[Question #2960] Gonnorhea Swab Culture Accuracy

39 months ago
Hi,
Just want to ask a few question regarding gonnorhea.

I took a gonnorhea swab culture and resulted in no growth, as well as gram stain negative from urethral swab. My risks were protected with condom vaginal sex and oral sex receiving unprotected 1.5 years ago.

Chlamydia already tested urethra swab PCR and urine PCR all negative so no worries about clam.

No symptoms for 1.4 years, but 1 month ago feel some uncomfortable in urinating, and urethra. no discharge, but in the morning occasionally (noticed this for the last 3 days) seems like there are white stain (dry, only very small parts). And also i've been feeling like uncomfortoble in my scrotum, and also sometimes sharp pain in scrotum skin (not testicles). Doc diagnosed varicocle and prostatitis due to no std to be found.


Just want to ask :
1. how accurate is my gonnorhea testing? Is it conclusive that I dont have gonnorhea? because there is no pcr gonnorhea in my city.
2. Is the timing possible? I did'nt have any symptoms for 1.4 years and suddenly its like this.
Please answer this because gonnorhea is the last of my std worries (all others have been negative conclusively). 

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Welcome to our Forum.  I'll be glad to comment. The short version is that you are in the clear.  I will provide details and answer your questions below:

From what you say, your risk for gonorrhea is low.  You do not say much about prior partners but most people do not have STIs of any sort and even when they do, most exxposures do not lead to infection.  From what you say, the only body site at risk for infection is your penis and over 95% of penile gonorrea infections cause obvious signs and symptoms, typically within a week of exposure. 

1.  Culture is accurate for gonorrhea diagnosis as long as you have not taken antibiotics before you were tested.  PCR type testing is a tiny amount more sensitive but not significantly so.  I am surprised to hear that you do not have PCR testing available as most commercial tests combine gonorrhea and chlamydia tests on the same specimen. 

2.  In science we can never say never but it would be very, very unusual for you to have gonorrhea and not develop symptoms until more than a year had passed.  Given your history, my advice would be to look for other causes of your symptoms and to not worry about gonorrhea.

I hope these comments are helpful. EWH
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39 months ago
So here is my complete std check : 
1. HIV antibody rapid test at 3 weeks, 4 weeks, 5 weeks, 2 months, 3 months, 6 months, and 1 year past 6 months ALL NEGATIVE 
2. HIV PCR test at 5 weeks NEGATIVE 
3. Antibody HCV and HBV at 1.5 year NEGATIVE 
4. Syphillis at 1.5 year NEGATIVE 
5. Gonnorhea urethra swab
(gram stain and culture) at 1.5 year NEGATIVE
6. Chlamydia PCR (urethra swab and urine) at 1.5 year NEGATIVE 
7. HSV 2 1.5 years IgG negative IgM positive borderline then repeated 2 weeks afterward for confirmatory IgG NEGATIVE 0.09 (which is very small negative number) I never have any herpes symptoms, and 2 of my std clinic doctor and Nurse Terri Warren (HSV expert) said that the risk I had and IgG negative 2x is indicative of HSV 2 free and I should move on and ignore the commonly false positive borderline IgM which is banned by CDC anyways.
My STD doctors  and urology said that its enough testing, and I have to move on to other non-std causes

So i'm in the clear for STD? Can I move on, and search for any other cause of my symptoms? (or is it just anxiety? My pains in the pelvic area began when I searched around and found out about gon and clam symptoms on the net).
Also, does tiny dry white stain on the underwear on the morning is normal? Can I start a family and began unprotected sex with my future wife?
39 months ago
Oh, and that two exposure is all of my exposure, no prior exposure. 

I was also given levoflaxin for 2 weeks due to my suspected prostatitis, and bactrim for 3 weeks. But my tests were all 3 weeks after finished my antibiotics. If i were to have gonorrhea, would these anti biotics clear it? 
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Your tests are accurate and, as you said, prove that you did not acquire an STI from the encounters that you describe.  Your doctors are correct.  There is no need for additional testing.  You should be free to move on without concern.

The antibiotics you took would have cured many STIS (chlamydia, most gonorrhea) if you had it and had no effect on your test results.

The stain you saw on your underwear on awakening was likely normal.  EWH
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39 months ago
Hi Dr. EWH,

I continually every day for the past month have noticed white stains on my underwear regardless of I ejaculate or not in the day.  Before I urinate in the morning, I try to milk out my penis and it has some clear, mucous-like thing but not white.

I'm not experiencing any other symptoms and is very confused whether this is normal or not. I asked my doctors and they keep saying that this is seminal fluid,
but it seems that its weird I kept getting it every day. They said to believe in my pcr chlamydia and gonorrhea culture.

Regardless of that, I experienced a cough for the past weeks and was given cefixime for my bacterial cough. I was given 200 mg, 2 pills a day for 3 days just for the cough. I was surprised that when i googled it, cefixime is also used to treat gonorrhea. Today is my 2nd day.

Questions : 
1. I'm really confused regarding this discharge in the morning. I asked my std doctor and urologist and said it is seminal fluid. Should I keep digging for the cause of this morning stain or not? I'm confused.
2. Even if I had gonorrhea, would cefixime 200 mg x 2 a day cure it for 3 days? 
3. I also read Dr. HHH said it would be impossible for chlamydia and gonorrhea to be present >1 years after contracting it? My last exposure were 1.5 years ago (received oral) and 2.5 years ago (protected vaginal).

Should I move on regarding chlamydia and gonorrhea, given these statements and medications?

Thanks


Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I strongly advise you to stop worrying and move on without further concerns.  In answer to your follow-up questions:

1. I'm really confused regarding this discharge in the morning. I asked my std doctor and urologist and said it is seminal fluid. Should I keep digging for the cause of this morning stain or not? I'm confused.
A certain amount of secretion is normal for men, particularly early in the morning.  You have been evaluated by a trained physicican who has told you that this is not infection but normal.  I agree with him.

2. Even if I had gonorrhea, would cefixime 200 mg x 2 a day cure it for 3 days? 
Yes.

3. I also read Dr. HHH said it would be impossible for chlamydia and gonorrhea to be present >1 years after contracting it? My last exposure were 1.5 years ago (received oral) and 2.5 years ago (protected vaginal).
Nearly all gonorrhea goes away even without treatment  Given the absence of symptoms and the interval since your last exposure, as well as your negative test results, you should be confident that you do not have gonorrhea.

This is my third response to your questions.  As per Forum guidelines this thread will be closed later today.  EWH
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