[Question #10347] Follow up 10309

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23 months ago
Hi Drs

Following on from my last q. I have now had a urine test at my GP. however it was into a large container which was decanted into smaller jars for a urinalysis & chlam/Gon test.

1. Would test still be reliable as normally it’s just the first part required. 

My rash on arms is spreading, it starts in the hair follicle as a small white dot and increases to around 3mm.I have also noticed an increase in petechiae

2.is this a symptom of any sti specifically DGI and can you have a negative urine test with DGI?

As mentioned my partner has had an acute onset of arthritis symptoms in her fingers following my exposure which is really concerning me.Her bloods show high CRP,ESR,WBC,RBC width, Neutrophil and lymphocyte.The Rheumatoid factor was in range.
 
3.does this point to Reactive arthritis rather than Rheumatoid and do any markers indicate an sti or warrant further testing? 

My last concern is syphilis due to continued white throat and tongue.

4. When is the earliest a syphilis test would be reliable ? 

Many thanks Drs 

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Edward W. Hook M.D.
23 months ago
Welcome back to the Forum although I'm sorry you felt the need.  Your follow up questions suggest that you have not been able to keep from searching the internet regarding both your and your partner's symptoms and that what you are seeing is continuing to lead you astray.  In response to your questions:

1.  Yes, your test result is reliable.  Your skin rash is unlikely to be due to the exposure you described and does not suggest either DGI or syphilis.

2.  See above.  DGI is a complication of gonorrhea that can occur following gonorrhea infection at any site.  What you (and your partner) are experiencing do not suggest DGI

3.  There are many potential causes of arthritis however both Reactive Arthritis and DGI are most unlikely in your situation.   She need to work with her rheumatologist to determine what is going on.  What has the rheumatologist said and what sort of treatment has been offered to your partner.

4.  In persons without symptoms, syphilis blood tests are not conclusive until 6 weeks following an exposure however, If your symptoms were due to syphilis, your blood test would be positive.  When syphilis symptoms are present, blood tests are always positive.  EWH
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23 months ago
Thanks Dr for your speedy response.I’m afraid you are right I haven’t due to the continuation of my symptoms (urethral burning) and that fact that my partners symptoms started shortly after which is my biggest fear although I try and stick to this site.

I appreciate your responses and believe me I refer back to them when I have niggles in my mind

Can I just refer back to question 2 and again ask if DGI was present would it be possible to have a negative test result ? 

She has just seen GP for now who ordered the tests but is now being referred to rheumatologist. In regards to her blood test results and the high markers would these generally be what you expect to see if an STI was present? 

Thanks for explaining the syphilis blood test q which I now understand.

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Edward W. Hook M.D.
23 months ago
Since the only site of exposure was your penis and your test was negative, you can be confident that this is not DGI.

Your wife's test results simply confirm that she has arthritis. They do not indicate the cause however, if her doctor expected an infection, antibiotics would have been started

EWH
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23 months ago
Thanks again Dr. I waited a few days to see how things pan out and although the burning and painful symptoms on my glans have eased up a little , I have started to develop very achey wrists and fingers esp knuckles with a lot of cramping and numbness. I can’t seem to get DGI out of my head esp as my partner has these symptoms. I may be going over old ground but I have read somewhere here that Gonorrhea may be missed on urine tests where it leads to DGI I think it was Dr Handsfield. 1. Is it possible that a urine test gives a negative result but could lead to DGI ? 2. Also I know it’s rare but would it be even more rare for us to both have it or if it was the same strain would that make sense that we would both have it . Timeline was she first had symptoms of arthritis but no others two weeks after SI and I started with symptoms of burning glans just over 48 hours after my exposure but the hand and wrist pain has only really started couple of days ago around a month after exposure . Although I have had numbness in either arm most nights since exposure . The only other thing I can think of is we both had a really bad stomach bug around two months ago before my exposure. 3. is it possible our symptoms are related to that, reactive arthritis affecting joints and in my case urethra as well as there is no discharge just burning/pain discomfort. 4.And lastly I am awaiting urologist appointment is DGI something they can or would look into and are there any specific tests to rule this out and are they are other signs that would indicate DGI or that I don’t have which makes it impossible I have it. Thanks  again really appreciate it  
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Edward W. Hook M.D.
23 months ago
The idea that you have gotten an STI from your low risk encounter and transmitted it to your partner during the time frame you describe is unfounded and unsupported by the fact, including the testing you have had.  I suspect you are wrestling with profound guilt, something that this forum cannot address.  I will reply to your final questions and then the thread will be closed.  You should not return as there is nothing more that I can tell you about your risk or to prove that you are not infected.  You need to figure out how to move forward and stop fixating on the unfounded possibility that you have gotten and STI and transmitted it to your partner to cause her symptoms.   Final replies:

1.   The diagnosis of DGI is proven by demonstration of gonorrhea in a person with symptoms.  Your tests are negative.  You should believe them.

2.  Partner of persons with DGI typically do not have symptoms.  For you to think that you both have DGI is totally off base.  

3.  No, once again for both members of a couple to have reactive arthritis is undescribed in the scientific literature.

4.  The tests for DGI are tests for gonorrhea.  You can certainly discuss the possibility with your urologist but I suspect he/she will have little more to offer.

I think  you need to decide how to address your guilt.  It is leading you astray.  End of thread.  EWH
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23 months ago
Thanks again Dr , I understand what you are saying and I am trying to accept the facts. I am definitely suffering from guilt/anxiety but this was after the symptoms began and am just trying to understand the symptoms and timeline to convince myself it’s just coincidence eg my wife’s symptoms or in my case non specific symptoms which have been exacerbated by anxiety/stress and heightened awareness. Because there has been no real discharge that should convince me but will work through the issues individually and try to remain calm in the meantime until symptoms subside. I am away how stress can affect the body in numerous ways. Thank you for all your help and answering my questions. 

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Edward W. Hook M.D.
23 months ago
You’re welcome.  EWH ---