[Question #1997] Gonorrhea Scare - Extremely Stressed

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83 months ago
Hello. I have unprotected sex with my regular, long-term partner, typically 1-2 times per week. About 2 months ago, I unfortunately and stupidly had unprotected sex with a man on a Monday, had sex with my regular partner on Thursday, and had sex with the other man again Saturday.  The other man calls me up the following Monday and says he thinks he has an STD. Sure enough, he tested positive for chlamydia.  He was negative for gonorrhea. I saw his results.  I went and got tested on Tuesday (3 days after last sexual encounter), and was positive for chlamydia and BV.   I was experiencing some vaginal irritation but not discharge.   Tested negative for gonorrhea and trich. I was treated with doxycycline 100mg x 7 days  and Metrogel for 5. I still felt that I had some irritation, and my regular gyno prescribed metronidazole oral, 3x a day for 7 days. I still feel that I have on and off irritation, but I am focusing excessively on my genitals. I now have a very slightly yellow, non odorous discharge, and can't recall if that has ever been normal for me. I know that doxy should have treated chlamydia and flagyl should  have treated trich. I'm concerned that I had a false negative for gonorrhea. Regular partner has had no symptoms and was treated for chlamydia. We have had protected sex twice since we both completed treatment (weeks after). How likely does it seem that I would have had a false negative for gonorrhea?
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H. Hunter Handsfield, MD
83 months ago
Welcome to the forum. Thanks for your question; I'm happy to help.

The current tests for both chlamydia and gonorrhea are extremely accurate. Statistically, there is no realistic chance that all three potentially infected persons (your partner, his other sexual contact, and you) all would have negative test results and that you would nevertheless have gonorrhea. Your symptoms really make no difference in this judgment:  almost all genital symptoms in women (amount and character of vaginal discharge, itching, irritation, painful urination, odor) are nonspecific -- that is, the same symptoms occur in several different infections. And vaginal discharge is especially nonspecifc, i.e. often not pointing to any particular cause. On the basis of the test results, you can be 100% confident gonorrhea is not the cause of your continuing symptoms. Finally, even if you had had it, doxycycline probably would have cured gonorrhea:  it's not the treatment of choice, but usually works.

Without the opportunity to examine you personally, it is difficult for me to judge the exact cause of your current symptoms. Yeast is always a good bet when there is vaginal irritation and discharge following antibiotics, which disrupt normal (protective) vaginal bacteria and allow yeasts to flourish; you should ask your doctor about this possibility and, with or without a specific diagnosis, trying treatment for yeast. (This is easily accomplished with a single oral dose of fluconazole, trade name Difclucan.) Beyond that, the bacterial disruption itself might be the cause of discharge, in which case it should clear up on its own in the next few weeks. But for sure no worries about gonorrhea.

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

HHH, MD

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83 months ago
Dr. Handsfield - I truly appreciate your response. 

I was so concerned about a false negative from possibly "testing too soon"  that it was taking over my life.

I'm an anxiety driven person in general, so this whole ordeal has caused me to do obsessive research of symptoms and has been emotionally exhausting.  I feel it's possible that intense guilt and stress over this have caused me to exaggerate some symptoms and read too much into everything.  It has been really hard for me to let this go. 

However, knowing that gonorrhea really is an unrealistic possibility here is extremely helpful to me. 

Thank you!

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H. Hunter Handsfield, MD
83 months ago
With the current gonorrhea tests on urethral or vaginal swab, or urine, it's almost impossible to test too soon. If infection takes hold, it's detectable for sure within 2 days and probably as little as 18-24 hours after exposure. (It's a bit longer for chlamydia, probably up to 3-5 days.)

It is certainly true that anxiety or other emotional stress can magnifty otherwise minor symptoms, or even normal body sensations and appearances that otherwise wouldn't be bothersome and perhaps not even noticed. And whenever someone suspects her own symptoms have a partly pschological component, usually she is correct.

Anyway, no worries about gonorrhea and probably not other STDs either. Most professionals treating STDs routinely test patients for syphilis and HIV, so probably your partner and his other contact have been tested -- and if negative, you can be sure you don't have them. But if not or if uncertain, you should be tested. Now 2 months, after this all started, sufficient time has passed for conclusive results. (And no, this doesn't mean I think either HIV or syphilis is likely. But that's the routine, and I imagine you would find the negative results reassuring.)

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83 months ago
Thank you again. Out of curiosity, I often see it stated that you should wait 1-2 weeks for gonorrhea and chlamydia testing. Is that just kind of an arbitrary recommendation out of caution?
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H. Hunter Handsfield, MD
83 months ago
It definitely is not necessary to wait more than a week for accurate gonorrhea or chlamnydia testing. I have no idea who said that or whether it was arbitrary, and in fact there have never been any studies to directly address this. However, what we know about the the causative bacteria plus the biochemistry of the tests indicates that gonorrhea testing is valid any time more than 2 days (perhaps even as soon as 24 hours) after catching the infection, and chlamydia by 5 days (probably 3-4 days usually would be OK). For sure there are no scientific data to suggest either one requires a week or more.

That completes the two follow-up questions and replies included with each question, and so concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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