About half the time, men who are infected with NGU do not have any symptoms and would not know they were infected unless they were tested. If symptoms do occur, they include painful urination, a discharge from the penis (which may only be noticed as stains in the underwear), or an itchy or irritated feeling in the penis. Sometimes the discharge may be noticed only after urination. There may also be an alteration in the flow of urine, such as a “spray” or two streams, which occurs because of the inflammation in the urethra. Often these symptoms are very mild. They usually take between one and three weeks after infection to show up, but they may take much longer.

Urethritis can, rarely, progress to infection in the prostate or epididymis, and this may be the first indication that infection is present (see the section on epididymitis and prostatitis). Usually NGU does not cause such symptoms as fever, chills, and nausea. If the urethritis is caused by the herpes virus rather than bacteria, there are sometimes lesions on the genital skin. Although the symptoms of urethritis caused by gonorrhea are usually more severe and occur more quickly after infection than those of NGU, this is not always the case.

Men and women can become infected in the throat with the bacteria that cause NGU. Usually they do not experience any symptoms, although occasionally there can be some mild throat irritation. When a man or woman has an NGU bacterial infection in the anal or rectal area, there are often no symptoms; if they do occur, they may include rectal discharge, bleeding, and pain.

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First infections generally take longer to heal than recurrences, for both oral and genital herpes. First outbreaks with herpes in the genital area, whether type 1 or type 2, last about ten to fourteen days on average, although they can last for as long as six weeks if not treated. The outbreak may last even longer if a person is taking oral steroids for other medical conditions or is mistakenly applying topical steroids in efforts to treat the sores. It is not uncommon for new lesions to erupt within a few days of each other during first infections. Treatment with oral antiviral medications will shorten both the first episode and recurrent infections (see the section on treatment).

The first symptoms that a person may recognize may actually be a recurrent outbreak from a prior infection; recurrent outbreaks usually last about five to seven days. As noted earlier, some people with herpes are unaware of it when they first become infected and only notice symptoms later, during a recurrence.

The symptoms that are caused by type 1 or type 2 herpes in the oral or genital area are exactly the same. The only difference is that type 2 herpes tends to recur less frequently than type 1 in the oral area, and type 1 tends to recur less frequently than type 2 in the genital area.

The bottom line for most people is that herpes is simply an occasional physical annoyance that can be treated with medication. For many people, herpes doesn’t even cause symptoms. Herpes doesn’t cause cancer (we used to worry about herpes putting women at risk for cervical cancer, but this does not appear to be the case), and in otherwise healthy individuals it doesn’t spread to other areas of the body. It is often the emotional issues that are harder to deal with, as discussed later.

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The diagnosis of epididymitis is made on examination. A red, swollen, tender testicle on only one side is suggestive of the disorder. An evaluation is usually carried out for urethritis and a bladder infection.

For a urethritis screening test, a man should not have voided for at least four hours prior to the examination. A small swab is inserted a short distance into the urethra, and then material from the swab is examined under the microscope for causative bacteria. (See the section on nongonococcal urethritis for more information about these screening procedures.)

Tests for gonorrhea and chlamydia are usually performed, and a midstream urine sample is obtained for analysis under the microscope and culturing. Both the screen for urethritis and the screen for a UTI are important in helping to sort out the cause of the epididymitis.

Other medical conditions can cause testicular pain and swelling. Torsion of the testicle is a medical emergency that occurs when the spermatic cord and blood vessels that lead to a testicle become twisted and cut off the blood supply to the testicle. This condition can lead to the death of the testicle if not quickly corrected surgically. It usually occurs on only one side, so it can be difficult to distinguish from epididymitis. However, torsion of the testicle usually occurs in young men and has a very sudden onset of symptoms, and there usually is no evidence of urethral infection on examination. Epididymitis typically has a more gradual onset of symptoms, but there are exceptions.

If there is difficulty distinguishing between epididymitis and torsion of the testicle, a study such as a Doppler-ultrasound can be performed to help make the diagnosis. This test measures blood flow to the testicle and, by bouncing sound waves off the internal structures of the scrotum, allows them to be visualized.

Other testicular problems that can be confused with epididymitis are trauma to the testicle (usually a man will know that this has occurred), testicular cancer, and other infections of the testicle such as tuberculosis, which is rare. An experienced health care provider can sort out these possibilities and order appropriate tests to make the diagnosis. For complicated situations, such as failure of the epididymitis to respond to antibiotic treatment, a urologist should be consulted for further evaluation and treatment.

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What if your partner never wants to discuss sex but still wants to have sex? Possibly he or she has difficulty with open, honest discussion. This may make the relationship difficult in other respects as well. Possibly your partner doesn’t understand the importance of the discussion and is poorly informed about STDs. This may mean that he or she has engaged in risky behavior in the past and may now put you at risk as well. Maybe your partner is afraid to talk about the issue for other reasons. Without talking about it, it’s hard to know. Having sex with someone who won’t discuss sexual health probably doesn’t fit into anyone’s plans for keeping safe. Remember: the decision about whether or not to become intimate with this person is yours. If you decide to not go any further, say no in a clear and unmistakable way to let your partner know where you stand.

Certain partners may try to make you feel embarrassed or awkward for bringing the topic up, or even try to make you feel that you are unusual for raising the issue. Such a person may not be the one for you. Consider the following ten statements from a person who is pressuring someone to have sex without talking about safe sex first, or is pressuring someone to have unprotected sex. Each of the statements is followed by a response that might be helpful, if not in convincing your partner, then at least in helping you keep your priorities straight.

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Irritable bowel syndrome (IBS). IBS is a very common problem among young women. It may cause pain that is experienced in the pelvis by most women, but the source of the pain is in fact the bowel. IBS causes abdominal and/or pelvic pain, bloating, and constipation or diarrhea. Sometimes the diarrhea and constipation alternate. Usually no structural abnormality is seen on examination of the colon, and no abnormalities are evident with laboratory tests. IBS is a diagnosis of exclusion, meaning that all other possibilities should be ruled out first. Although it is a chronic problem, IBS can be managed with diet, exercise, and medications in most people, and it does not cause more severe problems, such as cancer.

Ovarian cyst. In the normal menstrual cycle, each month one ovary produces an egg to be fertilized. If ovulation (the release of an egg) does not occur, a cyst, called a folhcular cyst, may form. When an egg is released from an ovary, another kind of cyst, called a corpus luteum cyst, may form. These two lands of cysts may grow quite large and may cause pain either on their own or if they rupture. An ultrasound device, which bounces sound waves off internal structures to visualize them, is used to diagnose an ovarian cyst. Most cysts go away on their own, or they can be reduced through hormone suppression with birth control pills or drained through a laparoscopy. Ovarian cysts must be differentiated from ovarian cancer, which usually has a different appearance on ultrasound than a cyst and does not shrink with hormone suppression.

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