[Question #1437] STD Concerns

46 months ago
Doctors,

I am concerned for my wife, who is complaining of thick vaginal discharge (light brown). It is odorless and appears to me as blood. She also says she has some crusting. She is worried it might be an std. Here is reason for my concern:

I was unfaithful to her some years ago and we worked through it. In the last 18 months, I have strayed again. First, I had one body rub massage, nude rubbing with some genital apposition but no penetration.  Seven months ago I had one episode of protected intercourse with escort. Everything covered and no condom malfunction. I put it all behind me and, though feeling very guilty, decided risk was too low to upset her or our marital stability again. Then she asked me the other day if I've done anything. I have denied but feeling terrible, mostly concerned I've jeopardized her health. I thought condoms were safe and body rubs w/o penetration was too.

Questions:

1. How likely I contracted or gave her anything that would cause her symptoms?

2.  Does this sound like chlamydia, gonorrhea or trich? Wouldn't those symptoms appear sooner than 7-18 months?

3. Would HPV cause bleeding. Wouldn't it be way too soon for her to have developed cervical cancer, especially after recent PAP smear?

4. How do you advise me to respond to her concerns knowing she is going to doctor soon? 

Thank you.
46 months ago
BTW, I meant to mention my wife is post-menopausal and had hysterectomy 10 years ago. Only has cervix.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

There are many causes of vaginal discharge, and an STD is low on the list of possibilities. Males are not known to carry gonorrhea or chlamydia for 6+ months, and your last exposure was condom protected, greatly lowering the chance you were infected. Also, as you suggest yourself, if gonorrhea or chlamydia caused your discharge, such a long delayed onset is atypical; any symptoms usually would start within a few weeks. Trichomonas could could do this, but your risk also was nil given your exposure history, especially the condom. But trich can remain dormant in women for years and then cause symptoms -- if that turns out to be the problem, it wouldn't necessarily have anything to do with your nonmarital exposures. Herpes could be possible, but unlikely without overt sores; and if so, probably recurrence of a distant past infection, unrelated to your more recent nonmarital adventures.

1) It is unlikely you are the source of any infection causing your wife's symptoms, although I can't say the risk is zero.

2) Answered above:  Very unlikely any of these, although a slightly higher chance of trich than the others.

3) HPV itself doesn't cause discharge, and the chance HPV progressed to cancer in a matter of months is extremely low. In the event she has HPV or cancer (or a precancerous cervical problem), it probably goes back many years, having nothing to do with your recent exposures.

While I can't give any guarantees, I would favor your wife seeing her doctor. She undoubtedly will tell the doc about her STD concerns. My guess is that nothing will turn up. But if it does, you'll obviously need to discuss your more recent indiscretion(s) with her at that time. Putting it in personal terms, if somehow I were in your circumstance, and knowing what I know, I would take this chance.

I hope this has helped. Let me know if anything isn't clear.

HHH, MD

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46 months ago
Dr. Handsfield,

Thank you for the response. I appreciate both your expertise and obvious concern. So, I went and got tested for bacterial std's today (chlamydia, gonorrhea, trichomonas and syphillis). Results will be in tomorrow or the next day. Now I am feeling foolish and even more afraid. I didn't even think about things like mandatory reporting if something shows up, and I have a prominent position in my community. However, the main thing is to make sure my wife is protected. So here are a few follow up questions:

1. How reliable is the NAAT test for trichomoniasis? Is it likely to catch an infection or are there a lot of false negatives? What about false positives?
2. Since my last possible exposure to chlamydia or gonorrhea (protected intercourse) was 7 months ago, would those even show up since you say that men are "not known to carry [them] for 6+ months? Also, I took a course of Azythromycin two weeks ago (500 mg once daily for 5 days) for a respiratory infection. Would that kill either or both chlamydia or gonorrhea, and therefore if I had been infected, would they show? I guess if my wife were infected, there is a possibility that she could/would have re-infected me within the 6 month window (even though we do not have intercourse often--maybe 4 or 5 times in the six months). TMI, I know. Sorry.
3. I would be shocked if the syphillis test is positive, except for a false one. How often is the RPR falsely positive?

Anyway, thank you again. I would love your answers so that I know how to interpret results. But I guess if any of them come back positive, there will be people at my door doing that for me. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
First, it is extremely unlikely your tests will be positive, and reporting is not likely to be an issue. If it is, nobody will show up at your doorstep; that never happens. Also, the systems to assure and maintain strict confidentialiy for infections reported to health departments are very secure, and the fines for noncompliance very substantial (minimum $5K for the lab, doctor, or health dept that lets the word out). Nobody would know unless you tell them. Anyway, I will be extraordinarily surprised if any of your tests is positive.

1) The trich NAAT is designed and approved only for vaginal or urine testing in women. It's probably accurate in males, however. False negatives certainly are possible, but false positive results are extraordinarily unlikely in either men or women; if positive, you're infected. But as I said I'm confident you wont' be.

2) The azithromycin would have curred chlamydia, and probably gonorrhea and syphilis. Any transmission potential to your wife ended within a couple days of starting that treatment.

3) False positive RPRs occur from time to time, but labs are prepared for it. If positive, the lab will automatically do a back-up test that will tell the truth. In any case, you definitely can expect a negative syphilis blood test.

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46 months ago
Thank you, Dr. Handsfield. Syphilis test came back negative, others returning tomorrow. Confident they will be non-reactive, as well. One follow  up re: my wife's situation. She has read several websites that indicate a symptom of vaginal HPV (warts) can be light brown vaginal discharge, which is why she is concerned about STDs. I have located the same sites. It appears from your earlier response that you would refute this. Am I correct? I will not initiate another question in this thread, and I would be most appreciative of your one final indulgence.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Tell your wife to be careful in her online searching. If you list every symptom that various medical conditions CAN cause, you'll always end up with a list 10 times longer than reality. Trust me on this:  In 40+ years in the STD business, I don't recall a single patient with HPV or warts who complained of vaginal discharge. The only possible exception is advanced cervical cancer, but that only occurs in women who neglect exams and pap smears for 10+ years.

As you know, each question comes with two followup questions and replies, and we're there. So that ends this thread. My parting comment is to restate my confidence that none of this will turn out to be an STD in either of you.

Best wishes.

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