Mid October 2020 - brief unprotected encounter with new parter. 

2 weeks later - symptoms were consistent with yeast infection, but I tested for chlamydia and gonorrhea. It was a NAAT test on urine, which was negative. Treated for yeast infection and symptoms resolved. 

April 24 - unprotected encounter with same partner from 10/2020. I tested again for CT and GN with a NAAT urine test, exactly one week later. I had no symptoms and the test was negative.  I had no reason to believe he was infected. No other contacts since then.  I am not in any romantic or sexual relationship. 

Every since about June 20, I have experienced intermittent burning and/or itching around my vulva. No unusual discharge or odor. It seems to happen every month around the 20th and last for about 2 weeks. I’ve used Monistat and it seems to help, but symptoms return the next month. It occurred to me to test for trich at the end of August, so I did so. This was also a NAAT urine test and was negative. I was experiencing mild symptoms at the time of testing. I’ve also done a few tests at home that check for abnormal vaginal ph, and have never had abnormal results.  I believe BV or trich would typically cause an elevated ph. 

Based on this info, do you think I should be retested for any of the STIs mentioned above?  I’m not sure how confident I should be in the results. 

There appear to be two separate questions here. 1. How reliable are the tests that you have had in evaluating your symptoms thus  far and, 2. What  might be causing your monthly recurring vaginal itching.

1.  Currently available nucleic acid amplification tests (NAATs) for diagnosis of gonorrhea, chlamydia, and trichomonas are amongst the most reliable pests in all of medicine. They are highly sensitive and really miss infections and really give a false positive results. I would urge you to believe your test results.

2.  Your second question is a bit more challenging. The fact that your symptoms seem to occur at about the same time each month relative to your menstrual suggests that this may be represent physiological changes occurring as a result of your cycle.  The symptoms that you describe certainly are not symptoms suggestive of gonorrhea or chlamydia. On the other hand they are symptoms which may occur on occasion with trichamonas which you have ruled out, but, I suspect more importantly, also are common with bacterial vaginosis and vaginal yeast infections. Both of these latter two infections have an all to common tendency to recur, and often at identifiable times in the menstrual cycle.  The fact that you had some relief with the use of anti-fungal therapy may represent either a soothing effect of the therapy itself or temporary suppression of a chronic yeast infection.  It would be inappropriate for me to try to guide you towards diagnosis over the Internet and without an examination. Rather, I would encourage you to discuss this with your gynecologist and embark on problem solving which may require repeated evaluations and testing for both BV and yeast.  Not all BV infections are associated with a high vaginal PH.

I hope this perspective is helpful to you. I am confident that you did not acquire an STI from the encounter you describe above. Your tests prove this. The problem of your recurring vaginal irritation however is something to address with your regular gynecologist. As you know, if any part of my response is unclear, or their further questions, please don’t hesitate to use your ability to follow ups for clarification. EWH