Unsure about Test Results

I had an unprotected encounter Oct. 20th.  Symptoms matching Gonorrhea and/or Chlamydia appeared the following week and on November 1st I was treated with a shot of rocephin and doxycycline.  The following week I had tests for Herpes, Gonorrhea, chlamydia and syphillis (syphilis).  So i was tested 17 days after exposure.  

The tests for herpes were an IgM and IgG tests.  The IgM being non-type specific and the IgG tests type specific i believe.    All tests results were negative.   Can i trust these results? after the fact i have read that the Herpes tests may have been done too soon to show up as positive.  

My concerns are these:  First, after testing negative i had intercourse with my partner.  Immediately after intercourse the buring/itching sensations returned.  They went away within a week and I felt as though maybe i brought these symptoms on mentally as i've seen described/mentioned on these forums repeatedly.  After about a week all  was well again and we had intercourse again on Wednesday (5 days ago).  Now i am having more symptoms, burning/itching at the tip of my penis but today i noticed 4 small white bumps just under the head of my penis.  They do not appear to be sore to the touch but I am still experiencing a burning/tickling sensation and i have a constant need to urinate although when i do go to the bathroom little to nothing happens.  The burning/itching comes and goes and appears to be worse when i'm sitting down or laying on my stomach at night compared to standing or sleeping on my back.


Thanks in advance.

[H. Hunter Handsfield, M.D.]

Hard to imagine a health care provider treating your for gonorrhea and chlamydia, without testing you first; then doing tests for those infections after treatment.  If that's an accurate description of what was done, all you can say is that you may or may not have had gonorrhea or chlamydia; and that if you did, it was cured with the antibiotics.  Similarly, it conceivable you also aquired syphilis, but since there are only 9,000 new cases of syphilis per year in the entire country, mostly in gay men, the odds are very low.  But if you were exposed to syphilis, cefrtiaxone (Rocephin) and doxycycline will have aborted the infection and testing for it was pointless.

As far as herpes is concerned, the chance you caught it without typical herpes symptoms is low; most STD specialists would not recommend HSV testing in this circumstance.  The IgM result is meaningless one way or the other; there was no need for it.  Whether positive or negative, it is an inherently unreliable test.  (Use the search link and enter "IgM" for extensive discussions about it.)  The IgG result indeed is type-specific, but meaningless in relation to your sexual exposure a month ago.  Although it turns positive for HSV-2 within 3-4 weeks in about half of all new HSV-2 infections, it takes 4 months to reach 95% reliability.  If you want to continue to pursue the almost zero chance you caught herpes, get tested again in late February.

I answered the initial quesitons without regard to your current symptoms, since they do not suggest herpes or any other STD.  At most, you might have some residual nonspecific urethral irritationn from the initial NGU, chlamydia, or gonorrhea, hwhichever of those you had.  If you develop an abnormal discharge again, get it checked out.  Or of course see a provider if you continue to be concerned any of those symptoms.  I can't say what the white bumps are, but clearly not herpes and almost certainly no other STD either.

Good luck--  HHH, MD

[littlehelphere]

Thanks for your response.

I was under the impression that if you knew you were negative for HSV-1 and HSV-2 going into an IgM test that the results could be trusted for identifying new exposure.  I know i'm negative for HSV1 and 2 prior to this incident so can I rely on the IgM test results?

Also, my current symptoms are just general tingling and soreness with few small bumps and some minor irritation around the rectum.  Do those symptoms alone warrant concern for any type of STD or other bacterial infection?

Thanks Again.

[H. Hunter Handsfield, M.D.]

Theoretically IgM antibody detects early infection. It doesn't work for herpes in adults. Many newly infected people don't develop detectable IgM; when they do, often it's no faster than IgG; IgM sometimes remains present in chronic infecion (infection); and on top of all that, the test is difficult to do properly and commonly gives false positive results. In 3 decades, we have never once done an IgM HSV test in my STD clinic.

I haven't changed my mind since yesterday, when I said that "...your current symptoms...do not suggest herpes or any other STD."