[Question #1003] Do I need another test? Scared.

49 months ago
I regrettably had an unprotected encounter (I'm a female and this was with a man, vaginal intercourse no condom) I was tested for the full 10 panel STD at 6 days out and again at 27 out along with trich, all results negative. I am still experiencing symptoms; however, they may be related to my ParaGard IUD which I had removed yesterday.  I have not noticed any herpes symptoms-no sores-more along the lines of itching and brown discharge. I'm very scared and I can't seem to get any answers from my OB... She seems to think this is all related to my IUD but then again she doesn't know about the regrettable encounter.  Specifically I tested negative for chlamydia, trich and gonorrhea... As well as herpes, hepatitis, syphilis and HIV. I know HIV risks are low but I'm more concerned about some of the others. Any advice you can offer is greatly appreciated. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Welcome to the forum. Thanks for your question.

In assessing STD risk after any particular encounter, we can consider several factors:  the nature of the exposure, in this case unprotected vaginal sex; the partner (about which you say nothing, but it's rather important -- more below); lab test results, which in general are highly reliable if done sufficiently long after the last possible exposure (as yours apparently were, with some possible exceptions); symptoms (you don't describe yours in detail); and a doctor's opinion (which isn't necessarily reliable, but usually is if the doc is reasonably experienced in STDs).

As those comments imply, most factors are strongly in your favor:  it is unlikely you acquired any STD. If your partner is not an injection drug user, bisexual, recently out of prison, or otherwise at especially high risk, the chances are he had no transmissible STD at the time of the encounter. Feel free to give me more information about him and I might have more to say about it. If you'll also describe your symptoms, perhaps that will also help; however, if your own doctor is confident they are related to the IUD, I see no reason not to believe she is correct. But here too I might have more to say if you wish to describe the symptoms.

As for the test results, negative gonorrhea and chlamydia testing on either vaginal swab or urine is conclusive; no worries there. Trichomonas by DNA test also is conclusive, but other tests (culture, microscopy) miss many infections. However, the risk of trich is believed to be very low from any single exposure. Presumably all your other tests were blood tests. The negative HIV result is conclusive if it was a 4th generation ("duo", "combo") test. However, HSV, viral hepatitis, and syphilis tests need to be done at 6+ weeks to be conclusive; same for HIV if it was a standalone antibody test; and HSV blood tests can take as long as 3-4 months to be positive. That said, the chance of herpes from any single encounter, without typical herpes symptoms, is very low.

All things considered, it is very unlikely you acquired any infection during the encounter described. But feel free to provide some of the missing information; perhaps I will have more to say. But for now, I think you can rely on your doctor's opinion and advice.

I hope this has helped. Best wishes--  HHH, MD

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49 months ago
Thank you so much for your prompt reply. What a wonderful service.

My partner was someone I know very casually. He is a straight male and j do not believe he uses any drugs and was not in prison. He is separated from his wife.  He claims he was recently tested and clean. My symptoms are mostly burning, itching, and some pasty brown discharge. None of the dishcharge has a particularly strong odor. I'm just very uncomfortable.

It may also be relevant that the day after the encounter I realized I had a UTI. I took an antibiotic for that and then later a yeast infection treatment. I am now on my second round of yeast infection treatments.

The trich test was "NAA" which is think is DNA, correct?  HIV was 4th generation.

The testing company told me syphilis results are good at 1-3 weeks and herpes at 4-6 but I guess that's not true?  If you were me would you retest for these?

And, just to settle my mind, the likelihood of two false negatives for chlamydia and gonorrhea at days 6 and 27 is low?

I am mostly concerned that I don't pass something off to my partner, who doesn't deserve any of this. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
Sounds like a very low risk partner.

I agree that yeast would be a good bet for your symptoms, or perhaps allergy to a component of the IUD. A few percent of vaginal yeast infections are resistant to usual treatments, i.e. the "azole" drugs; if your doctor believes continuing yeast is possible, especially after two treatments, an alternative treatment (e.g. nystatin) may be a consideration.

Yes, NAA is a DNA test (NAA = nucleic acid amplification).

If you had an IgG syphilis test, 3 weeks might be valid -- but those tests are relatively new, without the level of historical experience we have with older technologies. I tend to stick with 6 weeks as my advice for patients. However, the chance of syphilis in your partner or from this sort of exposure is zero for all practical purposes. 

And I agree exactly that the chance of two false negative for chlamydia and gonorrhea is virtually nonexistant.

Thanks for the thanks about our services. That's why we're here. Take care and stay safe.

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
And herpes blood testing definitely requires 3-4 months for a definitive result. But it's a very low likelihood, and a negative result at 4 weeks is probably 80-90% reliable.

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49 months ago
Thank you Dr. Handsfield.

So just to summarize:

- the risk of me having HIV, trich, chlamydia, gonorrohea and syphilis is negligible/non-existent;

- it might be a good idea for me to retest for herpes but since I don't have any symptoms probably low possibility?

- I guess I'm not that worried about hepatitis? I don't think I have symptoms 

When do you think it is ok to have unprotected sex with my husband? Should I wait until after a final herpes test? Any other final tests you recommend?

I know this is my final question so thanks again in advance. 

You have eased my mind and I may sleep tonight. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
49 months ago
I agree re HIV and the rest. As for herpes, I actually don't recommend any further testing; the chance is too low, and you'd have to wait too long for a clear result. However, if you feel you would worry less after a negative result in a few months, feel free. I agree about hepatitis; in my clinic, we never test for it after individual exposures. If you feel you need to do it, however, limit testing to hepatitis B. Hep C is definitely not an issue (not heterosexually transmitted, despite what you can find online). If somehow I were in your circumstances, I would have already resumed unprotected sex with my spouse. That's not that I can guarantee you don't have something. But the chance is extremely low. I definitely do not recommend any testing beyond what we have already discussed.

Thanks again for the thanks; I'm glad to have helped.

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