[Question #4175] PCR Test

30 months ago
Almost 6 weeks ago, I received unprotected oral sex from a female sex worker, but didn't see any sores on her mouth. 2 days after, I have had pain in the bladder area, frequent urination, lower back and pelvic pain, slight burning near tip of penis and feeling pee is stuck in penis. Haven't had any discharge or sores. A week from exposure, went to urgent care as the pains worsened and did rapid urine test but no UTI. Was given Cipro and Doxy to take for a week which made pains disappear for three days, then they came back again after that, but I completed the course of 1 week. Saw a urologist who gave me Doxy for 5 days. It worked for two days and then the symptoms came back again.  While I was taking Doxy, I got tested for Gonoreahha by PCR, Sephylis (anti body), HIV (anti body). Tests were negative. This was 3 weeks since the exposure. Then, I waited for another week and tested for Chlamydia by PCR and Herpes by PCR. Both were negative. When I asked the lab, they said they used my semen sample to test for chlamydia and herpes by PCR.  However, some online sites say that PCR for Herpes is done by blood or urine, yet the lab assured me that semen PCR testing is as accurate.  Is that true and do I need to test again? Also, do antibiotics affect sti test results? Lastly, is 4 weeks considered enough for PCR tests to detect herpes and chlamydia?  Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome to the forum. Thank you for your confidence in our services.

You needn't worry about herpes or any other STD. First, oral sex is low risk for all STDs and zero risk for some. In addition, all the tests you had were conclusive or at least very strong evidence against each infection.

In addition, contrary to what you (and perhaps some of your doctors) seem to believe, your symptoms are not typical for any STD. The main symptom of STDs involving the lower genital tract is discharge. Bladder discomfort, lower back or pelvic pain, frequent urination, and a feeling of incomplete bladder emptying are not STD symptoms. They are, however, typical of genitally focused anxiety. The failure of your symptoms to clear up entirely on the various antibiotics you have had is additional evidence against any infection as the cause. (The transient improvement you seem to have had with at least two treatments almost certainly was placebo effect, not because of partial treatment of any infection.)

PCR for HSV is accurate on any and all body fluids. Your negative HSV PCR result, including semen, is accurate. The antibiotics you had could make chlamydia or gonorrhea testing negative -- but that's because they cure the infection. In other words, if you had either one, not only would the tests become negative, but your symptoms would have cleared up entirely and permanently.

I suggest you read up on chronic pelvic pain syndrome (CPPS); google it for lots of information. The Wikipedia article is very good, and you also can find excellent information from the Stanford University Department of Urology. CPPS is sometimes called nonspecific or nonbacterial prostatitis, although the prostate itself may not be involved. As you will see, the symptoms are almost exactly what you report. The word "chronic" implies a longstanding problem, but it has to start sometime, and you will also read that CPPS (and genitally focused anxiety) often has an emotional or psychological component.

My strong advice is that you cease any attempts to find any infection and also not take any further antibiotic treatment. I am confident no STD, and no infection of any kind, explains your symptoms. If they continue, keep working with your doctor(s). You could print out these comments as a framework for discussion.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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30 months ago
Thanks so much Dr Handsfield!! So 4 weeks from exposure is long and good enough for PCR to show accurate results? Do you think I need re-test for all STDs at some point later including Trich which I didn't do before? If so, when? Chlamydia urine sample I gave was mid-stream and not first void, so got concerned tests didn't get done right and that I either got herpes and that's why antibiotics didn't continue to work, or it's a persistent Chlamydia.  I also forgot to mention, I had a prostate massage exam (was very painful) and urologist said I had Prostatitis, which may explain the transient burning near penis tip / testes and the pain I feel in my left testicle right after ejaculation (sometimes), which made me at first think it might be Epididmities or Urethritis (due to feeling of pee stuck sensation). I just wondered why I never had these issues until after this oral sex exposure. Urologist ordered a very detailed urine culture test that will take up to 2 weeks for results, to see if there's any bacteria and go from there.  I also been having diarrhea that started 10 days ago and ever since, feeling bloated, gassy, abdominal discomfort, belching, slight dizziness / nausea (worsens after I eat), body feeling bit warm and the growling worsens when the A/C is on.  These symptoms come and go though, but are present on a daily basis. Been seeing green stools after bowl movements.  I also have hemmroids (now treating with hydrocortisone), so I may postpone my colonoscopy a bit that my GI doctor ordered, and will also do stool culture.  My primary doctor said antibiotics might have caused the diarrhea although it's been 3 weeks since the last dose. I worried I had viral infection such as herpes as I know it could asymptomatic like in my case (no lesions or sores), and it may cause diarrhea.  Only other thing is a genital wart that my dermatologist froze and didn't seem worried and asked me not to test for HPV.   Sorry for the long note. Many many thanks!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Good grief. PCR testing never rules out herpes. It only means there was no HSV in the sample tested at the time it was collected. Based on your exposure and  symptoms, there is no possibility symptoms like yours are caused by herpes. You're also overthinking everything. Whehter or not a chlamydia sample was midstream or not makes no difference; and in any case, chlamydia is not acquired by oral sex. As already discussed, chlamydia is not a cause of symptoms like yours.

Your urologist's diagnosis of prostatitis is consistent with my suspicion of CPPS. I suggest you discuss my perspectives above with him or her. Your doctor is entirely right that the antibiotics you received are common causes of diarrhea. Herpes does not cause diarrhea.

You clearly have no STD. You came to the forum for reasoned, science based reassurance. I have tried to provide that, but this isn't a debate. Trust m on this:  there is NO chance you have any STD from the exposure described, and no STD that could explain the symptoms you have described. Do your best to accept and believe it!


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30 months ago
Thank you again, Dr. Handsfield.  I do agree with you my symptoms are not STD related. It's just that knowing that there are STDs that may not show symptoms and can be transmitted to others, felt the need to take measures to test and ensure I didn't contract any infections. Many online resources state that oral sex can transmit many STDs, hence I came to the forum to check. 

Just for my own knowledge, herpes is very least likely to be transmitted if the infected person didn't have active cold sores on her lips during the exposure, correct? And If an infection happened, the sores will show on the organ itself which is the penis in case of fallatio ( the oral sex giver is the infected one), and not near the rectum or other areas since those were not touched?  And since PCR can never rule it out, would IGG be more reliable after 16 months, or maybe re-test by PCR after a certain time?  My doctor stated a PCR should be tested once and no need to repeat it, so wanted to learn your thoughts too.  

I also didn't think I needed to test for Trich (which I never tested for and don't think it's caused oral sex?)  or test for HPV due to the genital wart, and probably shouldn't, unless you think otherwise.

I am sure it's anxiety and I will relax and move on, the genital focused anxiety was not fun to deal with.   I cannot thank you enough for all your valuable information. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
It's fine and often wise for people without symptoms to be aware of and potentially concerned about having asymptomatic STDs. However, not after a single episode of oral sex!

Even for people with real or substantial risk, testing for asymptomatic infection is recommended for some but not all STDs. In general, herpes is not among them, expect in people with known, repeated exposure (e.g. regular partners, such as spouses, of HSV2 infected persons). Still, the best measure of possible past asymptomatic HSV infection is the IgG blood test. It works very well for HSV2; almost all infected persons have positive tests by 3-4 months after infection, i.e. a negative result at 16 months is conclusive or nearly so. But negative IgG testing never can exclude HSV1, since up to 20-30% of infected people never develop positive tests. However, it rarely matters:  people with entirely asymptomatic HSV1 rarely transmit infection sexually to their partners.

Yes, initial HSV infection and symptoms are just about always at the exact site where infection enters the body, i.e. in men, on the surface of the penis if acquired by sex.

Trichomonas is not carried in the oral cavity and therefore is never transmitted to the genital area by oral sex, as far as is known.

Bottom line: based on the sexual exposure(s) you have described, being without typical STD symptoms, all by itself, is good reassurance against having an asymptomatic infection. Oral sex is safe sex, with low risk for all STDs and virtually zero risk for some.

Thanks for the thanks about our services. I'm glad to have helped. As you likely know, each question comes with up to two follow-up questions and answers, so that concludes this thread. Best wishes and stay safe.
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