[Question #7608] STD testing windows and probability

2 months ago
Good evening:
On 12/11/2020 I had unprotected sex with an acquaintance who I don't really know her sexual history.  She said she was clean but you never know. The health clinic put me on PEP just to be safe.  I have HSV-2 but didn't have any open lesions. I'm male 47, she's female 33.

On 1/14/21 I finished PEP.

On 1/21/21 I tested negative for clamydia and gonorhea but the urine sample was small and I urinated about a half hour before I urinated in the cup for the test. My urine was yellow. The lap tech said it was enough.
1) If the urine was too diluted the lab would let me know?
2) Would this test be accurate?

On 1/25/21 I was tested for Hep B, Hep C, HIV and Syphilis and those tests were also negative.
3) Would these tests be accurate? I know some say PEP can delay HIV results.
4) Would PEP affect the other tests?

On 1/26/21 I entered into a new monogamous relationship and we had sex with a condom.  In the beginning before intercourse, my underwear came in contact with her vaginal fluids as i was wearing them.  

12 hours later, on 1/27/21 I got tested for Clamydia and Gonnorhea while wearing the same underwear with the dried vaginal fluids and it touched my penis obviously.
5)  Would my penis touching the dried vaginal fluids on my underwear affect the urine sample for my gonnorhea and clamydia tests?
6) On the same day, 1/27/21, I was also tested again for HIV, Hep B, Hep C and Syphilis. Should I be concerned about these tests? I just want to be sure I a clear from the 12/11/2020 encounter.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Welcome to the forum. Thanks for your confidence in our services. Directly to your questions, and then some more general comments about your situation.

1,2) Neither the small amount nor the time since previous urination has any significant effect on reliability of gonorrhea or chlamydia testing; your negative results are entirely reliable. (In theory, the smaller the urine volume, the more accurate the result, not less. And time since voiding has long been known to make no difference.)

3) Correct about testing for HIV after PEP. If prophylaxis fails, it takes longer for reliable testing. Basically, the clock for testing starts after completing PEP, not the exposure. For conclusive result, you need an AgAb ("duo", 4th generation) test 6 weeks or more after the last dose of PEP. In the meantime, you really shouldn't be at all worried. If you're in the US or other industrialized country, the chance a partner like your has HIV is under one chance in a thousand; and people who state they don't have HIV almost always are correct. I'm surprised your clinic or doctor prescribed PEP in the first place; I would not have done so.

4) HIV drugs have absolutely no effect on the other tests you had. Those results are conclusive.

5) Touching vaginal fluids, either directly or via clothing, is risk free for any and all STDs and HIV. There was no need for testing, but in any case the negative results are reliable.

6) Repeating these tests was unnecessary. The results two days earlier were conclusive.

My general comment is that you seem overly worried about non-risky sexual choices and events. Not only would I have not prescribed PEP, I probably wouldn't have even recommended testing. Don't get me wrong -- it was OK to be tested:  negative results can be very reassuring, which in itself can be beneficial. But all things considered, both the inherently low risk nature of the events described and your negative test results, you needn't be at all worried.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes for success in your new relationship.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Correction. For question 5, I wasn't paying close enough attention to the dates. One day is too soon for gonorrhea/chlamydia testing, which should be done at least 2-3 days. However, because this was a completely zero risk event and there was no need to test in the first place.

2 months ago
Thanks Dr. Hansfield very much.

All of my tests came back negative.  I was tested on January 30th.
I do have another question or questions about Trich. I was never tested for it and the place I used, it wasn't even an option for me.

1) Is it common in men?
2) Sometimes if I don't shower, I put my finger just below the rim of my penis head and it has a fish type smell.  I am circumsized.
3) Sometimes when I pull my pants down to urinate I will smell the fish or odor type smell real quick and then it goes away.
3) No pain or smell when I urinate or ejaculate. No pain in my penis at all and no discharge that I can see.
4) I did have unprotected sex at night with that friend of mine in December and when I pulled out and did smell a fish smell really quick.  (actually the same person I mentioned in the previous comments in this thread.
5) Does Trich go away on it's own?
6) How long does it last?
6) With what I am explaining sound like Trich to you? 

2 months ago
Or is it just sweat and moisture?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Glad to hear of your negative test results.

These are good questions. The second post today (sweat and moisture) comes closest to the likely explanation of the odor you have noticed. White, cheesy material that accumulates on the penis, primarily in uncircumcised men, is called smegma; it's often strong smelling, including fishy odor. My guess is you have a pocket of foreskin remnant or other skin structure that is having the same effect because it is not exposed to air. Alternatively, perhaps you have a minor congenital anomaly, such as a urethral duct remnant or cyst you haven't noticed, in which similar material can accumulate. Examine yourself closely; if you find anything of the sort, try to expose it and wash with soap and water daily, e.g. when you shower or bathe; that will probably end the odor.

In any case, this doesn't suggest trichomonas or any other STD. Trich is common in both men and women, but usually causes no symptoms in men. When it does cause symptoms, men develop nongonococcal urethritis (NGU) urethral discharge and sometime discomfort on urination. But absence of symptoms doesn't mean someone isn't infected. OTOH, there are no known complications or serious health outcomes in men; it's much more a problem in women, in whom it primarily causes vaginal discharge. (Perhaps you've read that trich in women can cause fishy vaginal odor, which is true, and therefore linked your odor to trichomonas. The biology of the odor is similar, but trich isn't involved at all in smegma or such odors in males.) For all these reasons, routine STD testing in women should include trichomonas, but it's not done routinely in men. Unless and until you have a sex partner diagnosed with vaginal trichomonas, I see no need for you to be tested. However, you could certainly do that == it's just a urine specimen (the first ounce or so of voided urine, same as for gonorrhea/chlamydia testing).

Those comments cover questions 1-3 (including the second 3) and the second no. 6.

4) Fishy odor immediately after sex almost certainly originated with your partner. Conceivably she has trichomonas, although the main cause of fishy odor in women is bacterial vaginosis -- a separate problem, with no treatment necessary for male partners.

5 and first 6) The natural history of untreated trichomonas in men isn't known. Probably most infections are cleared by the immune system over weeks to months, but some may persist for years -- we really don't know. All we really know is that trich often is diagnosed in women who have been monogamous with an untreated male partner, in which case he must also be treated to prevent reinfection of the woman.
2 months ago
Thanks for your reply.  I guess I opened Pandora's Box with this one.  It leads me to more questions.  

When I was with my friend back in December, I only noticed the quick hit of fishy odor at the end of sex when I pulled out and never any other time during the encounter.  We had sex just once.  She told me she hasn't been with anyone for 3-4 months before me and that was a monogamous relationship.  We don't talk anymore and I knew she was going to get her STD tests done and she is on top of her yearly testing.  But since then we don't talk anymore.

I did have unprotected sex with a new partner/new relationship a month later after the one encounter with my friend. That relationship also ended because she decided she's not ready to date.  (Although I didn't know that at the time we had sex)

1) is it likely the December encounter with my friend had Trich? 
2) If so could I have passed it to my new partner? [Should I worry about I possibly gave it to her? (just trying to see how likely I could have contracted it)]
3) does Trich in women clear on it's own?
4) What problems does it cause women if not treated? The relationship woman doesn't plan to have any more kids and would probably go for her STD yearly in September.
5)How long would trich show up in a test?
6) at their OBGYN, do most women get tested for Trich?
7) just say I have it, is there anyway to find out when I got it?
8) it is always transmitted? I know your colleague says a sex act doesn't always means things are transmitted
7) Am I thinking too much about this? I do have anxiety as you can probably tell.
8) have a beer after this post! hahaha thanks so much for answering!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Going first to (7):  You certainly are thinking too much about trichomonas!

It would take a long essay to reply to your general questions about trichomonas. Excellent online resources are available. You can start with ASHA, the sponsor of this forum -- search the home page for STD/STI then look for trich. Or CDC (www.cdc.gov/std) and follow the links there.

I have no way of judging whether your December sex partner had trichomonas -- not zero risk, but probably not high; as above, fishy vaginal odor is usually due to BV. If she did, then yes you could have infected your regular partner. Gyns' habits on STD testing vary widely, but trich testing usually would be done whenever there is a concern about STDs, e.g. if gonorrhea/chlamydia testing were planned. But usually not if STDs are not on the doc's radar screen. Correct, no STD is transmitted 100% of the time, but there's no way to predict for any one exposure. And no, if you were to test positive, you would not be able to know when or from whom you were infected. But I'll point out that trich can persist for years in women, with few or no symptoms, and therefore is very common in women not at current STD risk. Many newly diagnosed infections are not new. If you were to have trich, your regular partner could be your source, or any woman you've had sex with in the past few years.

All things considered, it is unlikely you have trichomonas. But you're obviously obsessed with the possibility of it, and it seems clear you'll continue to worry until and unless you have a negative test result. The same lab that did you other STD testing should be able to do it.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.