[Question #676] Question About Test Results and Oral Sex

101 months ago

Hi. I have a quick question. 25 days ago, I gave and received unprotected oral sex with my ex-girlfriend (43) while on a business convention trip. I felt fine, but I was having some nervous feeling about the event such as upset stomach, pain in my urethra, and a pain in my groin. I tested 12 and 18 days after my exposure and both NAAT tests were negative; however, the day before my test I have a bad sinus infection and my doctor gave me azithromycin to treat a sinus infection I had. I only took 1g as the infection cleared up the next day. I now have a new woman I am interested in and want to know if I should trust my test results? Looking at stuff online, the tests seem highly reliable. For example, I was reading in the med help forum a comment by Dr. Hook that the test should be reliable using this link http://www.medhelp.org/posts/STDs/STD-Worry/show/669252 but then stated on another link the test may not be reliable http://www.medhelp.org/posts/STDs/STD-test/show/1579948 . My urine tests were taken first stream and I waited one hour.

I still have no symptoms other than an upset stomach, but I am interested in another women and want to make sure I can engage with her without any concerns.

Your thoughts doctor?

101 months ago

Thanks Dr. Handsfield. The girl I plan to be with said she was tested three months ago and has not had any recent partners. To be honest, I was a little more worried about Gonorrhea than chlamydia. So in short, my test results were a true negative and the antibiotics did not mess up the test other than maybe making them negative IF I had been infected. And from what I read, the meds I took would only cure some Gonorrhea but not most infections. For practical purposes, I should have a true negative?

101 months ago

The masking comment scared me a bit ; however, I see on the CDC site, these tests are 99% sensitive, which seems very reliable.

H. Hunter Handsfield, MD

101 months ago

Welcome to the forum. Thanks for your confidence in our services.

I think you have misinterpreted the second of the links to Dr. Hook's comments on MedHelp. On quick scan, I believe he meant that a negative test cannot prove someone was not infected previously, if that person has been treated. In addition, you are citing 8 year old posts, and we now know more than we did in 2008 about the performance of NAAT tests for chlamydia. Even with curative treatment like azithromycin, almost everyone with chlamydia would still have a positive NAAT only 1-2 days after treatment.

In this case, you should concentrate not on your tests alone, but on other factors as well: a partner at very low risk of chlamyda or other STDs, because even in the most sexually active women (i.e. with multiple partners), gonorrhea is very uncommon and chlamydia extremely rare beyong age 30; oral sex is safe sex, with low risk of all STDs and nearly zero for chlamydia; and symptoms that are not typical of any urethral STD. The combination of those factors plus your negative tests (twice) amounts to 100% proof you aren't infected.

Accordingly, I see no reason not to proceed with a sexual relationship with your new partner. Of course, condoms are always recommended in new relationships, until both of you are confident your mutual STD risks are low and/or both have been tested. But that's just a common sense reminder, not because of any signficant risk from your safe sex fling with your former partner.

I hope this has helped. Best wishes and stay safe-- HHH, MD

ADDENDUM:

With apology, in starting to reply to your follow-up comment, I mistakenly clicked on the prominent "Delete" button that shows on moderators' screens -- and in error nuked my original reply. I've replicated it above (with a minor tweak in wording).

My comments were intended to apply equally to chlamydia and gonorrhea. You can be equally confident you do not have gonorrhea. It is not possible to be 100% certain you did not catch it. But if you did, the tests prove you don't have it now. For gonorrhea in particular, antibiotics do not merely suppress test results. They make the lab tests negative because they cure the infection.

All is well. You can let this go without giving it another thought. Good to hear your prospective new parter has had recently negative STD tests as well.

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101 months ago

Just to clarify, Dr. Hooks comments was from 4 years ago about the testing maybe being suppressed; however, you are 100% confident the antibiotic had no impact on a true negative. If yes, then I will proceed with my new relationship.

H. Hunter Handsfield, MD

101 months ago

You're still too focused on the test results, as if they are the most important indicator. They are not. It is the combination of factors that gives 100% confidence you were not and are not now infected.

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101 months ago

Thanks Dr. H. Take care