[Question #10640] Concerns.
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21 months ago
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Hello Dr. I have a concern i was out of the country and got a STD panel done on OCT 28th for some reason they didnt do Gonorrhea. I got my results and it seems like they did a chlamydia blood test my results where Positive for IGM and negative for IGG. My exposure was with my long term partner unprotected 2 weeks before that on OCT 14th and hundreds of times before that. I had got a urine test done on OCT 11th for both gonorrhea and chlamydia and both where negative NAAT from state lab. I had my partner get tested as well on OCT 30th at the state lab she did a urine and negative as well. My concern is what does the positive chlamydia IGM mean if none of us have been positive on our urine samples? If it was a past infection wouldnt it be the IGG positive not IGM?
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H. Hunter Handsfield, MD
21 months ago
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Welcome to the forum. Thank you for your confidence in our services.
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It is unfortunate that some clinics and labs -- primarily outside the US -- offer and frequently provide chlamydia blood tests. They are entirely unreliable; nobody ever should be treated on the basis of a positive result, and treatment must never be withheld from someone likely infected or at high risk simply because of a negative blood test. Further, IgM antibody testing in general (for chlamydia or any other reason) is extremely prone to false positive results, which almost certainly explains your test result. I definitely would not conclude you have chlamydia or need treatment on the basis of that result.
You say nothing about your and your partner's potential STD risks. Did you have sex with someone other than your regular partner? Did she? If not, I don't understand why you felt a need for testing at all. If the ainswer is no, you can rely on both her and your negative test results for gonorrhea and chlamydia last month.
I hope this information settles your concerns. Let me know if anything isn't clear.
HHH, MD
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21 months ago
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what test may i take to rule out that i have ever had syphillis? When my partner was pregnant 2 years and half ago we had seperated and i saw a couple sex workers during that time. Mostly woman one trans, All protected sex except oral receipt unprotected. Never noticed any lessions on my penis. I did give cunnulingus to maybe 1 or two woman. Never noticed any mouth sores could i have missed them from if i got them from cunnilingus ? Both of her RPR tests where normal during pregnancy. but again i dont remember if i had any exposure after her last test. I did take a RPR test about 10months after baby and it was negative shes also did a RPR 7/8 months after giving birth. I also did a TPPA a year later and it was negative. However i cant recall if i had taken any antibiotics in that time i do remember having a throat infection and possibly took amoxcillin but dont know exactly if that was way before her pregnacy or not. Could that have caused my RPR or TPPA to to negative? I see you guys have previously told others a TPPA rules out syphillis anytime in the past but CDC and some clinical trials i read online show 15-25% of people will go negative after treatment some had primary some secondary and latent therefore i dont see how a negative TPPA excludes past infection
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21 months ago
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Got that info from https://academic.oup.com/cid/article/56/3/463/426795
Also do you think it is possible that both of our urine samples missed chlamydia? I dont understand why my IGM is positive. If it was past infection would IGG be positive not the IGM? Should i test again?
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H. Hunter Handsfield, MD
21 months ago
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Contrary to popular belief, taking antibiotics does not make syphilis test results false negative. Once someone has syphilis, they test positive for life: with RPR, only if the disease is active, but with TPPA positive for life regardless of antibiotics or other drugs in the meantime. You also describe a near zero risk sexual lifestyle for syphilis, incluiding your sex worker events a couple of years ago. (I am intimately familiar with the data on early treatment and T. pallidum specific test results like TPPA. The study you cite is one of several; see the scientific citations in that article.) The statistical likelihood that you ever acquired syphilis, and then had treatment adequate to eradicate it within the next few weeks, is zero for all practical purposes. And even if that happened, your recent negative tests prove it was cured and is gone forever (assuming no new exposure). Your test results prove you do not have syphilis and that neither you nor your partner ever had it.
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There is no realistic chance your two urine tests missed chlamydia, especially since you haven't been at risk for a long time before you were tested.
As I said, frequent false positive results are baked into the technology of IgM testing. It has to do with the biology and physical structure of IgM antibody molecules. There almost never is any other reason for false positive results. You should not test again.
Your questions, and the fact that you sought STD testing despite no evidence of risk suggest you have inflated ideas about STD risks and testing. I see no need for ever being tested again for any STD until and unless you and/or your partner have sex with other partners -- and not necessariiy even then, depending on the details.
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21 months ago
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I know i dont have syphillis now im just worried if what if i did when my partner was pregnant and infected her after her third trimester test. Im worried that if my other throat infection was at that time of her pregnacy and i took antibiotics for that it cured me and made my rpr and tppa go non reactive after infecting her. She had a RPR 8months after birth of baby but im not sure if she took any antibiotics after the birth if the baby for other reasons or maybe her own immune could have cleared it by then? Does congenital syphillis usually show symptoms my child is 2 going on 3 and seems healthy so far. Should i have my child tested ?
Okay that makes sense as far as chlamydia blood tests, I was just worried maybe the urine tests missed both of us. Can drinking a lot of water before urine sample dilute the urine and cause false negative? I do remember holding my urine 1hr before test but i read some websites say that first urine of the day is most reliable.
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H. Hunter Handsfield, MD
21 months ago
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These questions reinforce and support my closing paragraph above! You do see that, don't you?
Fluid intake has no known effect on chlamydia test reliability; and despite official advice to avoid urinating for a while before testing, 25 years of real-world experience is that it makes no difference at all in test reliability. And nobody knowledgeable ever advised that first monring voiding has any benefit. And what do you think the statisticla probability could be that ALL your tests (your wife's and both of yours) all were false negative?? Get real.
That concludes the two follow-up exchanges included with each question and so ends this thread. Do your best to avoid all the "what if" and "could I be the exception" sort of ruminations about STDs. And consider stopping web searching about such issues!
I do hope the discussion has been helpful. Best wishes.
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