[Question #4220] Questioning Test Results

83 months ago

Hello,

I am a female in my late 30s with a very, long-term partner. About a month ago, I had protected vaginal intercourse with another man in his 40s two times. A different condom was used each time and it was used for the entire time. I got very concerned about an STI exposure despite condom use and got testing (NAAT) for gonorrhea, chlamydia, and trichomonas through Labcorp at 15 days after the exposure (planning to also get syphilis and hiv tests in a couple of weeks). The results were negative. However, I have more recently (past week) been experiencing painful and frequent urination, bladder discomfort and pressure and am concerned about the accuracy of the tests I took. I haven't experienced any discharge or anything else concerning. I should note that I have a history of urinary and bladder symptoms that haven't ever been explored by a medical provider, but seemed to be somewhat hormonally influenced. Should I retest for the infections above or is there something else I should be testing for? I am HSV2 positive diagnosed about 18 years. Thank you for any insights either of you have.

H. Hunter Handsfield, MD

83 months ago

Welcome to the forum. Thanks for your question.

It seems you were at low risk for gonorrhea, chlamydia, and trichomonas on several counts. First, these infections become quite uncommon after age 30, so it probably is statistically unlikely your partner was infected. (I don't mean zero risk, but definitely lower risk on the basis of age. I cannot otherwise judge this, knowing nothing about him. Second, it seems condoms were used properly and carefully, ablating most risk that might have occurred. Third, the tests you had are highly reliable; it is very rare that any of these three infections is missed by standard NAAT testing.

Finally, it sounds like your symptoms are pretty typical for the same sorts of bladder discomfort etc you have experienced previously. While these STDs can cause such symptoms, it's uncommon; the large majority of gonorrhea, chlamydia, or trich don't cause urgency, frequency, bladder "pressure", etc. Presumably when you had those past episodes you were tested for urinary tract infection (UTI); your symptoms now certainly are typical for non-STD UTI and I suggest you be evaluated for that. I do not see a need and would not recommend retesting for STDs. Perhaps your doctor might recommend that, but only after evaluation for UTI first.

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

HHH, MD

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83 months ago

Thanks for your reply, very helpful. Would there be any other STDs that would cause urinary symptoms besides the ones I have been tested for? Also, how effective are condoms for preventing trich? I read this infection was more common in people over 30, but I trust your perspective!

H. Hunter Handsfield, MD

83 months ago

Trichomonas is diagnosed more frequently in older women, but that's largely because of delayed diagnosis. Unlike gonorrhea and chlamydia, trich can persist for years, and therefore remains more common as women age. There may be slightly increased risk of new infection in women your age, because of chronic, undiagnosed carriage in men their age. But most infections are acquired along the same age patterns as most STDs, i.e. teens to around age 30.

There are no data on condom protection against trich in particular, but no reason to suspect any less efficacy than for gon/chlam and all STDs transmitted primarily through genital fluids.

Could other, undiscovered STD bacteria cause symptoms like yours? Perhaps, but there is no reason to suspect a high chance of it.

As you may know, each question includes two follow-up comments and replies. Assuming you will seek care and get checked for UTI, it would be great if you could post the outcome when done.

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