[Question #10911] General Testing Question Based on Lifestyle

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18 months ago
My wife and I are non-monogamous.  We are both straight. Our last STD screening was a year ago and all was fine.  I had 12 partners over the past year, 7  were unprotected but each assured me they were ok. She had 2 partners, one protected one unprotected. Neither of us have had symptoms of anything. Most of these encounters were one-time occurrences. On to my questions: 1) We had physicals and the urinalysis came back as "no bacteria detected - clear". I realize this is not a substitute for an STD screening, but is this a good indication neither of us have anything bacterial going on? 2) She takes low dose doxycycline daily for an issue with her eyes. Will that skew testing results on her end? 3) Do you recommend hsv testing via IGG as part of our yearly STD screening? 4) Given our lifestyle is it likely we have Chlamydia at any given time since it is so prevalent and symptoms are rarely present?
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Edward W. Hook M.D.
18 months ago
Welcome to our forum. Thanks for your questions. I’ll be glad to comment.

1.  While I urine test is a rough indicator of the presence or absence of inflammation, specific screening is preferable. When infections are present and asymptomatic, they are typically associated with only minor amounts of inflammation and as a result, that inflammation may not appear in a urine test.  I would add that for both of you the same urine that would be evaluated using a urinalysis could also be sent for testing for gonorrhea, chlamydia, and trichamoniasis.

2.  The doxycycline that your wife is taking virtually eliminates any risk that she might have for chlamydia or syphilis. It’s activity against gonorrhea is uncertain, and there would be no activity against trichomonas.
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Edward W. Hook M.D.
18 months ago
Apologies, I pushed passed the submit button in error, my answer continues

3.  If you have not had a blood test for herpes in the past, I certainly would not recommend adding iit to your screening at this time. These tests are notoriously, unreliable, giving both false positive and false negative tests all too often to be recommended.

4.  It certainly possible that you or your wife may have had chlamydia in the past at some point. As I mentioned above, depending on how long she’s been taking doxycycline, your wife’s risk for chlamydia is quite low. You, however, do not have that protection, and as a result, periodic screening would be beneficial.

I hope this information is helpful to you. If any part of this response is unclear, or there are further questions, please use your up to two follow-ups for clarification. EWH
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18 months ago
Thanks Dr. Hook. Generally speaking, how much more likely is it for a woman to contract an STI from a man than vice versa from unprotected sex? In other words, is she at greater risk from new partners than I am with unprotected sex (I am heterosexual, she is bisexual)? Also, is there less risk if she is with another woman than with another man? How much do condoms offer her protection vs. me? Lastly, assuming we have no symptoms, how often do you recommend we routinely test? Thanks in advance 
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Edward W. Hook M.D.
18 months ago
After a single sexual encounter with an infected partner women are more likely to acquire common STIs like gonorrhea or chlamydia than men.  The data on this are best for gonorrhea but are assumed to be relevant to other STIs.  Women having any for of sex with an infected female partner are less likely to become infected than women having genital contact with an infected male.  

Condoms provide good protection for both partners as long as they are worn throughout the encounter and do not break (which occurs about 1% of the time, on average).

The  frequency of testing  depends on your level of concern, your knowledge of your partners (i.e. discussing with them when they were last tested and the results).  Given the numbers of partners you mention above, I would suggest somewhere in the rage of every 3-6 months.  EWH
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