Final Tests Suggestion. Follow Up of Previous Post.

[WorriedFellowJ]

Hi Dr. EWH / Dr. HHH,
I have had a post earlier with Dr. EWH: http://www.medhelp.org/posts/STDs/Antibiotics-Interference-with-Syphilis-Test-Need-advice/show/1756859.
Of course, don't get me wrong, I believe Dr. EWH. However, I cannot throw away my fear that I might have Syphilis.
Apart from the antibiotics taken as mentioned in earlier post, I had Vibramycin at 94 days after the exposure, given for some pimples, dosage 5 days. And, finally at 143 days after the exposure, again I was given Vibramycin for 5 days for sore throat.
As mentioned in previous post, I have taken VDRL Test at 85 days after exposure (before Vibramycins), result non-reactive, so the Vibramycins couldn't have affected the test.
I know that you do not like 'what-ifs' questions. However, I find it's tough for me to move forward without a final test.
(Dr. Hook, please, I'm not doubting your expertise. I'm doubting myself.)
Questions:
1. Assuming the antibiotics that I have taken in previous post do in fact interfered my VDRL Test, when is the best time for me to test for conclusiveness, considering the Vibramycins that I have taken? Today, it is 247 days post the exposure, which is also 100 days from the last Vibramycin I took. And do you recommend TPHA Test or just VDRL will do? Here, I have a link discussing about Vibramycin: http://fdadrugs.net/vibramycin/. In the link, there's a statement that vibramycin, may mask syphilis and suggest to test monthly until 4 months. If I understand correctly, then I will need to test end of this month to fulfill 4 months (120 days) after completion of Vibramycin. (I hope I did not understand wrongly about the article, perhaps you can comment?).
2. In the Gonorrhea and Chlamydia PCR urine tests previously, I provided midstream urine. Recently, I found out it should have been first catch. I don't know if the results are reliable or not. Do you think it's appropriate for me to retest again? Earlier, it was my doctor who told me it's mid-stream. Disappointed.

[WorriedFellowJ]

Thanks, Dr. Hook and have a great weekend.

[Edward W Hook, MD]

Correct on both counts.  EWH

[WorriedFellowJ]

Hi Dr. Hook,
Thanks for your response.
One clarification though, in your last reply, you mentioned about 'Best to wait until 30 days after your tetnus shot just to be sure.' I'm assuming that if I would like to do any blood tests, I should wait until 30 days have passed after the tetanus shot, right?
And, your second statement 'No, your tetanus test should not effect your VDRL or ther blood tests.  Not the urine test either.' I believe, there probably was a typo error, you meant to say the tetanus 'shot' instead of 'test', right?

[Edward W Hook, MD]

Brief final answers:
As you point out, we, like your doctor would not have recommended HSV blood testing. I do not recommend repeat testing for you.

Best to wait until 30 days after your tetnus shot just to be sure. No, your tetanus test should not effect your VDRL or ther blood tests.  Not the urine test either.

You really need to focus on why you are so anxious and have such a difficult time believing test results and professional advice.  This ends this thread. EWH

[WorriedFellowJ]

Hi Dr. Hook,

Just to clarify on my last question, I have actually taken the package test at 85 days after exposure. Just that now, I probably will do again. Regarding the tetanus shot, my concern is the tetanus shot causing false positive more than anything else. My results at 85 days for for all tests described above are negative. So, I think I should re-phrase my final question: Does tetanus shot affect blood tests in any way, especially causing false positive?

Thanks and I'm very sorry for posting so many follow up posts (including the questions before on HSV).

[WorriedFellowJ]

Hi Dr. Hook,

I have missed one last question. A short one on top the questions above. And, I promise this will be the last one.
Question is:
If I will to proceed with my tests for VDRL, there is a package which will include other STDs tests also (i.e., HIV, Hepatitis B, Hepatitis C and etc.). of course, I can take single test, but probably will be more expensive. I have taken a tetanus shot around 2-3 months ago. My question is can this tetanus shot affect VDRL or HIV or Hepatitis B or Hepatitis C blood tests or even the Gonorrhea and Chlamydia Urine PCR tests? If it does, when is the best time to take the tests after the tetanus shot?

Thanks, Dr. Hook.

[WorriedFellowJ]

Hi Dr. Hook,
Thanks for your response. You were right, probably I will re-test again just to have a final conclusion from this bad episode. Again, Dr. Hook, not that I do not trust your judgement or prediction. I do. In fact, I trust you more than my doctor. Just that, it's my mind.
One last question, if this question needs to be posted in new one (too bad, this is my second question within 6 months). So, hopefully, you will conside this question. Thanks in advance.
At 85 days after my exposure, I also did HSV Type I IgG Antibodies and HSV Type II IgG Antibodies Tests (Blood Tests). From the name, I think they are type specific tests like this forum has mentioned many times. However, I think the tests are probably different from what is used often in US, because the readings of result interpretation are different from what I see from other posts. Anyway, my result is negative for both. My questions are:
1. I have seen that in some posts, the time to perform HSV Tests is 12-16 weeks. I have done at 12 weeks. Do you see any reason to repeat? As I mentioned above, now is 247 days after exposure (35 weeks).
2. I have no symptoms suggesting of HSV 1 or 2. I realize that, usually if patients have no symptoms, you and Dr. Handsfield will advice no need to have HSV Tests. In fact, my doctor also said the same. Is this because of, the tests are not very reliable, have a little higher false positive or false  negative compare to other tests. And testing is only recommended when there is symptoms? So for patients without symptoms, if the results come back positive, it will complicate matters even more or more seriously will affect the patients' emotionally and mentally?

Thanks again, Dr. Hook.

[Edward W Hook, MD]

I'm sorry that you have continued to worry about this.  I will address your comments below and, after than you can (and, I presume will) do as you please.  I am however confident that no matter when you test, you will not find that you acquired syphilis during the exposure you described.  

Both the amoxicillin and the doxycycline (virbramycin) you took do have some activity against syphilis however a key consideration is the timing.  The further out from your exposure, the less likely it is that taking antibiotics would affect your syphilis test results.  Thus if someone took these drugs within a few days of exposure to an infected partner, their test results MIGHT be delayed. In your case, the time between your exposure and the antibiotics would not have change the time course of test development.  

To address your questions:
1.  Testing at this time will be definitive.  A VDRL test is sufficient.
2.   Initial void specimens are preferred and what is described in the package inserts however studies have shown no meaningful difference  when the specimen is a mid-stream one.   Further most of the antibiotics you have taken have activity against chlamydia and gonorrhea.  There is no medical need for re-testing

EWH

[WorriedFellowJ]

I have read in some posts before in this forum and in forum moderated by FreedomHealth doctors in STD - International. If I understood correctly, the time to test for syphilis upon completion of antibiotics is 3 months (to conclusively rule out the possibility of antibiotics interfere syphilis test). However, in those post, the antibiotics taken / time taken might different from mine. Moreover, the link provided mentioned about 4 months for Vibramycin, confuse me even further. Need your advice, Dr. EWH / Dr. HHH.