[Question #12609] Lingering symptoms or false negative?

6 months ago

Hi doctors,

Not exactly a follow up question but this is indeed about the same exposure I asked few weeks ago.

So I’ve had unprotected oral sex in late December.

21st since exposure: HIV RNA negative

25th since exposure: Urine test negative which includes Chlamydia, Gonnorhea, Ureaplasma, mycoplasma, Trichomonas, Candida and Gardnerella.

28th since exposure: TPAB+VDRL negative

While I’m not really worried about HIV, I noticed that my penis was red, a bit of skin peeling (it’s already gone) but still slight itchiness like 2-3 times a day till now, a bit of fainted rash on my glans, other than that I don’t feel anything, no discharge no urine pain whatsoever.

I’ve googled the symptoms a bit and it seems to be balanitis and it could be yeast infection.

I know this is not a place for diagnosis so I’m just looking for some advice. My questions would be:

1. How likely a urine test can be false negative after 25 days of exposure?

2. Is urine test accurate for yeast infection?

3. While oral sex is quite not usual for syphilis, what’s the accuracy for a VDRL/TPAB test on 28 days? Do you think I should get tested again?

I will do another HIV test early next week (after 45 days just to be safe)

Im not worried about HIV but this skin peeling / rash developed after the unprotected oral sex just seem to be too coincidental and I’m a bit frustrated despite not very concerned. Thanks

H. Hunter Handsfield, MD

6 months ago

Welcome back. I'm sorry you're still so obsessed with an essentially zero risk exposure. I'm glad you're at least no longer worried about HIV, but Dr. Hook's reply a month ago also reviewed the reasons you almost certainly acquired no other STD either. Honestly it sounds to me like nothing at all is wrong withyyour penis. Transient redness and "a bit of skin peeling" can occur naturally, and everybody has itching of penile skin from time to time. Almost certainly your anxieties about your exposure and a regretted sexual decision are leading you to focus on trivial symptoms or even normal body sensations that otherwise would not be bothersome and perhaps you would not even notice.

1. The negative urine test was conclusive for all the organisms tested. False negatives are rare. And anyway you have no urethral symptoms. You can be confident you have none of those infections; and even if you did, they could not explain the symptoms you have described.

2. Urine is not normally used to check for yeast infection in males. It might pick up some infections, but not all. But anyway, having yeasts on the penile skin (or under the foreskin, in the urethra, etc) is entirely normal and would not require treatment in absence of symptoms that you currently do not have.

3. The syphilis blood test takes up to 6 weeks to become positive; probably 90% of infected persons would have positive results by 4 weeks. But if you had acquired syphilis, by now you would have had an obvious chancre (open sore) of your penis. Absence of a chancre plus your negative test at 4 weeks can be considered conclusive evident you don't have it.

In summary, I remain confident you have no infection of any kind from the oral sex exposure a month ago. You can safely stop testing and can continue unprotected sex with other partners without putting them at risk for anything.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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6 months ago

Hi Doctor,

So I’ve done my HIV and syphilis on exactly 45 days now and they are both negative.

However going back to the minor symptoms, I am still concerned if it could be any sort of STI or simply a UTI?

I mentioned about yeast infection last time but I forgot to mention that my girlfriend has given me a canesten clotrimazole cream just to “try” if things get better, and apparently it didn’t work. I stopped using it (can’t remember exactly how long) a day or two days before I did my urine test. May I know if this kind of cream can affect my urine test result?

I don’t have discharge or any other typical STD symptoms but I also have this slight lower belly pain too which seems to be one of the UTI symptoms? The itchy tip of my penis seems to also be a bit more frequent than before my exposure back in December. I’m worried not because of STD, to a certain extent I tend to believe everything will be negative if further test is required, I’m actually more concerned if I leave this slight discomfort for long I may get severe bladder infection or possibly sepsis??!

Anyway, if the cream could’ve affected my previous urine test results then I may go tested again, followed by a urologist if everything comes back negative.

I just feel weird down there but the pain and itchiness are both really really minor, the lower belly discomfort might probably be described as “bloating” rather than pain.

6 months ago

One more thing to ask, as I took a flu vaccine 2 days ago, may I know if the vaccine could interrupt the urine test results if I need to do another one?

H. Hunter Handsfield, MD

6 months ago

Your continuing symptoms do not fit with any STI. They are definitely not due to any infection from the oral sex event several weeks ago. If they are related to that event, they are the result of anxiety about it -- indeed I could use your story to teach med students and residents about genitally focused anxiety after a regretted sexual event. Anxiety is a powerful force in magnifying trivial symptoms or even normal body sensations that otherwise would not be bothersome and perhaps not even noticed. Neither influenza nor other vaccine or medication can interfere with HIV/STI test results.

That concludes this thread. I hope you are able to move on without further worry. Please trust me: you have no infection of any kind from the oral sex event. Believe it!

HHH, MD

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