STDs Expert Forum
Question regarding PCR testing and gonorhea
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Question regarding PCR testing and gonorhea

Hello Dr.,

I'm a little bit confused of all types of opinions belonging to PCR testing (Gonorrhea & Chlamydia).

My questions, and I need an answer from a real professional:

How safe is PCR testing when the male patient is asymptotic at all AND the point in time of infection is eventually 7 month ago? Is there a chance to still find bacteria via urethral swabs? Or from the anal region?

In the meantime I'm the owner of 3 negative PCR-tests (1x anal, 2x urethral). Can I be happy with that and say "I never had GO?" Because of the long time period I was also doing an "old fashioned" anti body test for GO, also negative (was thinking of chronic Gonorrhea). A good sign, but is that enough of testing now?

On some websites I found hints that PCR testing in urine is much better than with urethral swabs if the patient is asymptotic and male. Is that correct? So should I do a next PCR test with urine?

As you can see - Im quite insecured. So please help me. Do I have to test on or would you say: That's enough, and type of testing was great?

Best regards,
Simon






239123_tn?1267651214
Welcome to the forum.  Thanks for your question -- which actually has several interrelated questions.

A minor clarification first:  there are several nucleic acid amplification tests (NAAT) to detect DNA of gonorrhea and chlamydia (which I will abbreviate GC and CT*).  Polymerase chain reaction (PCR) is one kind of NAAT but is now used infrequently.  Most likely your tests used a technology other than PCR.  But the following applies to all NAATs, including PCR.

The CG/CT NAATs are extremely accurate:  a negative test is virtually 100% proof that infection is absent at the site tested, at that particular moment.  Your statement about urine being better than urethra in asymptomatic men is wrong; you misunderstood something you read.  Urine testing is preferred in asymptomatic men only because it doesn't require the discomfort of a urethral swab.  A negative GC or CT NAAT is equally reliable on urine or swab.

The duration of GC and CT in the absence of treatment hasn't been carefully studied and never will be.  (Such research would require not treating infected people for prolonged periods, an ethical impossibility.)  Probably most infections are cleared within several weeks to a few months:  longer for CT than GC, and probably longer for rectal than urethral infection.  Most GC or CT at any site probably clears within 6 months.

As you already have learned, the CT antibody test isn't helpful, and GC antibody tests are offered by few if any labs anywhere.  In any case, neither positive nor negative results are reliable.

Perhaps that's more information than you were looking for -- but I decided to take the time for a blog-like reply that will be useful in responding to future questions along these lines.  For your specific situation, the bottom line (no pun intended!) is that your negative test results reliably show you do not have a genital or rectal infection with either of these STDs.  While in theory you could have acquired either infection that cleared up before you were tested, most likely you never had either GC nor CT.  In any case, you do not need treatment and do not need any further testing.

* For the bacterial names:  gonococcus (GC) and Chlamydia trachomatis (CT).

I hope this has been helpful.  Best wishes and stay safe--  HHH, MD
4 Comments
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Dear Dr. Hunter Handsfield,

thanks a lot for your long and detailed answer! I really hope not to be infected with GC and CT, my negative tests seem to be accurate.

But there is still my concern about being an asymptotic GC patient without treatment who is now in a chronic mode. Because of other problems I went to the doctor last week and he made a general ultrasound check. He noticed that my vesica showed calcification, also the prostate (for me a hint that there was an bacterial infection in the past, but yes, no proof for GC). He just said: "Yes, there was some kind of bacterial infection, but no idea if 2 month ago or 10 years. At the moment everything seems to be fine. No enhanced organs, lymph nodes etc."

My basic question is: If I WOULD have a chronic GC infection, were PCR testing and bacteria culture still the right way to check?
The duration between the point in time of potential infenction and my late suspicion is more than 7 month...Or is it a better method to check bacteria via blood culture etc. ...?

I'm afraid of being still infectious for other people (if I had GC) and also getting strong desease as an afteraffect of this infection (heart problems, infertility,...).  

If this is a new question just tell me and I will open a new post!

Thanks a lot for your answer and best regards,
Simon

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239123_tn?1267651214
There is no such thing as a "chronic mode" of gonorrhea with negative testing.  If you had gonorrhea, your PCR test would have been positive.  Believe the test results and move on without worry.  And stop searching the web!  It seems obvious you are one of those persons who is attracted to information out of context.
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Avatar_n_tn
You are absolutely right!
Thanks a lot for your help and fast response.

Best wishes,
Simon
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University of Washington
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