[Question #470] Faith in test results?

94 months ago
I have asked a couple of questions on here before and I feel like I need to ask one more time.  I received unprotected oral sex outside of my relationship.  I feel horrible.  This was just now over 3 months ago.  I have tested two times now for STD's.  Once through a website called stdtestexpress.com and another with my doctor.  I tested at about 4.5 weeks and 7 weeks post potential exposure.  I tested negative for Gonorrhea, Chlamydia, Syphilis, HIV, Herpes 1 and 2 and the Hepatitis's both times.   Urine culture at 5 weeks post exposure was totally fine.

1)  Syphilis, I tested negative twice with the RPR test apparently.  I have heard this test is not that reliable.  Do I believe the results?  Chances of false negatives?
2)  I have never had Herpes.  No cold sores my whole life.  Tested negative twice.  I hear 12 weeks is the gold standard.  Do I test again?
3)  I had a 4th generation HIV test at 4.5 weeks negative.  Negative again at 7 weeks.  I assume that is good.  Correct?
4)  Should I have faith in my tests?  I realize this is mostly driven by anxiety.  

The reason I ask.  I have had a rash on my penis for over 2 months.  It developed roughly 3 to 3.5 weeks after potential exposure.  Dermatologist, after two visits made it seem like a non-issue.  My brain keeps correlating the rash with this event.  There have never been blisters, lesions or anything.  I am circumcised and I am wondering if I somehow, someway developed a form of Balanitis.  I am at just over 12 weeks now.  Do I retest for anything?  Thank you for your time and your expertise.  I need guidance, and maybe some mental help.
H. Hunter Handsfield, MD
94 months ago
I'm sorry to see the previous replies have not settled your irrational fears.

1) You heard wrong. Your negative RPR proves without doubt you did not acquire syphilis. And the risk of syphilis from a single episode of oral sex is very low.

2) The chance of herpes is also very low from a single episode of oral sex, and lack of symptoms is very strong evidence you were not infected. But if you need a negative lab test at a conclusive time, have another HSV test at 12 weeks if not yet done.

3) As you were told previously, your 4th gen test result at 4.5 weeks was 100% conclusive and proved you didn't catch HIV. Anyway, receiving oral sex is virtually zero risk.

4) Yes you should believe the test, and yes your problem is purely psychological.

5) The large majority of genital rashes are not STDs. (The book case right next to me includes a Genital Dermatology Atlas. It is over 300 pages long. Only 15 pages are on STDs. Balanitis is not due to STD and your penis problems are not due to any STD from the oral sex encounter. Believe the dermatologists.

Finally, in response to " I need guidance, and maybe some mental help." You have finally hit the nail on the head. It seems clear you are feeling guilty and ashamed over a sexual decision you regret, and your mind is mixing up those emotions with STD risk. But they aren't the same. I suggest you re-read your previous discussions with Dr. Hook and Ms. Warren and concentrate this time. You have no STD and can put that out of your mind and concentrate on the real problem. Professional counseling would seem to make sense.

Best wishes--  HHH, MD

94 months ago
Dr. Handsfield, thank you for the response.  To put my mind at ease I am waiting the results of a Herpes test.  This will be my final test. It will be 14.5 weeks post potential exposure. Should get results here within the next day.

I have a few more questions about the procedures for urine samples for Gonorrehea and Chlamydia.
1) When sampling for this how long are you not to urinate? I think both times I hadn't urinating for about 2 hours and was well hydrated.
2) When urinating for the sample do you sample from the onset of urination or does it matter?  Both times I did I started urination, got a steady stream and then start collecting.
3) When I sampled the second time i had wiped the head of my penis with an antiseptic wipe per their procedures? Would that have potentially killed any bacteria I was trying to test for?
4) Finally, does Gonorrehea produce any kind of rash?

I appreciate your time and information.
H. Hunter Handsfield, MD
94 months ago
1-3) The DNA tests for chlamdyia and gonorrhea are extremely sensitive, i.e. detects a very small amount of DNA. Despite official manufacturer advice is to wait 1 or 2 hours (depending on the test) since previous voiding and to collect initial urine, not midstream, it probably makes no realistic difference. Antiseptic also does not interfere with DNA testing. Your negative tests were reliable regardless of these details.

4) Gonorrhea rarely causes disseminated gonococcal infection (DGI), a systemic illness with arthritis, fever, and a particular kind of rash. But it doesn't cause the sort of rash that occurs by itself, i.e. red, itchy patches, etc. In any case, since you don't have gonorrhea, it can't be causing any symptoms you may have, no matter what they are or what may show up in the future.

93 months ago
Dr. Handsfield, Dr. Hook and Ms. Warren, I just wanted to first of thank all three of you for your patience with me on this forum. I want to apologize for being so paranoid and anxious about this whole ordeal I put myself through and all of you.  A quick update, I got test results back after 14.5 weeks for HSV1, HSV2 and Syphilis (RPR and confirmed with RFX titer) all negative and non-reactive.  With that, and with all of the testing I have done I am going to take a deep breath, look over all of it and accept that science is telling me I am STD free.  I had an advisor from stdtestexpress (tested through them twice), that I may want a 3 month HIV test, but you have all said my negative HIV tests 4.5 and 7.5 weeks post potential exposure are conclusive. I am going to roll with that.  At this point I have scheduled an appointment with a urologist to get a second opinion on my skin rash (non STD related).  I made a terrible choice three months ago.  I will NEVER do that again.  Again I can't say how grateful I am to all three of you.  Besides being rock stars in your fields you probably feel like counselors as well.  You have all helped me.  Thank you for being there.  I will trust the science.  My best wishes to all of you and to everyone seeking your counsel.
H. Hunter Handsfield, MD
93 months ago
Thanks for the kind words about our services and the website. I'm glad to have helped and that you have a proper perspective on things.