Covering all the bases - Do I have an STD?

[Omaha Ray]

My girlfriend is on tetracycline to treat acne. We have frequently have unprotected sex. Over the 3-4 months, she has complained about a yeast infection that comes and goes intermittently. Over-the-counter treatments work short-term.

I also have sex with other girls. I receive unprotected oral sex, but the vaginal sex is always protected.  Except the last time (8 weeks ago) when my condom fell off.

So I’m not sure that my girlfriend simply has yeast. I fear I have given her an STD. And I fear we keep giving it to each other back-and-forth.

I also have had a red rash and discomfort on my penis in recent months, including a slight burn when I urinate.

So I went to a health clinic 2 weeks ago and told the PA my situation. He asked if I ever experienced a discharge (no), where I felt the burning (the tip of my penis), and if I ever had cold sores (4-5 years ago). After examining my penis, the PA diagnosed me with ‘dermatitis’ and prescribed a topical cream. The cream has since alleviated the rash and discomfort. Sometimes my symptoms reoccur after I have sex, but it goes away after using the cream.

I took both an HIV and a HSV test. The PA said there was no need to test for Gonorrhea, Chlamydia or Syphilis test. My results: HIV negative, a 38.9 result for a combined HSV 1/2, but and less than 0.9 for HSV 2.  

What are my next steps? I don't want to tell my girlfriend unless I have no choice medically. Could there be another STD I'm not aware of?

[H. Hunter Handsfield, M.D.]

Yeast infection sounds like a pretty good bet for your penile rash.  The provider is wrong about "no need" to test for gonorrhea or chlamydia; while neither of those would explain your symptoms, your sexual lifestyle is pretty high risk and you should be tested periodically for those STDs.  Also syphilis, although the risk is lower and almost certainly isn't causing your symptoms.

I don't know how to interpret those HSV blood test results, i.e. don't know of any "combined" HSV 1-2 test nor of a numerical value of 38.9.

My guess is you and your regular partner are just sharing a yeast infection, but no way to be sure.

Good luck--  HHH, MD

[glg]

offended.

[Christie2004]

If she is on Tetracycline long term, it is likely she has a chronic yeast infection.  What is she doing, treatment wise for it?
It's my understanding that men can also be affected by yeast, but I believe this is less common.  Did your doctor explore the possibility that you might have yeast?

[Cardinal Fan1]

I hate to add to this string -- but a question on HIV testing.  You continually state that 90 days is conclusive and many of the sites agree with you to include the New York and Seattle.  However, in one string you mention your friend in San Francisco at the clinic and they say it is 95% accurate at 3 months and 100% at 6 months.  The CDC on its site says 3-6 months, but on the Oraquick site they use 3 months.  Can you help me any here. I had a very low risk (the lowest) and tested at 15 weeks with Oraquick so I assume I am negative. Please help with an answer.

[guilty too]

http://www.cdc.gov/mmwr/preview/mmwrhtml/00040569.htm#00001553.htm
can anybody answer me??

[guilty too]

http://www.seriousliving.net/new-2020674-465.html
can we make sure about the available testings??

[Omaha Ray]

Hey, Christie. Yes, the PA told me my condition was most likely due to yeast. And he says I probably got the yeast from my girlfriend. I forget the name of the cream he prescribed me, but it had 1.0% of one active solution and .05% of another active solution. I believe it treats fungal problems. Again, it has worked great -- it addition to removing the redness on my shaft, it also has eliminated the stinging I experienced on the tip of my penis while urinating.

Except for some over-the-counter treatments, my girlfriend hasn't done anything about her yeast problems yet. I have been urging her strongly to talk to her dermatologist about her problems. She goes there every 6 weeks or so, and her next appointment is later this month. One reason I went to the clinic first was to determine if I have any STD's beforehand -- I want to know first in case my girlfriend is diagnosed with any STD's.

Again, I did ask the PA if I should take other STD tests than HIV and HSV. While he didn't say I couldn't, he told me they were expensive and that I didn't have any of the symptoms to make him believe that I should take them. Admittedly, the HIV and HSV tests were pricey -- I paid out-of-pocket.

[Omaha Ray]

Thank you, doctor.  This is an invaluable service, and your frank, non-judgmental answers are much appreciated.

I have two follow-up questions.

1.  I will get tested for the other STD's based on your response. However, I'm worried about the costs. These can cost me several hundred dollars out-of-pocket at my local health clinic. I do not want to visit a government clinic because I choose to stay anonymous. Another alternative is a local chain that provides inexpensive STD testing (as well as other blood tests). How reliable are these for-profit businesses verses a health clinic that staff professional health providers?

2.  My girlfriend is a tetracycline. If I do have Chlamydia or Syphilis, statistically how would this drug possibly interact in my girlfriend, as a possible protective barrier?

[H. Hunter Handsfield, M.D.]

Of course I can't comment on the quality of care at any particular clinic, whether low- or high-cost or for-profit or not.  But a good bet for quality STD testing, and for assurance the provider knows STD issues well, is the local health department STD clinic.  Such "government clinics" generally provide much higher levels of confidentiality than any other provider or clinic, not lower.  In fact, surveys show that 20% to 30% of people attending STD clinics do so exactly for that reason: they prefer the greater confidentiality than they can expect from their private physicians.  And in any case, public clinics rarely if ever check their patients' IDs; they won't know whether or not you are using your real name.

A person taking tetracycline won't get chlamydia or syphilis, and probably not gonorrhea, if exposed.

HHH, MD

[Omaha Ray]

In case anyone is interested, I tested negative on everything.