Hello doctor, sorry for coming back but I have a few concerns about my tests.

As you know I took Urethral Swab test and Urine Test for Gono & Clhamydia and other bacterias.

How does this tests work? 

1) I did urethral swab 2 months post exposure. How good is this test? Is it better than urine test? I don't know how long I stayed without peeing before the test is this important? Ive read that you need to prevent urine for a couple of hours before and that this test is not as accurate because it only looks for bacteria at the entrance of the urethra.

2) I did Urine test at 7 months. It was first urine in the morning but I gave a whole cup. Should I just give literally the first void? Was it too much and could this dilute the sample? I took a course of Augmentin and Azithromycin like 3 weeks before the test, could this compromise anything? Ive rad that I shouldn't have given more than 20-30ml of urine, more than that could dilute the sample and cause less sensitivity on test Thats my concern

3) Overall for this tests how can antibiotics and medicine affect? And how long should I wait after antibiotics to test? Im not sure about the Urethral swab (If I was taking any antibiotics). For the Urine Test I know for sure I took Azithromycin and Augmentin like 3 weeks before.

4) For HIV tests, I took prednisone and some biotin some days before my last test, could this really cause false negative tests as Ive read in other questions?

Additional to the symptoms I shared with you earlier. I have trouble ejaculating (It feels weak, like I really need to "push" to get eveything out, doesnt feel normal). 

5) Does this tells you anything?

6) Ive really read a lot of answers from Dr. Handsfield stating that Gono & Clhamydia for sure are cleared by the inmune system way before 9-10 months, yet Dr Hook answer to me seems somewhat less reassuring: "You asked about clearance- yes it occurs in a relatively small proportion of untreated cases over time" If I indeed did my tests wrong and I could have the infection and not know, I cant be sure I cleared it out by itself?

7) Whats the difference between VDRL and RPR test? For some reason my lab in my results at 9 months has both test names like this: RPR (VDRL) --- Non Reactive

A central theme of Dr. Hook's replies is that STD test results overrule all other considerations:  no matter the symptoms and no matter how risky the exposure might have been at the time, with few exceptions the test results should be believed. Also, support can be found for any conceivable position or perspective on the web, regardless of accuracy, and anxious persons often are drawn to viewpoints that sustain or elevate their concerns. You have gained some inaccurate perceptions, including misunderstanding of symptoms that suggest various STDs. You probably should stop online searching about STD risks, symptoms, exposure, and test interpretation; or at least limit searching to professionally operated or moderated websites.

The gonorrhea and chlamydia tests work by detecting the organisms' DNA or RNA, respectively -- i.e. nucleic acids, hence the term nucleic acid amplification test (NAAT).

1-3) Clinical experience for 2+ decades has shown that the supposed requirements for first void or time since previous urination have no effect on reliability of the gonorrhea and chlamydia tests. If someone is infected, taking these antibiotics may cure the infection, making the test negative; in general they do not make tests negative without cure. A negative result shows infection is absent at the time of the test, but says nothing about previous infection that may have been cleared by the immune system.

4) There are no drugs, medications, or medical conditions that have any effect on the reliability or timing or accurate results of any HIV blood test. The biotin business is an urban myth that does not apply to the doses used as an adjunct to body building or physical conditioning.

5) None of the symptoms described in your previous thread are suggestive of any STD, nor does any change in ejaculation. But even if you had typical symptoms, the test results would mean you did not have them.

6) There is no meaningful difference between my advice and Dr. Hook's perspectives on duration of infection in absence of treatment. I never said that the immune system always clears gonorrhea and chlamydia within 9-10 months. However, any exceptions beyond that time are very rare. In any case, your negative test results show that this is irrelevant to your situation.

Looking back at your previous thread, for all practical purposes you had a zero risk exposure in the first place and didn't need STD testing.

I hope these comments settle these issues for you once and for all. Let me know if anything isn't clear -- but please do not ask for repeat statements of confirmation, or questions whose answers are obvious. Before asking anything more, I suggest you go back and carefully re-read every word of both my comments here and your previous discussion with Dr. Hook. OK?

HHH, MD

1) I understand first void or time since previous urination doesn't affect the test. Could you please clarify if amount of sample does? Its supposed to be 20-30ml, I gave the whole cup which is a lot more. Could this dilute or affect the test?

2) Which test is better, urethral swab or urine test?

3) Ive read other interactions in this forums stating that certain antibiotics could be enough to "mask" an infection enough to cause a negative test but not to cure an infection completely. Is this true? What medications can do this and how could I know the medications I took didnt cause this effect? I dont know if I took the medication long enough or the enough dose to cure the disease or just mask it

4) What symptoms would make a doctor like yourself believe re testing or not believing a test result is warranted?

5) This question was not answered on previous message: Whats the difference between VDRL and RPR test? For some reason my lab in my results at 9 months has both test names like this: RPR (VDRL) --- Non Reactive

7) From my exposure the condom was placed by the CSW with her mouth, I really didtn check if it was put correctly. I just remember taking the condom out after finishing. Would you consider any of this as a risky behavior? Like putting it with her mouth or not checking if it was tight enough or if it was broken at the end in some way

1) Urine amount makes no known difference.

2) Urine misses a few more infections than swab, but too little to make a difference in your case, since you were not at risk and did not need testing anyway. 

3) Some antibiotics may have this effect, but not the ones you took. See previous replies.

4) Obviously, the typical symptoms (discharge combined with painful urination) increase the odds someone is infected, but they have no effect on test result intrepetration.

5) RPR and VDRL are different technologies to detect the same kind of syphilis antibody. They are equally reliable and their results equivalent to each other.

6) Repeat question:  none of these symptoms suggest any STI.

7) How the condom was applied makes no difference if it was properly in place during the exposure. Your closing questions about condoms make zero difference in condom reliability and protection. That includes natural membrane versus latex condoms, despite what you think you learned online.

That concludes this thread. Please note the forum does not permit repeated questions on the same topic. This being your second about this exposure and STI/HIV testing, it will be your last. Future ones will be deleted without reply and without refund of the posting fee. This policy is based on compassion, because we have found that repeated questioning tends to prolong anxiety rather than relieving it. In addition, the forum sponsor does not like collecting fees for questions with obvious answers. Finally, such questions have little educational value for other readers, one of the forum's main purposes. Thank you for your understanding. I hope the two discussions have been helpful:  as already suggested, if you have continuing concerns, re-read all the replies to date. With any understanding at all, they should completely settle any concerns.