[Question #3663] Testing Conclusiveness and Partner Symptoms

35 months ago
Hi docs, 
To refresh of my exposure and details: 

- Oral sex with a sex worker (somewhat brief)
- Analingus for a short time

I've had testing done at 18 days post exposure for both Gon/Chlamydia which were both negative. I have experienced symptoms of urethra and penis tip pain, albeit sometimes worse than other times, as well as a general burning feeling of the genital area. Something doesn't feel right, but I don't have any discharge and it has never hurt when I urinated. My GP doesn't have much to add other than an in-office UA that was negative for whatever basic stuff it looks for. 

My regular partner is now complaining of one eye being very painful and bothersome. This is the second day in a row it has been this way, and I can't help to think that I may have passed something on to her, based on what I've found online. 

1. How conclusive is a UA from Quest Diagnostics at that time frame, 18 days? What are the chances an infection was missed? What percentage of these tests would be falsely negative? I hadn't urinated for quite some time before submitting the test, multiple hours, and it was early in the morning. 

2. Could an issue in one eye be cause for alarm? I've read online that Chlamydia can cause that, although I've also read it's rare to get that infection through fellatio and analingus in the first place. Why would the eye be singled out in an infection like that with no other symptoms? Does the eye have to be externally touched or is it spreading in her system? Finally, how common is that? 

3. I'm visiting a urologist tomorrow to put this officially behind me with a swab test, but this new development is killing me. Would their testing in-office be more advanced than a GP and can I expect conclusive results at that time? Do I need to do some type of anal testing as well? I sure hope not....
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome back to the forum, but sorry you found it necessary. I reviewed your recent discussion with Dr. Hook and agree entirely with his assessment and advice. I also am confident you did not acquire any STD from the sexual exposure described.

I also agree with your self-assessment in that thread, where you said "I'm sure mental focus plays a role, but these sensations are very real." I have no doubt the sensations are real -- but that doesn't mean they don't primarily have a psychological origin. Tension headaches, as the name implies, are due to stress, but the pain is real, related to increased tension in scalp and neck muscles. It's no different for genital symptoms. I call it genitally focused anxiety (although that's not a formal term you'll find in textbooks or online), and it's very common in persons (seemingly men more than women) who are anxious about a sexual decision they regret. In any case, your negative tests plus absence of discharge or painful urination, plus the inherently low risk nature of oral sex, make it conclusive that you have no STD or other infection from that event.

To  your specific questions:

1) A normal urinalysis is solid evidence against a non-STD urinary tract infection. In itself it doesn't rule out a urethral STD like gonorrhea, chlamydia, or NGU, but in conjunction with all the other evidence against all these, it adds to the confidence you aren't infected.

2) You may have read of chlamydia or gonorrhea causing conjunctivitis (pink eye), but both are extremely rare. In contrast, conjunctivitis due to viruses and allergy are everyday occurrences experienced from time to time by all humans. I am completely confident your wife's eye irritation has absolutely no relationship to the sexual exposure you are concerned about.

3) Based on all you have said, I really don't think you need to see a urologist or any other health care provider; and don't see that having a "swab test" will help anything (assuming you mean another gonorrhea/chlamydia test). Testing collected by a urologist, or any office-based test s/he might do, will not be any more reliable than in your GP's office. You have already had conclusive testing.

Finally, I see no need for anal testing. Analingus is a safe sort of sexual exposure, with little or no risk of infection transmission mouth to anus. (The main risk of analingus is for intestinal infections, for the oral partner.)

If you carry through with your urology consult, I suggest you print out this thread, and perhaps the one with Dr. Hook, as a framework for discussion. I'm pretty sure s/he will agree with my assessment.

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

35 months ago
Thank you so much for the detailed response. I’ll be brief:

- Just to clarify, the UA I was referring to was an Aptima Combo2 for chlam/gon dome by Quest. At 18 days post exposure, would you consider that conclusive and reliable without a doubt? Is there any benefit to doing it again? Are false negatives common at this timeframe?

- I was planning on the swab test for NGU possibilities. If anything, it perhaps will bring peace of mind and allow me to move on. I assume the swab, or even an in-office UA would show something abnormal if anything was present. 

To put it in perspective, I vomited this morning when the eye complaint came forward again, after googling symptoms. I was terrified of the possibilities. I have no doubt my fear/anxiety are playing a part. 

Thank you again, this service is amazing.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
OK, sorry I misunderstood. "UA" usually means urinalysis, not a test for specific infections. In any case, that test was conclusive proof against gonorrhea and chlamydia.

I strongly recommend against swab testing to check for NGU in the absence of urethral symptoms like discharge or pain during urination. Entirely healthy people sometimes have detectable WBC in their urethras, so a positive result does not confirm urethritis. Also, NGU following oral sex is generally considered harmless, especially when chlamydia is absent -- exact cause(s) unknown, but probably often from entirely normal oral bacteria that are cleared by the immune system. In any case, NGU from oral sex is not known to ever cause harm in either affected men or their sex partners.

So none of this changes my opinion and advice that you have nothing to worry about and should do your best to move on without worry.

Thanks for your kind words about our services.

35 months ago
Hi doc,
I went through with the urology appointment. 

They did the in-office urine test, no swab, urine was normal. He said there was nothing to swab anyway. He looked at my penis and saw nothing abnormal. He offered me a course of 2 antibiotics and said that’s what he would have done in the first place if I started my journey there. In his words, “Kill the whole battlefield, ask questions later.” Based on my interactions here, I thought it’s probably best to decline. 

1. Would it be a bad idea to just do the antibiotics for peace of mind? What if the discomfort persists, meaning it’s not mental? He suggested cipro and doxy. 
2. Can I consider 18-day chl/gon testing conclusive?
3. Would you expect the body to need time to relax if indeed the area has been over stressed for 6 weeks obsessing over it? Instant relief hasn’t happened yet, but neither have serious symptoms. 

Thank you for the time, it’s appreciated more than you can imagine. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
1) Antibiotics are never a good idea when there is no need. They alter one's normal bacteria in the intestines, genital tract, skin, and all body orifices, sometimes leading to colonization with resistant strains and thus the risk of poor response to treatment if a severe infection should happen to arise; and excess antibiotic use in society is the main cause of increasing resistance, which has been much in the news. There is also a risk of making your symptoms worse by stimulating symptoms from overgrowth of certain organisms, especially yeasts (which is normal in the genital tract but can cause pain and discharge if overgrowth occurs.) The risk of a bad outcome in any particular individual is fairly low, but definitely not zero. I recommend against it and certainly would no do it if somehow I were in your shoes.

2) Yes, as I said above.

3) I don't know what this means. Nonspecific anxiety driven symptoms typically resolve over time, as it sinks in -- emotionally as well as intellectually -- that nothing is wrong and nothing bad is going to happen.

That concludes the third response and so ends this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last; future new questions about this exposure, testing, and your fears about STDs will be receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding.