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Diagnosed with NSU. Taking zithromax. Could it be due to phimosis of the penis?

Jul 2012
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Answered by

Practicing since : 1993
Answered : 1196 Questions
I have a query regarding Non Specific Urethritis (NSU). Below is my history:
In Feb. 06 I suffered a blackout. I may have had a sexual encounter with a sex worker. I had a girlfriend at this time (now fiancee). We weren't having full sex at the time (unprotected oral only). After my "possible" exposure I didn't have oral sex again with my girlfriend until I had been examined at an std clinic. (All screens came back neg. except for NSU which is recurring). Main concern is any possible damage I may cause/have caused to my fiancee.

July 06 - Tested positive for NSU (no known bacteria found). - Prescribed 1g Zithromax in a single dose. - Was not called back to GUM & was told to continue on as normal. - Girlfriend not prescribed anything.

End Aug. 06 - Rec. unprotected oral from my girlfriend. GUM didn't say it wasn't safe to do so.

Early Sept. 06 - Gram stain came back negative.

Dec. 06 - Attended GUM with my girlfriend. - Her screen was clear - mine showed NSU (Negative for Trich also - Wet Mount). - Both prescribed 1g Zithromax.

Mar. 07 - Gram stain came back neg.

Apr. 07 - Gram stain showed NSU (not chlymidia or any known bacteria). Prescribed Doxy for 1wk & 400mg metronidozole for 5days.
XXXXXXX 07 - Urologist diagnosed prostatitis following cystoscopy examination. - Prescribed alpha blockers. Urologist said it was anxiety related.

Aug. 07 - Attended GUM with my girlfriend - Doctor told her nothing else they could do for me & referred for counselling.

Sept. 07 - Protected sex with girlfriend.

Dec. 07 - Diagnosed with NSU (Neg for Trich - wet mount & no known bacteria found). - Prescribed 1g Zithromax & 100mg Doxy for 1 week.
XXXXXXX 08 - Still NSU - Prescribed 100mg doxy for 1 week & metronidozole for 5 days & told not to return.

Since Mar. 08 Protected sex with my girlfriend.

1. Can it be caused by phimosis of the penis? My foreskin is very tight & doesn't retract when erect.
2. Can it be caused by non bacterial prostatitis?
(I have been told I have both of these by doctors previously).
3. I am concerned I may have passed something to my partner especially after the initial zithromax "failed". See the unprotected oral in Aug 06 above.
4. Is mycoplasma genitalium considered XXXXXXX & is zithromax used against it? I know there are no tests available for it but I also heard zithromax is not 100% reliable.
5. Could trichonomas be transmitted orally?
6. Could I have had NSU BEFORE my "exposure" in Feb. 2006 which could simply have been from unprotected oral with my girlfriend & it simply showed up later? I may not have been aware of any symptoms prior to Feb 2006 as i wasn't concerned about anything prior to this but once the possible exposure happened with the CSW I became more aware & anxiety built up etc & started noticing symptoms.
7. I am aware of my urine been cloudy for many years at stages & indeed long before the possible Feb. 2006 exposure. Sometimes the initial stream is cloudy, other times the mid or close to the end stream is cloudy. My urine would also be quite dark as I don't drink much water.

Thank you very much & apologises for the excessive length of the above post.

Kind Regards
Posted Thu, 7 Mar 2013 in Men's Health
Answered by Dr. Praveen Rodrigues 7 hours later
Hi there.
Yes your post is of excessive length but do empathise with & understand your wanting to get your point across clearly & precisely. I shall attempt to clarify your points one by one..& provide you with closure on this query.
Yes the irritation can well be due to Phimosis of the Penis & your symptoms can easily fit in. A simple remedy & one that can be done instantly is to get yourself circumscribed. It is a minor procedure done under local anaesthesia in day care & is a very good option to excercise. Good for you in either case.
I disagree with an entity called non-bacterial prostatitis especially at your age (34). But it cannot be ruled out as a distant to go across to a urologist & do a sonogram specifically targetted at the prostrate. If not enlarged, this can be disregarded. your next three questions. I think the medication was adequate even though i note initially both were not treated at the same time; later,you were & in the present situation, that suffices.
Yes you could have NSU earlier. It is basically a term that is usued loosely by medical professionals when they cannot arrive at a diagnosis. Believe me, i would go out on a limb & tell you that my gut feeling is that you are absolutely clear. However, i do concede that the black-out coupled with the guilt factor weighs heavily on your subconscious. I would encourage you strongly to forget about all these deliberations & tests & go across to a counsellor/psychologist/psychiatrist (preferably the latter) either in your area or a distance away if you desire discretion & get an opinion. Yes, drinking loads of water & more so at frequent intervals coupled with a healthy sprinkling of Guiness' ;-) (yes my sister is an Irish citizen & i have had the pleasure of sampling your stouts & ales) would be just what the doctor orders' :)
Relax, take a XXXXXXX breath, strongly encourage you & your girlfriend to take a holiday & things will soon get better with the right counsellor in hand. Drop this line of thought of trying to figure out the causes of this NSU, follow my advice & assure you, all will be well. When next i visit Dublin or if you should come down to Bangalore (with your girlfriend on medical tourism which is the rage nowadays ;-) ) perhaps we can share a Guiness or Irish tea together! Cheers & Godspeed!
Dr Praveen Rodrigues MD
Above answer was peer-reviewed by
Follow-up: Diagnosed with NSU. Taking zithromax. Could it be due to phimosis of the penis? 41 hours later
Thank you for your reply doctor & your thorough answering. You are correct in that I would be extremely guilty over any "possible" incident that took place & indeed disgusted with myself also if it did take place.

Just to clarify one point you made regarding the prostatitis. My urologist informed me that this is different than (BPH) Benign Prostatic Hyperplasia / enlarged prostate which affects older men. Non bacterial prostatitis he said on the other hand can affect younger men & is not as a result of an STD. I was just wondering if you agreed with his view & that this could cause my NSU?

Very finally would you be confident that after the initial dose of azithromax any infection I had would have cleared even though the white blood cells returned again (sometimes after oral sex with partner & sometimes after no exposure whatsoever). I wouldn't even have had unprotected oral at the time but the GUM clinic didn't see an issue. However when I returned to them (on my own insistance) & NSU was found again they treated me again. So I am confused why they would do this if it wasn't a concern.

I know at this stage I should leave well enough along. I think it is perhaps raising its head again as a issue simply because I am getting married to my partner this year & I suppose I can't help but think back on very very hurtful & distressful events such as this. As said again my GUM said all is fine. This seems to be your view also I understand.

Thank you again for all your help & I hope you enjoy Dublin when you arrive. I would highly recommend the west of XXXXXXX (Galway, Mayo, Clare) also as it is very very beautiful if you get the XXXXXXX weather of course which is no guarantee.

God bless.
Answered by Dr. Praveen Rodrigues 6 hours later
Hi there.
To put it simply..Yes, your Urologist's explanation is plausible & possible as regds the prostatitis in young men.
Yes am confident that you are in the clear.
Very often, when the patient is anxious, the medical professional tends to 'over treat' or 'over compensate' as the case may be to allay the anxiety & not always is it necessary. More often than not as a placebo!
Congratulations on your impending marriage in advance & wish you every happiness. Am sure she is very supportive & together, you can put this behind you & move forward. Again i stress, relax, lots of water, couple og guiness' & do take that vacation! I do agree the west of XXXXXXX is beautiful & have caught glimpses. I did love Dublin by itself & if the medical council ratified Indian degrees as in the days of old, would love to come practice there :)
For the moment, i think our work here is done & trust you have recieved some closure on this issue. Do close this query & give us a healthy rating & recommmendation if time permits. Cheers! :)
Dr Praveen Rodrigues MD
Above answer was peer-reviewed by
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