[Question #7771] Testing accuracy

8 days ago
Hi, 

I have been having ongoing pelvic pain and some joint issues. 

I have been tested four/fives times for gonorrhea/chlamydia in the past 4 years and I’ve been tested for everything else too. Most recently I’ve had two negative CT NG tests, one from all three mucosal sites and one from the vagina. 

 Syph, HIV, hep b c and tricho and mycoplasma. All negative after the window period. 

I’m worried that the tests aren’t picking up an infection. Is it possible for a past infection to spread to other parts of the body then test negative on swabs repeatedly? 

I’ve been with the same person for five years I’m more worried that this is an infection from 10 years ago when a condom broke. 

My concerns ares specific to chlamydia/gonorrhea because I know they can involve the joints. 

I have been checked over for PID and the consultants have both said they don’t believe it to be this but I’m worried that I’ve had gonorrhea and the infection has got in my blood and is now showing negative on tests 10 years or something later. 

I want to try for a baby but this anxiety is ruining my life. 

Thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 days ago
Welcome to the forum. Thnaks for your confidence in our services.

You really needn't be worried about gonorrhea, chlamydia, or any other STD that might contribute to abdominal pain. The tests are highly reliable; and in any case, neither would persist this long. the immune system cures both gonorrhea and chlamydia over time, generally within a few months for chlamydia and faster for gonorrhea.

I'm also confident you do not have PID, given both your STD test results and, more important, your multiple exams and doctors' opinions. There are many potential causes of otherwise unexplained abdominal pain -- but among them, PID is rare, especially for pain persisting this long. I'm certainly not an expert in abdoinal or pelvic pain -- but I can say for sure that some cases are simplky unepxlained.

You also mention "joint issues", and perhaps you have read that certain kinds of arthritis can complicate gonorrhea (disseminated gonococcal infection, or DGI); and reactive arthritis, which can be triggered by chlamydia. DGI is inpossible to explain ongoing joint pain -- it's a complication of early, active gonorrhea. Hard to speculate on reactive arthritis, but in any case it is not related to ongoing chlamydial infection.

What do you think about the possibility that your aches and pains are psychogenic? Certainly such symtpoms are much more common in anxious persons. (I'm not a believer in anxiety or other emotions causing pain out of nothing. However, they clearly can greatly magnify minor symptom or even normal body sensations that otherwise wouldn't be bothersome and perhaps not even noticed. Maybe something to discuss with your doctors? But in the meantime, do your best to put gonorrhea, chlamydia, and other STDs out of your mind. For sure you are infection free and do not have PID.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes -- and here's hoping for success in conception and motherhood!

HHH, MD
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7 days ago
Hi HHH MD 

I do certainly suffer with anxiety, which is definitely exaggerated by this unexplained pain. 

It was DGI I was referring to yes haha. I was under the impression that it could last for a long time and just rage on in the body causing untold damage until someone identified it and treated it. 

I have read horror stories (usually obscure peer reviewed papers online that barely anyone reads) about men who have tested negative for gonorrhea but it’s been found on culturing the synovial fluid and honestly I had convinced myself that was what it was. Especially as I have also had a sore throat for weeks on end   now. 

I’ve always been a safe girl but accidents do happen and I wasn’t so good at getting tested when I was younger (I didn’t even really acknowledge any STDs other than HIV until I was 20) so it’s panicked me, especially now I’m looking to have children. 

However if you are certain that these tests would have picked it up by now then I need to believe the expert (you) and stop trying to self diagnose. 

I don’t necessarily have the healthiest attitude to sex. I’ve got a lot of guilt and shame around it which I guess makes me very aware of any changes in the ole lady parts. 

Does any of this make sense or does it sound like the ramblings of a man woman? 




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 days ago
You have misunderstood whatever source(s) you found about DGI. It's never chronic in the way you describe. In my early research days -- the 1970s-80s -- I and my colleagues were the nation's lead invesigators of DGI, so this is something I understand intimately. Indeed, there are some patients with positive tests in blood or synovial fluid and negative at mucosal sites, but all those patients were within a week of onset of symptoms. There is no such thing as chronic, ongoing DGI.

Sure "accidents do happen" -- but you're imagining scenarios never known to occur. Presumably you don't go around worrying too much about being struck by a meteorite, and I would not advise you to modify your life to take that risk into account. 

For sure these are not the "ramblings of a mad woman". You're obviously not alone in modern culture (or historical cultures, for that matter) with anxieties around sexuality. But I can assure you once again there is no chance you have any continuing STD, and that your symptoms are unrelated to past sexual exposures or decisions -- except perhaps through an emotional/psychological link.
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7 days ago
Well HHH MD this is exactly why you’re a leading expert in sexual health and I am just a woman with an obsessive personality and too much time on my hands to read literature which was only ever intended for other physicians!  

I am very glad that people like you exist. I often wish I had focused my academic interests towards sexual health as what you do is incredibly important. 

You are without a doubt the perfect person to have answered this question for me and please do not doubt how grateful I am that you have taken the time to properly explain this to me! 

After many years of worrying needlessly over something that’s not scientifically possible perhaps I can now move on with my life and enjoy sex like I did as a carefree 20 something! 

Maybe I should be looking out for meteorites though! 

From across the pond I am sending gratitude and hope that you continue to stay safe in what you do in the current Covid climate. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 days ago
This completes the two follow-up exchanges included with each question and so ends this thread. Thank you for your very kind comments. i'm glad to have helped; that's why we're here. Best wishes.
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