Test Results Troubleshooting

I am a male that had sex with a working lady.  Other than her almost paranoia insistence on condom usage and no involvement of oral fluids, her status and condition are unknown.  In the middle of it, I experienced condom failure (completely burst so was noticeable fairly quickly), immediately stopped, urinated and washed thoroughly with antimicrobial wash (Chlorhexidine Glucconate based - have it on-hand for another long term skin condition elsewhere).  Within 6 days of the episode I had sex with my long term partner, but did NOT include ejaculation.

After reading more about STD's and in spite of being completely without any symptoms, I became concerned about syphilis so 2 weeks after the event (and before any additional encounters with my partner) I provided a urine sample, blood sample, took an oral HIV test, received a shot of penicillin and swallowed 4 zithromax - admittedly blind treatment.  Symptoms never arose and, as expected, test results subsequently came back negative, with the exception that I had shown an antibody for Chlamydia.  As this was the first known urethral exposure of its kind in over 20 years outside of my partner and the odds of her being unfaithful are as close to zero as one could imagine (please assume so in the response anyways), I would greatly appreciate clarifying some loose ends:

1.  Are females in the U.S. routinely screened for Chlamydia, active and antibody sourced, during their OBGYN check-ups?

2.  What are the chances that Chlamydia can be spread by heavy kissing?  What about other bacterial based STD's?  I am aware viral ones are inherently prone to spread this way.

3.  How long would a chlamydia anti-body reside in my blood and assuming such a long period, are there predictions on the likely levels that would be present provided I had not been exposed for over 20+ yrs?

4.  The continued scrubbing caused some irritation and I had applied some neosporin in the end of the urethra right after voiding the morning of the tests.  As I was asked for an initial stream urine sample, I did the best I could to wipe the area (inside and out .... in spite of it already being dry) before providing the sample 3 hrs after the morning void and ointment application.  Could this have affected the urine results at all?  What is the accuracy of the urine test vs. the blood VRDL test?

5.  In the unlikely event that the urine test was inaccurate and I did have Chlamydia as a result of this exposure, what are the chances of passing it along to my partner if no ejaculation was involved in the one episode before the zithromax?

6.  I plan to have another oral HIV screening at week 4 and week 12 and a follow up blood/urine panel at week 12.  Are there any other testing/precautions of which you would advise?

7.  In general, how effective is the anti-microbial wash (used properly) on the spectrum of STD's against such types of exposure had it been quite a bit longer?

Thank You

[H. Hunter Handsfield, M.D.]

Your commercial partner's insistance on condoms is a good sign, indicating a relatively low risk she is infected.  (In general, commercial sex workers are at higher risk from their partners than vice versa.)  Further, your unprotected exposure was very brief; the risk you were infected, even if she is, was low.

1) Routine STD screening is highly variable in the US.  No way to predict for any particular person.

2) Chlamydia is not transmitted by kissing.

3) Chlamydia antibody tests are highly inaccurate and not recommended.  I cannot imagine why your provider did it.  Your positive result has nothing to do with your recent exposure.  The chlamydia blood test cross-reacts with Chlamydia pneumoniae, a common respiratory organism that is not sexually transmitted.  Or you might have had a distant past sexually acquired infection.  There is no way to know.  But it has nothing to do with your recent event.

4) Your urine test was accurate despite whatever washing and rubbing you did.

5) Irrelevant. There is no realistic chance you acquired chlamydia, given both the low risk nature of the exposure and your negative test result.

6) It makes no sense to have HIV testing on account of the exposure you describe.  If you're going to worry about HIV from that exposure, I assume you don't drive, don't cross busy streets, and won't ever take a commercial flight.  All these carry a higher risk of killing you than the chance you caught HIV from the exposure you describe.

7) The "antimicrobial wash" you describe has never been studied, but the odds are that it had no protective value at all, indeed might have increased the risk of infection.  Chlorhexidine and similar agents can damage the epithelium of the urethra and increase the risk of infection if exposed.

Bottom line:  Mellow out, rely on the negative STD tests you have had, and go on with life.  This event is a non-issue with respect to your and your wife's health.

Good luck-- HHH, MD

[worried/nervous]

Doctor,

I recently had a chlamydial blood test as well.  For some reason (I am not sure why), I was given both a urine test and the blood test.  The result for the urine test was negative.  I have not received my result for the blood test.  

From what I have read on this forum, I do not really want to know my results for my blood test since it is unreliable and the urine test is already negative.  I don't see any reason to worry myself.  Also, I am almost 100% sure I have never had genital chlamydia.

I have been in a monagamous marriage for nearly 8 years, had a son a couple of years ago,(thus wife was tested).  I only had one encounter outside of marriage (received oral) a few months back with a female.  I know this is not a chlamydial risk.  

I told the doctor today that I did not want to know my results of the chlamydial blood test.  He told me the test was already ordered.  I asked him to cancel it, but he just told me to relax and await the results.

Is he ethically bound to tell me the results, or can I ask him to only give me the results of other tests I took (HIV, syphilis).  I really don't want to know.  If he slips and tells me, can I completely disregard and not fear for my wife if it is positive for some reason?  I am comfortable with the urine negative test as I have seen you say that people are home free after this test.  

I went to do all these tests to put it all behind me, but now I find myself worrying about worrying later for a test that I have not even gotten the results for!

Any advice?

[H. Hunter Handsfield, M.D.]

At this point, it's between you and your doctor.  I don't think it's an ethical issue, just one of your anxiety.  Just ignore the result if it's positive; it is your urine test that counts.

HHH, MD

[pogo]

Please help me out. One week ago, I had sex with a condom on for vaginal, but I received oral from her without a condom. Two days later I have symptoms of chlamydia/gonorrhea, I had some discharge for about 2 days, and a slight burn when I urinate. I am familiar with this because about 8 years ago I contracted both (at the same time, had treatment).

I went to get tested for these STD's 2 days ago. It was a urine type test not the swab. I recieved the results today and they came back negative for chlamydia and gonorrhea. I am almost positive I have one of them because I remember the symtoms (symptoms) from before. What should I do? Could this be something else? The discharge went away but I still have the burning. Your comments would be appreciated.

[wonderer123]

I have been in a monogomous relationship for 6 months.  My girlfriend was experiencing a burning sensation after we had sex on one occassion this was not the first time we have had unprotected sex but this was the first time she felt this way.  

She went to the doctr and they gave her test fo HIV, ghonoria, chlamedia all came back negative.  She was treated for a urinary track infection. We had sex again and she had it happen again.  So I believed that I should get a complete physical and get all of those tests.  The Clamydia (chlamydia) came back positive.    

She nor I have had sex during this time with anyone else. and the tests were two months apart from each other.

How is this possible that she is testsed negative but then I am tested positive?