Clean?

[runner12]

About four months ago, I received unprotected oral sex from a female escort for about 5 minutes.  I only received oral sex and nothing else.  I am uncircumcized, healthy, and 37.    

About 10 and half weeks after the encounter, I went to get STD tests to put this episode behind me once and for all.  I live in Japan, and the doctor I went to does not speak much english.  I told him I wanted to be tested for chlamydia, gonnorhea, syphilis, and HIV.  He wrote up 4 lab requests and I went to an adjoining lab room where I gave a urine sample and blood sample.  When I was walking the lab requests over, I noticed that the top request sheet said in english "candida."  

I got my urine test result as I waited and the doctor told me it was negative.  I returned in a week to get my blood results.  The doctor said HIV and syphilis were negative, but he said (his english was very difficult to understand) that a chlamydia blood test had also been done.  He said something to the effect it might not be an STD and is common, and not to worry about it.  I wasn't sure what he was saying, but it appeared he was saying the blood test was positive.

When I got home, I started to wonder if the chlamydia blood test was done instead of the urine test.  I called the clinic to make sure.  I asked the nurse to ask the doctor if my urine had been tested for both gonnorhea and chlamydia and I was told that it was.  She said the Dr. said I would have taken more specific tests if my urine had shown something.  Then she asked me if I meant "candida."  I said that might be chlamydia in Japanese.  She was not familar with the term.

I remembered that the lab request I saw also said "candida."  I checked the internet and found that it has nothing to do with chlamydia.  I began to fear that I was not checked for chlamydia by the urine test, and maybe not even for gonorrhea.

I have been married for ten years, and this oral sex encounter is the only encounter outside of marriage.  Prior to my marriage, I was with only one other woman in a long term relationship.  I am very confident that I never had any STDs.  

My questions are:

1.  Do you have a guess as to what the doctor meant when he said that the chlamydia blood test might not indicate an STD and is common?  Even if whatever he was talking about is common, is it any danger to me and my wife's health?

2.  Is there one urine test that tests for Candida, chlamydia, and gonnorhea.  Do you test candida by urine test as well?

3.  My main fear is that I did not get checked for chlamydia by urine because the doctor mistakenly understood it as "candida."  I am more confident about gonnorhea since it doesn't sound anything like candida, but this whole episode has me worried about both.  I really do not want to re-test, and I have not had any symptoms in nearly 4 months.  Do you think I should re-check just to make sure or should I just move on?

4.  Is the 10 and a half weeks conclusive for syphilis?      

[H. Hunter Handsfield, M.D.]

The main thing is that your risk for any STD for the exposure you describe was zero, for practical purposes.  Chlamydia is not acquired at all by receving or sex--or at so rare it has never been documented, not once.  Gonorrhea of the urethra almost always causes symptoms, so that is out.  Candida isn't an STD and isn't acquired by oral sex.  Syphilis is rarely acquired that way, and when it is causes a visible penile sore. HIV is possible but vanishingly rare; there has never been a proved case of acquiring HIV by receiving a BJ.

So your first mistake was the sexual exposure.  (Well, maybe not a mistake--except to the extent that you consider it one.)  The second was being tested for STDs.  Your third mistake was being tested in a setting with a language barrier, by a provider who may not know a whole lot about STD diagnosis.

1) Chlamydia blood tests are useless, for exactly the reason your Japanese doc apparently tried to explain:  the test cross-reacts with a different and very common chlamydia species called C. pneumoniae--which, as the name implies, causes respiratory infections.  So a postive result means nothing with respect to genital infection. (Which is why my clinic never does the test.)

2) We all carry candida normally on our skin, in the rectum, in the genital tract.  We're all positive from time to time, means nothing, so there is no point in testing at all.  Chlamydia and gonorrhea are tested by urine--but as I said above, there is no chance you acquired either one from the exposure you describe.

3) Doesn't matter; see above.

4) Doesn't matter; see above.  But the syphilis test is valid any time 6 weeks or more after exposure, so you can rely on the negative result.

I hope this helps.  Best wishes--  HHH, MD

[runner12]

Doc Thanks so much!

Is C Pneumoniae dangerous in any way or is it a normal infection like a cold?

[H. Hunter Handsfield, M.D.]

Like almost every cause of respiratory infections, most cases of C. pneumoniae cases are asymptomatic, some cause minor colds or bronchitis, and a few cause pneumonia--almost never of dangerous severity.

HHH, MD

[runner12]

Doctor,

If you can answer this it would be great.  If not, I'll just drop it.  I did an internet search on C pneumoniae and articles linking it to artherosclerosis keep popping up.  Also, I keep reading that "virtually everyone is infected at some point in their life and that 50% have serological evidence of c pneumoniae by age 20 and rises to 75-80 percent by age 60-70."  

I am a bit confused in that if everyone is infected at some point, wouldn't that mean everyone is at risk for artherosclerosis?  Is this a case where most people don't need to worry?  

Again, I know this is going a bit away from your expertise, but would really appreciate your opinion if you have one.    

Thanks so much for your wonderful service!

[H. Hunter Handsfield, M.D.]

As an infectious diseases and public health specialist, I have the expertise--but it's off topic for the STD Forum.

Very briefly:  yes indeed, almost the entire population is at risk for atherosclerosis; that's not exactly news.  C. pneumoniae may or may not have a causative role.  If it does, the contribution to overall risk isn't known but certainly is small compared with standard risks (genetics, smoking, cholesteral, exercise).  Treatment of C pneumo antibody-positive persons at risk for heart attacks (e.g., azithromycin) has no benefit in preventing heart attacks or strokes.

In other words, forget it.  You don't know you have had C. pneumo.  (If your chlamydia antibody test was positive, it could be C pneumo or a prior undiagnosed sexually acquired chlamydial infection.)  And if you have, it isn't a signficant health risk.

HHH, MD

[runner12]

Doctor,

I just want to thank you so much for your advice.  I have seen that most people who come to you are like me - scared and frightened from making one mistake.  Unlike other sources on the web, or even telephone hotlines that are impersonal and robotic, your words are always truthful, realistic and compassionate.  I just wish all doctors could be trained by you.  

Thanks so much again.