[Question #7591] Tested enough?

1 months ago

4 years ago I was in a relationship with a man who had (many years before me) a brief but promiscuous history with men. Supposedly all contacts were w/ condoms. I asked him to get tested for everything, but found out much later that they only tested for Chlamydia, Syphillis, anti-HBC and Hep C. We were together a month and used condoms all but 2x.

He was not tested for gon & although he kept getting yeast infections, this was a persistent problem with a tight foreskin that he has had for many years (fish smell, itching etc that resolves with yeast infection treatment & continues to recur over the last 4 years). He had no conventional gon symptoms, and the time elapsed from his experiences with men, lack of dripping from his penis & the length of time of this issue lead me to believe it cannot be gon-related. 

I have been in another monog relationship for 4 years & since then I have been tested for HIV 4th gen (3-4x), hep C (x4), m gen swab (unsure of spec or sens), gon/chlamydia 3-4x (only starting abt 8 months after we broke up), trich (x2 but after antibiotics for BV), RPR (3x), HSV 2 (2x), oral/rectal gon/chlamydia, Treponema pallidum and Hep B (hbsag and anti-HBC even though I am vaccinated).

1)Have I been adequately tested for everything and I can move on? All neg

2)The Treponema pallidum test that I ordered was FDA cleared but not FDA approved, and I can’t find out the sens/specificity. I believe it was through Quest diagnostics. Can I trust that this test and the RPR tests (in addition to his neg RPR test) rule out that I have ever had syphillis at all stages? 

3)I had neg hep c but some of the results say “.1” & others say “<.1”. None of them are flagged- these are all negative, correct? 0.0-0.9 s/co ratio, Negative: < 0.8 

4)I’ve had 4th generation HIV tests, is this sufficient? I know there is a 5th gen now. 

I want to move on but now that I am married with a child I think my guilt is preventing me. Is it safe to move on & have more kids?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Welcome to the forum. Thanks for your questions.

From your description, you were at low risk for all STDs from the exposures described -- that plus absence of symptoms would be highly reassuring even without any testing at all. I'm not arguing against being tested -- just making the case that there was little chance of anything turning up positive. To your questions:

1) You have been over tested -- I would have recommended against some tests entirely, but more importantly against all the repeat tests. None needed to be done more than once.

2) All syphilis blood tests legally marketed in the US are highly reliable, and Quest certainly would not use any unreliable ones. Your results prove you do not have syphilis now and never did.

3) First, hepatitis C has been over-sold as an STD. The ONLY proved sexual transmission scenario with any frequency at all is for traumatic anal exposure in men having sex with men (likely involving overt bleeding); and is almost entirely limited to HIV infected MSM. So there was little chance you were infected from the sexual events described. As for the result itself, your own interpretation is correct:  any index value below the positive cut-off (0.9 for most such tests) is negative; there is no difference in meaning or interpretation below that level. You could have had a numerical value of 0.8, 0.2, or 0.5 -- all are equally negative. In fact, the same specimen tested 10 times could give 10 different numbers. Certainly you should pay no attention to 0.1 vs <0.1.

4) The "5th generation" terminology is marketing hype. These are antigen-antibody (AgAb, 4th generation) tests with identical performance. All results more than 6 weeks after your last possible exposure were conclusive.

You don't ask about your gonorrhea/chlamydia results, but they too are conclusive. 

I hope these comments help you move along. For sure you're in the clear on all these infections. Let me know if anything isn't clear.

1 months ago
Thank you for answering. I feel much relief.

Additionally, I have a very promiscuous past but was always vigilant about at least annual STD testing. A few more questions:
1) I lost a baby very early before I had this one, the guilt and trauma of which led to an uncontrollable case of OCD that I am embattled with now.  Is it possible that trich (which I had never been tested for before pregnancy) was present unbeknownst to me and caused my miscarriage? I had a pap smear before getting pregnant, and although it lacks sensitivity it didn't show up. My husband, with whom I had unprotected sex hundreds of times, tested negative a year after. My test was neg after the miscarriage but I had taken Flagyl for BV so it is irrelevant. 
2) Same question for m. gen, which I was only tested for after my miscarriage. It was negative. Studies seem to show no correlation with miscarriage but I thought I'd throw it out there.
3) This guy did have low-risk HPV. I was vaccinated and took the risk anyway, never had any symptoms. Is it possible I got low-risk HPV anyway and it caused my miscarriage, or that I gave it to my husband and this adulterated his sperm parameters? He had slight agglutinization but normal, no symptoms etc. 

I only mentioned my OCD status because these are clearly anxiety-driven questions. I am aware of this and am working on it with a therapist, I just cannot stop feeling as though I somehow caused the death of my child. Providing a non-judgmental platform for these questions has been a big help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Thanks for the additional information.

1) Trichomonas doesn't increase risk of miscarriage.

2) With Mycoplasma genitalium relatively recently recognized, knowledge continues to evolve. But you are correct that there are no data showing an association with miscarriage. In fact, there are no data that clearly confirm M gen ever causes anything in women:  while some reports support it as a possible cause of cervicitis and PID, other studies do not. It's largely for this reason that CDC and other experts do not currently recommend routine testing for it. In any case, there is no reason to suppose it had anything to do with your miscarriage. (The large majority of miscarriage are unrelated to any infection at all.)

3) Everybody has one or more genital HPV infections during their sexually active lives. That your past partner was in the small minority of men who were diagnosed with HPV did not elevate your own risk -- which existed with every partner you have ever had, including your husband. In any case, HPV also is not known to be a cause of miscarriage.

I'm so sorry you're feeling guilt over the miscarriage. Aside from uncommon cases of women reverting self-induced abortion, this is NEVER a valid cause of guilt or shame. Although the cause of miscarriage usually isn't known, the main theory is that it's the body's reaction to an abnormally developing embryo or fetus -- i.e. a safety valve against seriously impaired offspring. I'm glad you're working with a therapist and hope this discussion helps you work through this.
1 months ago
Thank you for that. I really appreciate it.

Before we close out.

1) Am I correct in that his yeast infections were in fact that? (occurred for 3.5 years and prob ongoing, treated effectively with yeast infection pills, caused fish smell and smegma production). He had a tight foreskin and terrible hygiene habits and seems emphatic that these are yeast infections. In the 5 years before me, he had only been with one person, a woman who was a one night stand, but they did not use a condom. He had no pus dripping from his penis, etc.

2) In the event he did have gonorrhea and I got it from one of our 2 unprotected encounters, could this have caused a miscarriage? I was for sure negative at the time of pregnancy but I suppose I could have gotten gon, gotten subclinical PID, then tested negative 8 months after our encounter then gotten pregnant and had a miscarriage from past PID or tubal adhesions. 

3) I got pregnant the first month we tried, miscarried, and became inconsolable for a number of months. I wasn't able to achieve pregnancy again for another year, and it was the cycle right after a clear HSG procedure. It was water-based but I wondered if the actual HSG procedure cleared out adhesions caused by previous PID and allowed me to get pregnant? My fertility clinic said that this test was purely diagnostic and is not known to increase chance of pregnancy, but some people believe it does.

Thanks again- I know my questions are up and truly appreciate your time and commentary. I hope I can move on and live a normal life.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
1. Those symptoms are a perfect description of balanitis, i.e. inflammation of the head of the penis resulting from tight foreskin and/or poor hygiene, often both together. Yeast often is the specific cause, but not always. The symptoms are not typical for gonorrhea or any STD.

2. As I said above, miscarriage is rarely the result of any infection, STD or otherwise. Gonorrhea doesn't causet it, or so rarely it can be disregarded. 

3. I'm not a gynecologist, but to my knowledge the fertility clinc is correct:  a hysteroslpingogram (HSG) cannot cure adhesions or increase the chance of pregnancy in women with scarred or damaged fallopian tubes.

I see all this as evidence of your OCD as the main problem here. You're drawing unwarranted conclusions, perhaps out of the guilt you describe for your miscarriage. As I said above, I hope this discussion has helped get beyond all this. Best wishes and stay safe.