[Question #2102] STI Test

47 months ago
Hello,

May be worthwhile looking at my previous question for the background on the situation. However to summarise, I had unprotected vaginal sex with a girl who was not my partner (15/20 secs total encounter). I also received oral sex with the same girl. The only symptom I noticed was aching testicles, but this lasted for only 2 days and was pretty sporadic. 

My partner who I have had sex with numerous times since the encounter described above has since had potential symptoms. Bleeding between periods and after sex (she had this before I had sex with another girl though), odor from vagina, some stinging sensation whilst having sex (recent symptoms, although 5 months after the encounter described above). 

Edward Hook said that the encounter was low risk but not no risk, so I have been tested. The results as follows: Chlamydia - negative, gonnorhea initial test positive, then sent for validation and twice tested as negative. The test done was urine NAAT.

So, strange situation, but what are the chances this test was positive, but as the sample became less 'fresh' the bacteria died and it became negative? Or the test was a false positive? Isn't gonnorhea rarely asymptomatic in men? I have since been tested again but as you can imagine, the worry is killing me. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome back to the forum. I reviewed your previous discussion with Dr. Hook and agree all he said.

While chlamydia and gonorrhea are cleared by the immune system within weeks to months, without treatment, this is not known to happen less than 6-8 weeks. Your negative test result shows you were not infected. There is no realistic chance you were infected and the infection had cleared before you were tested.

Yes, gonorrhea is rarely asymptomatic in men. Chlamydia more often is asymptomatic.  But I don't see why this is relevant. Your negative test is valid regardless of your symptoms.

There was no need for another test, and no rational basis for "the worry is killing me". You weren't infected. Stop worrying about it.

HHH, MD

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47 months ago
Not sure you have fully understood the premise of my question. The gonnorhea test was positive at my local hospital, it was then tested in London 2 days later and was negative, twice. 

This, I am told, is unusual and 99% of the time the second tests back up the first. The hospital have therefore offered me treatment for gonnorhea and strongly advised a re-test, as they couldn't be sure I wasn't infected. Hopefully you can see my rationale for worry. Please can you provide some clarity on reasoning for the conflicting test results. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Sorry, I did miss that important aspect and I certainly do understand why you are concerned about it. Apologies again.

Presumably all your gonorrhea tests were nucleaic acid amplificaiton tests ((NAATs), which very rarely given false results. False positives are especially rare, but false negatives slightly more common. I'm also wondering whether the hospital might do DNA probe test, not NAAT; the probe tests are more prone to false positive results. Either way, having 2 negative results is strong evidence that you weren't infected. The fact that you have had no symptoms is additional important evidence:  under 5% of men with urethral gonorrhea don't develop symptoms, perhaps under 1%. So all things considered, I'm fairly confident you do not have gonorrhea and never did. I would be further reinforced in that belief if the initial result was from a probe test rather than NAAT.

Another approach would be to test your casual partner, i.e. the potential source of your infection. That should have been done by now -- presumably you (or someone) contacted her after your first positive test, right? The usual approach is to treat such partners routinely, and to test them before treating. If she was tested and negative, it would further reduce the likeklihood that your initial test was valid.

Having said all that, it would not be unreasonable for you to be treated. Treatment is easy, with single doses of antibiotic (usually an injection of ceftriaxone and a single dose of azithromycin by mouth). This advice doesn't change my judgment that you probably weren't infected.

I hope these comments are helpful.

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47 months ago
No problem I should have highlighted this more clearly. When I asked what test it was the nurse told me NAAT. She didn't mention whether this changed dependent on location of testing so hard to say. Is the idea that the bacteria deteriorates over time, thus creating a negative result, a valid one? Or is this pseudoscience?

I do agree that the likelihood I have been infected is very low. And the positive result is puzzling. The casual partner who I have since asked again insists that she was not and is not infected with any STI. 

You mentioned after 6-8 weeks your immune system should clear the infection. So would a positive result even be possible? Is it possible that I've 'ping ponged' the infection between my long term partner over the last few months? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
I don't even know what you (or a nurse?) mean by bacteria "deteriorating over time creating a negative result". If someone has gonorrhea or chlamydia and the test becomes negative, it means the infection is gone. After the immune system clears gonorrhea, testing is negative.

I agree the positve result is the puzzling aspect of all this. That said, your casual partner probably is right -- most people who believe they are uninfected are correct. However, there are plenty of exceptions. In view of your positive result, it would be really very dumb of her not to be tested to be certain. (Feel free to tell her I said so.). It would even be reasonable for her to be treated, although that's mroe optional.

I see no realistic likelihood you and your regular partner have ping-ponge the infection back and forth.

That completes the two follow-up comments and replies included with each question, and so ends this thread. 
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