[Question #8515] Testing

43 months ago

Doctors,

You have been incredibly helpful to many, and we appreciate your service.

I am a mid-40s white male and recently had unprotected vaginal and oral sex with a long-time heterosexual white friend who is also in her mid-40s. I have tested yearly as a rule for various STDs, and this year’s test coincided with the beginning of our sexual relationship. She noted that she has an annual panel and all is well, and also that it has been a few years since her last partner, so I was comforted with not using protection.

I had a urine panel done 7 days following our encounter, and tested negative for chlamydia, gonorrhea, mycoplasma, ureaplasma, trichomonas, gardnerella, and herpes 1/2 DNA. All except the herpes test note PCR.

All said, I’m having some minor discomfort (not pain but perhaps best described as a very dull sensation in my testicles and a slightly tingly penis opening). No other symptoms.

Questions…

1). Are my results conclusive at 7 days? If not for any, which one(s)?

2). If you can rule out an STI with these results, do you have any other thoughts?

It’s possible that I could be anxious and hypersensitive, but would appreciate your thoughts on the matter.

Edward W. Hook M.D.

43 months ago

Welcome back to our forum. Thanks for your continuing confidence in our forum. Congratulations on your practice of regular screening as well as your practice of discussing testing and risks with your partner. Straight to your questions

1. Your results for the organisms you tested for are conclusive, ruling out penile infection but not the somewhat lower risk of orally acquired infection as you and I have discussed on this forum previously. I would add that ureaplasma, gardnerella, and mycoplasmas other than mycoplasma genitalium are normal constituents of the genital tract and testing for them is typically not recommended by experts.

2. Yes, you have ruled out infection. The symptoms you describe are not particularly suggestive of an STI but, as you suggest, could result from a state of heightened awareness causing you to notice and elevate their import.

I hope this perspective helps. Please don’t worry. EWH

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43 months ago

Thanks for the prompt reply, Dr. Hook. A quick follow-up:

I didn’t intend to do any oral tests due to the remote possibility of an infection (given that I don’t have symptoms, my genital tests were negative, and my partner stated that she is “clean”).

1). Do you agree with the above?

2). Do you see any reason for me to get tested for HIV, syphilis, or Hep B? I normally get tested for these annually, but thought that unless I have another new partner, the odds of being infected here are incredibly remote, so I will probably not elect to have any further tests.

Thanks in advance for your response.

Edward W. Hook M.D.

43 months ago

I asgree that the risk from this encounter was quite low and do not feel strongly that you need oral testing. I felt the need to mention it for completeness sake. Thus

1. Yes, I agree. No need to test.

2. No I do not se a need to test for HIV, syphilis or HIV. Were I you, I'd just move forward without concern

EWH

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43 months ago

Thank you, Dr. Hook.

43 months ago

Before closing this particular thread, I’m curious if you could share what your thoughts are about odds of a false negative for the NAAT urine tests? You’ve noted so for the various HIV tests, but I’m not sure if I have seen what you know to be the accuracy of the urine NAAT tests, assuming that sufficient time has passed to be within an accurate testing window. Helpful to provide comfort in future annual testing.

Thank you.

Edward W. Hook M.D.

43 months ago

In clinical trials evaluating urine NAATs in comparison to swab specimens using the same test the urine test is one or 2% less sensitive. Statistically this is an insignificant difference. There are not good data on how test sensitivity is impacted by incorrectly collected specimens, i.e. urine collected at midstream or less than one hour following the most recent urination. Given the discomfort and inconvenience of swab specimens you’re in tests have almost completely replaced swab specimens and false negative tests are very, very rare.

As you know this instance thread. Take care. Please don’t obsess over STD risks. EWH

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