc's found in urethral swab or urine. took 10 days of doxy w 2g of metronidazole, and then 3 more weeks of doxy recently.
the woman i got ngu from tested neg for trich, and neg for everything else as well.
symptoms persist somewhat today. discomfort in urethra, occasionally very small amount of discharge in morning (only some wetness at the tip when i milk it...), and dull ache sometimes in epidydimis when i am physically active.
1) was/is my s.o. at risk of anything? i'm kind of confused about this...
2) will this clear up on its own or should i persue additional treatment? my urologist thinks it's viral prostatitis because of the neg testing and because the ineffectiveness of the medication. but to me the timing doesn't suggest this (symptoms started only a few days after unprotected sex).
3) can you recommend a std specialist in the boston area? (that is, if you think another visit is even warranted.)
thanks doctors

[Edward W Hook, MD]

Presumably you did not have sex with your SO during the interval between your casual contact and being treated for NGU.  If that is the case, she was at no risk.

The Inpuch is the best commercially available test for trich in persons of either sex.

EWH

[allentg]

Thanks for your answers doctor.
Is it safe to assume my SO was not at risk BEFORE i was treated with doxy/flagyl, but still AFTER azithromycin?
Is the Inpouch trich test sensitive on men?
Thanks again

[Edward W Hook, MD]

You have not failed therapy and need not worry about yourself or your SO.  In persons with persistent discharge following NGU therapy who have negative tests, there is no further risk of STD.  The residual discharge may be normal urethral secretions which occur but are typically not noticed or concerning unless one has had a recent STD experience or, at worse are non-infections and not risky for partners.,  This was studied over 30 years ago and shown to be the case.

In your specific case, you have the best of all possible worlds having received treatment, having negative follow-up tests yourself and having had your casual partner checked and found to be without infection.  You most likely had what we call non-chlamydial NGU.  There is no reason to think that your SO is at risk given the steps you have taken.  Job well done.  

As for your specific questions:

1.  See above. No risk to your SO (or you for that matter).
2.  I think your urologist and I agree that this not need further treatment.  it will resolve on its own.  There is really no reason for further testing.
3.  I really don't think another visit is needed.  If you wish to pursue this further I would contact the Boston Sexually Transmitted Disease/HIV Prevention Training Center and ask them who you might see.  this is a CDC sponsored site with specialty expertise in STDs which can refer you to an appropriate clinician.  

Hope this helps.  EWH