[Question #6174] False Negative

18 months ago

My apologies - the first draft printed in a light color font because my phone was in night mode. 


Follow up to question 6167: 


Could taking 500-1000mg of Cefuroxime a couple days before NAAT test for chlamydia, gonorrhea and trichomoniasis suppress the test and cause a false negative? 

The test was done 14.5 days post single, protected insertive vaginal and unprotected cunnilingus exposure and was negative. 



I am returning to your forum to get this opinion due to my increasing discomfort.  At 24 days post exposure I started getting a noticeable tingle around the tip of the penis. Now at 27 days I continue to have a constant slightly worse burning sensation that encompasses more area. This may be due to self examination? 


I had a basic urinalysis done at a walk-in clinic that showed moderate bacteria and was put back on sulfameth/trimeth as they thought it was prostatitis. I have had a history of prostatitis but never had a burning sensation from it. The sensation does not increase with urination. 


Should I be re-tested for the aforementioned test, or do you think this may be more uti or prostate related? 


Also, just curious if falling asleep wearing the condom would make any difference in risk. 


Thank you 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome back, but sorry you found it necessary. I'm taking your question this time, but I reviewed your discussion with Dr. Hook.

First, no antibiotic (or any medication) has any effect on reliability of HIV testing. That test, or future ones if you do any, will be as reliable as normal (i.e. conclusive when done sufficiently long after the exposure event).

Second, cefuroxime would prevent gonorrhea from taking hold, making testing negative. But that test still is reliable -- that is, the antibiotic almost certainly would not merely suppress gonorrhea, but cure it before it gets started. It has no effect at all against chlamydia or trichomonas. For those reasons, all those test results are reliable and conclusive, despite the antibiotic.

It sounds like you indeed might have prostatitis -- or, perhaps more likely, the chronic pelvic pain syndrome (CPPS), the evolving term for what has been called non-bacterial or nonspecific prostatitis; you can google it for more information (spell it out). The Wikipedia article is good, and you also can find excellent information from the Stanford University Dept of Urology. It can be thought of in the same terms as a tension headache:  the source of pain and discomfort is similar, increased tension in muscles of the pelvis or the scalp and neck, respectively; and the symptoms can include pelvic or rectal area pain or discomfort, and thingling or painful sensations referred to the penis. You may find on reading that your symptoms match CPPS; they certainly sound typical to me. The underlying cause probably is often psychological, basically the result of genitally focused anxiety. That's a good bet for noticing a recurrence of symptoms at this time.

As those comments suggest, I am skeptical you have true prostatitis and do not expect the latest antibiotic prescription to help. CPPS, and even most true prostatitis, is not due to any known bacterial infection. Antibiotics often are tried, but usually make no difference in symptoms. And your recent urinalysis likely was normal. Just seeing "bacteria" on UA is not abnormal; evidence of inflammation (increased white blood cells) is necssary. If your symptoms continue, I would advise seeing a urologist, and stop relying on walk-in or urgent care clinics. Proper diagnosis and treatment of such problems requires much more expertise than you're likely to find in a walk-in clinic.

Except for the potential psychological/anxiety link, I am confident your symptoms are unrelated to your recent sexual exposure, i.e. that you have no STD or other infection from that event.

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

HHH, MD
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18 months ago
Thank you 

Also if I were to have contracted genital herpes while wearing a condom would the infection start at an area outside the protection of the condom (site of infection), or could it initially start at the head of the penis? 

It’s been 29 days at this point and the tingling started around 23 days. Would it be quite obvious at this point if it is an initial outbreak. 

I’m going today to get a test done. If I am having an outbreak would the 29 day timeframe be enough to show a positive result? 


Thank you 
18 months ago
I apologize for the lengthy questions....

I think I was able to answer one question in regards to where the infection would enter. 

I also did not note that I received unprotected oral sex 39 days ago which would have put this at about the 33 day mark when I first became aware of the irritation. Yesterday there was a small red mark that showed up but there wasn’t a blister preceding the red mark. 
Should I be concerned or is this far too late to have signs of an initial infection? 

I did see a walk-in clinic doctor and he said he couldn’t say.  But that usually it starts with a blister, an open lesion and a pretty bad outbreak that typically starts within the first two weeks.  I have merely a red mark which could be friction related from masterbation and due to self inspection? 

As I mentioned I did get a blood test today but this doctor mentioned it would have no way of telling if I have herpes or not. 


I appreciate your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
"Tingling" (medical term is paresthesia) and other neurological symptoms can precede recurrent herpes by 2-3 days, but it is not happen with initial herpes, is never the only symptom, and if due to herpes would not last more than 2-3 days before blsiters/sores appear. A "small red mark" also doesn't suggest herpes. Probably you're examining yourself too closely and noticing normal skin variations that have always been there. There is no possibility this symptom is due to herpes. It would be a waste of money and emotional energy to be tested for HSV. 

The walk-in may not understand HSV blood tests in detail, but it is true that a blood test is not likely to be helpful. If positive, it would be from a past exposure, not a recent one. And the blood tests are not completley reliable, and the possibility of a false or misleading result is a lot higher than the possibility you have herpes.

Just let this go. You came here for our expert opinions and advice, which is that you clearly have no STD from your recent exposures. Do your best to accept and believe that judgment. You're having the same symptoms as in the past with prostatitis or CPPS (did you read about it?) and that's all that's going on here. Happily, both prostatitis and CPPS are harmless -- issues of comfort, not disease.

That concludes this thread. Please note the forum does not accept 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 and symptoms, or about prostatitis or CPPS, are subject to deletion without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.

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