[Question #3880] STD Testing

34 months ago
Hey Drs., thank you for the insight about all things STDs you administer. I am hoping one of you can quell my worries about what is possibly in my body. My background is: 22-years old, hetero-sexual male with a promiscuos past: 9 different women without using a condom, and 9 different women with one. Never had symptoms of an STD besides Pearly penile papules/fordyce spots, and a cyst, all diagnosed by multiple dermatologists. I have had one STD test for Trich/Chlamydia/Gonorrhea in March 2017, and one complete test (Herpes, Trich/Gon/Chlam., HIV, Syphillis) in May of 2018. Both came back negative. Just today I went in to my doctor for another complete palette of tests.  

I've had a stressful year, filled with obsession surrounding STDs. For me, peace of mind is by knowing that I am doing everything possible to not affect anyone in the future, and finding out if I have an STD to notify past partners. I know about the incubation windows, symptoms, etc. The last thing that is really bugging me are the type of tests used. Through my (unfortunate) Google binges, I've found there are different tests for each STD.  

My question is are there specific tests I should be asking to be used on my samples? Or do I trust that the lab my doctor is sending them to is using the most accurate tests they have available? Dr. is a great guy, but he repeatedly has told me things like 'stop worrying about STDs if I don't have symptoms' and 'herpes is a fluid based transfer, so just wear a condom.' I've read conflicting information to both of these statements (that many STDs are asymptomatic and you can get herpes skin-skin) which is why I am concerned of his knowledge. Being said, do I trust my doctor is getting me the most accurate results? And, what are the tests for each STD/STI I should be asking for, if you recommend I ask (ex. do I ask for IGg test for herpes)? Thanks guys. Hopefully this will be my last concern. 

Best, Luke

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

First, your sexual lifestyle probably has not been as risky in regard to STDs and you might assume. While many persons with such partner numbers will have had one or more STDs, many will not.

You can be certain you have or have had HPV, probably several times, but HPV is essentially a normal consequence of being human and sexual, generally remains asymptomatic and harmless, and accurate testing is not routinely available (and positive results generally don't require medical attention except in connection with pap smears), and doesn't require medical attention unless and until specific problems appear (warts, abnormal paps in women, etc).

The tests you have had were accurate at the times you were tested, i.e. this month. All the standard tests used by various physicians, clinics and laboratories are equally accurate and valid. There is no point in online searching and/or obsessing about minor differences in test performance that you can find online. Of course any two tests for a particular conditions (e.g. chlamydia or gonorrhea)  will give slightly different numbers when evaluated in different groups of persons at risk. But those variations do not mean actually important differences in real world testing.

Blood testing asymptomatic persons for herpes is controversial. Most experts do not recommend it in persons with histories like yours, but would limit testing to those with symptoms that suggest herpes and some persons who have had regular contact with partners with known herpes (e.g. if you had a regular girlfriend who you know know has genital herpes). If you do seek herpes testing, be aware the tests are not perfect. If tested, for sure have only the IgG and not IgM tests for HSV1 and HSV2; be prepared for a fairly good chance of a positive result for HSV1 (mostly from childhood oral infection); and also for a possible weakly positive but unreliable HSV2 result. But I recommend you not do it.

I strongly urge you not to waste money or emotional energy on yet another rounds of tests. You clearly do not have, and almost certainly have not had, any conditions about which you need fo inform future or past partners. You definitely should not say anything to any past partners, based on what you know now, and there is no need to say anything about STDs to future partners. You'll just create trouble for them and for yourself, without any benefit to either their health or yours. 

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

HHH, MD
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34 months ago
Thank you for the response, Dr. H. That definitely puts my mind at ease. I understand your response about the type of tests (two tests may report different levels of a disease for a person, but it's not statistically significant: correct me if I am wrong) and I will stop worrying about that. 
I just have two quick follow up questions. One: I forgot to mention the last time I had unprotected sex was with a stranger (Caucasian female, 22) mid-April 2018. I know you are recommending I stop putting money into tests, but based on this information, should I go in for a 3/6 month follow up to make cover the incubation window for HIV? Or is the test I just did yesterday fine for that window? 

Also, is there any way you can explain why experts don't like giving out the tests to people who are asymptomatic/been exposed? I know herpes is essentially an over-stigmatized skin-rash, but shouldn't you just get the IGg test to be sure? 

Thank you!!
34 months ago
And lastly, if I do get a low positive for HSV-2 on the IGg, should I tell my partners about this information? Or is it not necessary? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
We almost never recommend testing after any single heterosexual exposure unless there are symptoms or there was known exposure to a particular STD. Without these, the overall risk is low enough that tesitng isn't warranted. A smarter strategy is for people with occasional new partnerships to get tested at regular intervals, e.g. once a year, rather than doing it after individual exposures. But in any case, for sure it isn't necessary to be tested 3-6 months later. If testing is done at all, it should just be a urine test for gonorrhea chlamydia (valid any time more than 4-5 days after exposure) and blood tests for HIV and syphilis at 6+ weeks. So for sure you don't need any additional testing on account of that event. (Tha said, I would urge you to get into the condom habit for new partners or exposures. What were you thinking??)

Your second question apparently is herpes related. But surely you understand that not all rashes suggest herpes. Of course all experts would recommend diagnostic testing for persons with symptoms suggestive of genital herpes. But just any rash doesn't cut it, only particular symptoms or rashes that are consistent with HSV. The large majority of genital area skin problems are not STDs.
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34 months ago
I wasn't thinking. Also, I understand the skin situation, doctor. It is just annoying that the IGg test gives out so many false positive results. That's why I am wondering if I do end up getting a positive result within a level of 1.1-3.5, should I even tell my partner, or past partners? Extremely confusing
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
It is pointless to worry about what to say in the event of a low-positive test results. You have misinterpreted what you think you have learned about HSV2 testing. Most test results are cleanly positive or negative. Cross this bridge if and when you come to it. My advice remains that you not be tested and that you go ahead with your life on the very high probability you do not have HSV2.

That finishes the two follow-up comments and replies included with each thread and so ends this one. I hope the discussion has been helpful.

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