Today I wonder with what likelihood a urine PCR test for gonorrhoea and chlamydia would come out positive if the bacteria have already lead to an epididymitis or vasitis. I would assume that in the case of an epididymitis or vasitis caused by the former bacteria, there would (almost) always also be a urethritis caused by the same bacteria, and therefore the urine test would be positive with a very high likelihood, yes? I am asking because I had a vasectomy done today. And I have noticed some occasional minor pain (like a fleeting electric shot every now and then) in my testicles for a few weeks (prior to the procedure). And when the doctor injected the anaesthesia for the vasectomy, it felt like he did so into the same location where I sometimes feel the pain sensations. I did do a urine PCR test just 1 week ago. And it was negative for all bacterial STDs tested. But might it be possible that I do have a bacterial STD that is "hiding out" in my testicles and doesn't show up in the urine? Also, the urine sample was not the first morning urine. How reliable is that? I want to make sure there is no dormant infection that might interfere with the healing process after the vasectomy. 

Thank you for reading.

First, FYI I've never heard of "vasitis" (vas defrens inflammation/infection) as a manifestation of any STI. The closest would be epididymitis -- but epididymitis due to chlamydia or gonorhrea typically is very painful, with pretty dramatic enlargement and tenderness of the testicle. Second, I can't image the operator performing a vasectomy would not notice obvious enlargement and tenderness of the vas defrens or epididymitis in the course of his or her pre-operative exam, and during the procedure itself. Third, although I'm not a urologist and have no experience doing the procedure, that you have pain within a day of having vasectomy sounds entirely expected and normal; I see no reason to remotely suspect that it indicates prior inflammation due to an STI or anything else.

Finally, urine gonorrhea/chlamydia testing is around 90-95% reliable; that is, it misses a few infections compared with urethral swab. However, in absence of typical symptoms -- urethral discharge, painful urination -- the chance you have either infection probably is under 1%, even in view of the rather active sexual lifestyle you described in your four previous forum threads. (For gonorrhea, without symptoms it's under one chance in a thousand you are infected.) So even with a test that is "only" 90-95% sensitive, it is almost impossible you are infected. And on top of all that, you have -- as I said above -- the apparent absence of any abnormality observed by the professional who did the vasectomy. (And by the way, first morning urine is not known to make any difference in gon/chl test performance.)

I suggest you put all these thoughts aside and have no STI testing at this time. And discuss any pain or discomfort you are having with your vasectomy team.

Best wishes for a speedy recovery. Let me know if anything isn't clear.

HHH, MD

I really, really appreciate this forum and your work.