Truly appreciate all the effort and education that Dr. Handsfield and Dr. Hook have administered over the years!  Thank you in advance!

I'm a 45 years old female who is concerned. 

My questions are as follows:

1) How accurate are the icare std chlamydia rapid tests in your opinion?  Also if there is no presence of antibodies from my urethral vaginal swab will the test come back invalid or negative for CHL?  I recently did one of these tests and it came back negative although I'm not sure i had enough of my antibodies on the stick.  I should note i did test positive for CHL though a month before purchasing the Rapid Tests.  I was treated with 1g of AZITH  and was told i was negative for GN

2)I also had a 'URINE CULTURE' test at the time of my initial testing and it came back as 'no relevant growth'.  Would this indicate i did not have TRICH?  Do urine cultures test for TRICH?

3)After i finished my treatment for CHL, i still noticed a 'musty', strong  smell particularly during masturbation and thought what if i have TRICH?  I had some left over Metronidzole from a previous BV infection and decided to take 3 days worth of treatment at 500mg a day.  The smell cleared up by the second day.  Although the dosage was incorrect for the proper treatment, if I did have TRICH, do you think this would have cleared it up?  Do you think the smell will come back if I'm not sexual with anyone?  I know I should have consulted a doctor but I let the better of my fear and embarrassment get the better of me and just got back with an BF who I do not want him to know my history on this.

4) Lastly when I stopped taking the MET medication I did notice some dark brown spotting.  I read this could be a side effect to the medication.  I have no other symptoms or pain.  I have had spotting (pink and brown) at other times over the years.  Could this be the infection clearing out.  I have no itch and the only vaginal discharge i get is after exercise and its not a lot.

Please let me know your thoughts.

It would be helpful to know something about what your risks are, i.e. why you are being tested for STIs. But directly to your quesitons:

1) The rapid tests for chlamydia are very unreliable. It is difficult to know if your positve result a month ago was accurate, i.e. whether or not you really had chlamydia. The recent negative result itself also does not rule out infection. However, azithromycin is highly reliable so it is unlikely you still are infected. But the only way to know for certain is to have Ia proper test in a doctor's office or laboratory.

2) Standard urine culture tests for bacteria that cause urinary tract infection. It does not test for trichomonas. For that, a specific trich test is necessary.

3) I think you are correct to suspect bacterial vaginosis from the "musty" odor. Trich is possible but a lot less likely. The dose of metronidazole you took might cure trichomonas, but not necessarily. Reliable treatment for trich requires a 5-7 days of metronidazole 3 times daily.

4) None of the infections mentioned, or the metronidazole or azithromycin, should cause vaginal bleeding, even minor spotting. If that symptom continues, you should be professionally examined.

Sorry I can't be more helpful. I'll be happy to comment further if you'd like to fill in some of the details implied by my replies. In the meantime, I hope these comments are helpful.

HHH, MD

I should note that the original CLM positive result was April 19 and was done by a lab. 

AZ medication was done on the spot.   I had no symptoms prior.  I received the CLM infection from a cheating BF who told me he was infected 

The std rapid test was done may 5th in my house and was negative.  I was too embarrassed and scarred  to go back to the doctors office 

I did not experience the spotting until May 14th and currently  I’m expecting my period any day. 

Questions

1) I thought pinkish brown spotting is a symptom of CLM?  Below you state it isn’t 

2). Why would you say the home std rapid tests are unreliable?  Just curious. Also if I didn’t swab enough would that have altered  the results ?  Meaning wouldn’t the results show invalid as opposed to positive or negative??  I really don’t know how these rapid tests work. 

3)since the smell has subsided should I assume that the BV or possibly trich has cured ?

4) I  feel fine. No real discharge of any green or yellow. If I had PID I would assume it would worsen and not just give me bleeding brown. I mean I don’t have any pelvic discomfort currently.  I would assume it would worsen. Does PID from CLM come and go?

I’m really hoping I get my period and all is back to normal!

Thank you sir. 

1) Vaginal spotting is a nonspecific symptom -- meaning it has many causes and usually does not point to any one cause. Chlamydia can do it, and I didn't say otherwise. But most women with vaginal spotting do not have chlamydia.

2) For 20-30 years, various test manufacturers have been trying to develop rapid and reliable chlamydia and gonorrhea tests. So far they have not been successful, and STD experts never recommend their routine use. The main problem has been false negative results, i.e. missing an infection. Probably positive results usually are reliable. This may change -- one of these days, I imagine we'll have reliable rapid testing. But not yet.

,3) Absence of both strong vaginal odor and abnormal vaginal discharge is good evidence against BV. 

4) And absence of low abdominal pain, in combination with no odor or discharge, is strong evidence against PID. And no, PID due to any cause (chlamydia is one of several causes) doesn't come and go.

I also hope things sort out normally. It sounds like they will. However, you should be aware that azithromycin is around 95% reliable against chlamydia -- that is, there's one chance in 20 that treatment fails. All persons with chlamydia are advised to be retested, preferably several weeks after treatment, to detect both treatment failure and, in many cases, new infection if they have resumed sexual activity. Unfortunately, however, that requires standard lab-based testing.

Last few questions:

1)What are the top 3 symptoms in males and females that have CL if they are displayed?

2)do you roughly know the percentages of false -negative results from at home std rapid tests?  Some of these companies claim to be ISO certified 

3) is brown spotting usually associated with old blood or is it common in infection?

4)how effective is clarithromycin in treating CL?  Just curious as I know it is a macaloid agent. 

5)do you think Tom Brady can actually play until 47?

Peace and god bless good doctor!

2) As I recall -- rough estimate -- the current rapid chlamydia tests miss up to half of all infections. I could write a 3 page essay on the reasons such poor tests can have regulatory (FDA) approval.

3) I'm not an expert on non-STD genital symptoms in women. I would think brown spotting usually means old blood, but your gynecologist would know mroe about it.

4) Clarithromycin has been little studied. One report suggested 2 weeks treatmen would be necessary, vs single dose for azithromycin -- which is one reason few other studies have been done.

5) I certainly hope not!

Thanks for the kind words. That completes the two follow-up exchanges included with each question and so ends this thread. I hope it has been helpful.