Do I Need Additional Testing

[NC2008]

I would like your opinion as to whether additional testing is required.

I had a single episode of unprotected vaginal intercourse with a woman of unknown history.  I bought some rapid tests at 4 weeks post exposure from a company called First Diagnostic for Chlamydia / Gonorreha, HIV, Syphillis and Hepatitis. The tests were called FirstVue and InSTICheck.  All were negative.

I developed urethritis symtpoms at about 6 weeks post exposure.  Specifically minor burning sensation in penis not while urinating but at other times. The mild burning sensation would sometimes be felt in feet and lower legs with sporadic tingling and cold sensation in feet. Frequent urination. No discharge or itching.  The symptoms seemed to coincide with an episode of unprotected oral and vaginal sex with wife.  

I went for another round of tests at Quest Diagnostics a week later (7 weeks post exposure) for Chlamydia / Gonorreha (Aptima ACT 2), HIV, Hepatitis, Syphillis and herpes (HerpeSelect).  All were negative.

I used another First Diagnostic test for HIV at 8 1/2 weeks.  Again negative.

The only other symptoms to report were a couple of bumps on my inner thighs at around 6 weeks.  Two on the right thigh and one on the left.  No apparent vesicles, pus or scabs.  No itching or burning. They are still there but have faded. A couple seem to have a hair growing out...maybe folliculitis?  No lesions on penis, scrotum, perineum or anus.

After the lab tests, I saw my doc who put me on a weeks worth of Cipro.  He said urinalysis was normal and called it UTI but I didnt give him the whole story. The symptoms are largely gone (9 1/2 weeks). This whole episode has been extremely stressful which I know can contribute to symptoms.

Questions:

1) Do I need additional confirming tests for HIV and Herpes?  
2) In your experience, how accurate is the Aptima ACT test?
3) Have you heard of or used the First Diagnostic rapid tests?

Thanks for your help.

[H. Hunter Handsfield, M.D.]

First I will directly answer your specific questions, then I will elaborate a but.  1) No, you need no further tests; you aren't infected.  2) Aptima is highly accurate, probably the most accurate gonorrhea and chlamydia test on the market.  3) I'm not familiar with First Diagnostic, FirstVue, or InSTICheck, but most likely they use valid methods.  The most reliable test technologies are pretty inexpensive these days, so there is no incentive for online testing services to use poor tests.

With repeated tests negative in someone with no symptoms that suggest STD -- and that is how I judge your symptoms -- there simply is no realistic chance you are infected.

Urethritis does not cause the sort of symptom you describe.  The urethral irritation symptoms with urethritis are primarily discharge, and pain or discomfort that occurs pretty much only with urination.  No STD, including herpes, causes the symptoms you describe, including the thigh bumps.  See my reply in the thread immediately before yours, which describes a very similar situation; my reply explains why it is easy for people to read the web and believe that such symptoms might be due to herpes.  It doesn't happen.

And of course there is nothing in this that even hints at HIV. I wouldn't have recommended testing for HIV, except to the extent you had a psychological need for the reassurance of a negative test result.  Your negative result at 8+ weeks is completely reliable.

Since your symptoms are fading, I suggest just letting it go. Clearly you have no STD, nor any other health problem than can ever harm you or a future sex partner.  All is well.

I hope this helps. Best wishes--  HHH, MD