Sex worker, Chalmydia, False neg test, should I retest

[stillneedtoask]

Dr., I hope this is not redundant but as most of the folks here i am terrorizing myself with anxiety and hope your logic can help me end this nightmare. On October 19th I had protected sex with sex worker in Canada (97.5% certain it didn't break but i was drunk and sloppy...). I was 100% HIV negative prior to this episode as i had gotten tested for an insurance matter and am in a committed relationship (at least i was)... a few weeks go by and i get some itching and burning during urination... i went in for STD tests on the 24th of Nov (six weeks) and all were negative including HIV... however i still felt the burning and after some internet homework found out you needed to not urinate prior to a urine test so i got tested again for STD (not HIV), held my urine for 2 hours this time and it came out positive for Chlamydia... the Dr used a different test he called DNA... i took the antibiotics and am feeling better down there however now that i know the first round of testes came back neg when i was actually positive for Chlamydia I've started worrying myself sick that the first Dr did not do the HIV testing correctly as well... i have read that HIV testing at 6 weeks is ~90+% reliable but how about in the face of the Chlamydia test being wrong? should i retest tomorrow which is ~8 weeks or wait for the 3 month mark or not worry about it? I am worrying myself sick and seemingly causing myself to feel sick but i have also read where you say ARS would not simply show up here 2 months past the act, is that correct? I think fundamentally i am just so upset and mad at myself for doing this act and potentially hurting my loved ones that i just want to beat myself up emotionally and that is why i am loosing sleep, cant eat cant work and am obsessing on this... i am sure this is redundant but could you please , please answer me and provide me direction that i promise i will take??? Thank you for being there and helping the suffering masses as you do...

[stillneedtoask]

Dr. My testicals have enlarged and are very red... could this be Testicular torsion or Epiditimytis? there is little or no pain... if i got treated with doxycycline will i need to be treated again? will my spouse? this has been going on for 4 days now... please help.

[Edward W Hook, MD]

I realy think that is the right thing to do. Take care.  EWH

[Edward W Hook, MD]

This is neither torsion or epididymitis.  If you have new concerns or need further reassurrance, please see your own health care provider.  I have little more to add,  EWH

[stillneedtoask]

Should i be checked for Epiditimytis even thought the Chlamydia is gone after the Doxy? could it have gone into my testicles during the course of treatment? My testicles remain swollen and red and there is a slight heavy feeling to them. all the other symptoms are gone... would it make sense that Chlamydia could have gone into Epiditimytis in the 5 weeks it took me to get treated? Please help me I am panicking again... what else could this be???????

[stillneedtoask]

Thank you Dr., so very much. I have been taking Xanax daily because i am so afraid of hurting m wife and now i think with your words i will stop this and move forward loving my wife and forgive myself for my sins. Gos bless, have a happy and prosperous new year...

[Edward W Hook, MD]

If you had NGU, the doxycycline would have cured it.  

You wife's itching could well be a yeast infection related to her recent antibiotics.

In some persons after exposures they have concerns about symptoms can linger despite negative tests.  Your symptoms will get better.  I am sure that if you ask enough doctors you will find some who are willing to give you antibiotics "just to be sure" which can be loosely translated that it is easier to goive you antibiotics than argue with you that you do not need them.  If you have no lab normalities on your tests as you say however, I would not treat you.  Sorry but I really have little more to add. Good luck.  EWH

[stillneedtoask]

Dr. Thank you for all of your advice. My wife and I took the Doxycycline as I didn’t feel relief from the symptoms. We took it faithfully for 7 days, no sex, no milk, no vitamins etc. It has been 4 days and I still feel a slight burning during urination, pain in the tip of my penis, frequent urination. What else could this be? If I read your notes carefully it seems this could not be Chlamydia any longer since we took both antibiotics. My wife has been asymptomatic through all of this however yesterday she started experiencing external vaginal itching, could be from the antibiotics so she got a yeast infection treatment. What else could I have? Could it be prostatitis? I have the pain in the tip, slow urination and my GP did put me on 1 month of Cipro as he think this could be it… what else could this be? Thank you again for all of your advice.

[stillneedtoask]

Today was the last day of the antibiotics for Chlamydia and i feel ~90% better, some minor symptoms like tingle after first urination and a few times throughout the day... However better than it was.. I called my Dr and let him know and he said there are some resistant strains out there that he is seeing a rise in... he offered two options, come in and get Doxy now and it will be all done or wait three weeks and if i am still feeling some symptoms he will retest and then give me the Doxy... What would you recommend in my situation? Is it optimal to get the Doxy now or wait for conclusive evidence that this strain is resistant to the original 1g Azithromyicin?

Again, thank you Dr for your help and this excellent site!

[stillneedtoask]

Thanks Dr...

i went out today (8 weeks) and tested negative with an oral quick test... i assume the condom must have broken from your note above however i didnt see or feel anything. the worker at the clinic said many people now fill their condoms up with water after sex to ensure there are no leaks, do you recommend that? Should i test again in 3 or 6 months or consider this saga over???...

i appreciate your response and all you do for the folks out there who are worried and feeling hopeless/helpless... i feel a million times better now knowing i am 99.9% in the clear!

[Edward W Hook, MD]

There are several different types of test for chlamydia and not knowing what type of test you had the first time, it is hard to comment on why your first test was negative. There are multiple potential explanations - less than optimal type of test, you had not waited long enough to void, etc.  Little of this influences your chances of HIV however which are very, very low.  The reasons I say this are  as follow:

1. The HIV tests have less built in error than the tests for chlamydia and blood is a far more reproducible specimen than urine.
2.  HIV is less infectious than chlamydia.  Your odds from a single unprotected episode of sex are hundreds of times higher for getting chlamydia, if exposed, than they are for HIV.

Let me also point out one problem.  You used a condom. If you did, you should not have gotten chlamydia from the exposure you are concerned about.  Thus either you did not or did not use it properly, the condom failed, or you already had chlamydia before (if this is the case, your regular partner should be tested.  I realize this raises other questions but even before you get to them, I can’t answer them, just point out the issues which are play.

Having said all of this, it is unlikely you have HIV.  You will probably want to get re-tested however for your own peace of mind. Rather than worrying, just go and get tested and put this behind you.  I say this not because I think your risk is high - I do not, but because I want to help you put this behind you. A single negative test at this time should do that.

Good luck. EWH

[stillneedtoask]

i forgot to mention we were tested for trich and that was neg... could it be NGU or other? Please help!

[Edward W Hook, MD]

There are no reported strains of antibitoic resistant chlamydia to worry about.  You do not need re-treatment.  If your doctor is seeing repeatedly positve tests they are due to re-infection by untreated partners or some other casue but not antibiotic resistance.  I do not think you need treatment with doxycycline.  EWH

[Edward W Hook, MD]

I would consider these results as indicative that you do not have HIV and move on.

As far as testing condoms is concerned, there are no data on testing condoms for leaks with water and to me it sounds like a messy waste of time. When latex condoms leak, they don't leak just a little, they break wide open.  If you look, you would know if the condom was broken.  EWH