Taking zithromax for non specific urethritis. Is this caused due to unprotected oral sex?

Posted on Wed, 6 Mar 2013 in Sexually Transmitted Diseases
Question: dr,
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
Answered by Dr. Sudarshan 55 minutes later
Thanks for writing in.
To answer your queries.
1.It can be caused by tight foreskin and irritation.

2.It can also be caused by nonbacterial prostatis.
Other explanation for symptoms can be mechanical irritation,condom(latex allergy)allergy,microscopic renal stones,crystaluria etc.

3.I dont think there is any infection in you or your girlfriend.After going through all the tests and antibiotics hardly any infection can be present.
4.Mycoplasma is not at all XXXXXXX Infection is hardly symptomatic.
A five day course of azithro is more effective than single 1gm dose.

5.trichomonas can be present in oral cavity and rarely can be transmitted.

6.There is a possibility of you already having infection and it became symptomatic after you had sex with your girlsfriend.
7.Cloudy urine does not always mean infection.
You must get a renal function test done and also urine examination for casts and crystals.Also a ultrasonography of abdomen would be ideal.

Hope this clears your doubt .
I will be available for follow up.
STD and HIV specialist.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sudarshan 5 days later

Thank you for your response. I was hoping to clarify one or two other issues.

In relation to your statement below what would these examinations establish & do you think i need to have them as you said "must"?

"You must get a renal function test done and also urine examination for casts and crystals.Also a ultrasonography of abdomen would be ideal."

Is Mycoplasma Genitalium not now recognised as an STD & a cause of NSU?

At this stage would it be your opinion that there is little or nothing to worry about for my partner or me?
Answered by Dr. Sudarshan 15 hours later
Hi Again,
As you have taken many antibiotics and without any relief,you could have what is known as crystalluria.It is non infective condition.
Doing these test will diagnose crystalluria if you have it.
Mycoplasma is not considered STD and it is cause of NSU.
There is nothing to be worried in your case.
If the above mentioned test is normal there is hardly anything to be treated.
You just need to increase your water intake.
Can take himalaya cystone syrup .It helps in reducing the burning sensation in NSU.
Hope this helps.
I will be available for follow up.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sudarshan 1 hour later
Sorry doctor,

Just to be clear on this is it that any issue at this point in time is completely separate to STD concerns even if crystalluria was found? My urologist thought previously it could be kidney stone but this was not found on examination. He did a cystoscopy exam previously & only noted non bacterial prostatitis.
Apologies Doctor. I meant to add this in in my previous reply:

What happens if the test is not normal, would this be a health issue for me or my partner? This is in relation to this statement: "If the above mentioned test is normal there is hardly anything to be treated".

Thank you again. I have been to numerous doctors over the years as i was afraid of the STD factor but if this is now dealt with & crystalluria is not a serious issue I think I may just leave well enough alone. I would appreciate your views.

thank you again.
Answered by Dr. Sudarshan 19 hours later
Hi again,
This is different issue than STD and is metabolic problem rather than infectious.
The fact is the crystalluria if found is treatable .You dont have to suffer from the pain of urethritis.
It is not a infective condition.Undergo Urine examination for crystals/casts.
Undergo one ultrasonography of abdomen and pelvis.
Also a serum uric acid level for hyperuricemia or Gout would be advisable.
crystalluria is not a serious issue and is treatable with drugs.
Hope this makes things clear.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sudarshan 4 hours later
Thank you very much doctor for your detailed responses. Thanks again for all your help.
Answered by Dr. Sudarshan 2 hours later
Hi Again,
If you have any skin /hair/nail or STD related query you can directly ask me by ASK DR XXXXXXX in your query.
Wishing you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Sudarshan


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