Equivocal Result?

[Mr_Equivocal]

The last 3yrs I've visited parlours adhoc & tested yearly for STD’s. Neg until yesterday when I got an equivocal Chlamydia result. Tested again this morning and awaiting results.

I rec unprotected oral at a parlour 8-9 mths ago, tried full sex with a condom unsuccessfully due to not being able to maintain an erection. I've rec unprotected oral at a parlour 2x since.

2 wks after I had sex with my wife, foreplay (unprotected) actual sex protected. 1 wk later she commented about diff discharge to norm, itching & slight burning on urination which panicked me. Itching & burning disappeared, she still gets discharge sometimes which doesn't concern her as unusual. (The last 4 yrs she has been to hospital with abdo pain which was largely unresolved & put down to ovarian follicles or something? The doc's explanation was complicated. I tested and was neg for all STD afterwards.)

For 6 months I have experienced diarreah, lower back pain, erectile dysfunction all for which I visited the doctor. Stool samples, urine tests and blood tests all clear. Symptoms weren't always concurrent apart from lower back pain and diarreah. Last time I visited my doc was Dec when he diagnosed prostatis and gave me antibiotics.

Antibiotics didn't work and I visited the STD clinic. All clear apart from an equivocal Chlamydia test.

I understand (via web) of an equivocal result is it's borderline or the sample gives discrepant results on repeat testing.

I know Chlamydia via oral contact is rare/non existent. That said I can't see how else I have been exposed.

Why would this happen and what do you feel would be the likelihood of it returning positive given all the info. I asked the asst at the STD clinic this morning, she left the room to check what the practice nurse had told me before returning to say they simply couldn't get a result. The fact she had my file in her hand but had to leave the room before answering also concerns me!

Any help is appreciated. Many Thanks.

[H. Hunter Handsfield, M.D.]

Putting together all the facts, if you have chlamydia, you caught it from your wife, not at the massage parlors.  If you are confident that your wife has had no other sex partners in the past couple of years, then a false positive result is the only realistic explanation.  However, your description of her illness suggests she might have had pelvic inflammatory disease (PID), which usually is sexually acquired and often due to chlamydia.  Gonorrhea is also a common cause--and unlike chlamydia, gonorrhea can be acquired by oral sex.  On the other hand, gonorrhea almost always causes urethral discharge that you would have noticed.  The timing certainly is suggestive of something she caught from you, but it really doesn't prove anything.

"Equivocal" chlamydia test results are rare with the modern chlamydia tests used by almost all laboratories; generally the results are clearly positive or negative, and I don't recall ever seeing an equivocal result in my STD clinic.  But I suppose it is possible.  Anyway, my prediction is that the repeat test will be negative and you can put the whole episode behind you.

I cannot comment on the peculiar behavior you report by the STD clinic staff.  You should telephone, or return in person, and insist (politely!) on clear information about what is going on.

The bottom line is that I can't give you the clear answers you were hoping for.  It seems that clear, honest, and sensitive conversations with all concerned -- the STD clinic, your wife's doctor from the illness several months ago, and perhaps your wife herself -- is the best route to clear things up.  Or, if both you and she now are well, perhaps drop the whole thing, once you confirm that your repeat chlamydia test is negative, as I expect it to be.

Good luck--  HHH, MD

[Mr_Equivocal]

Thank you very much for your prompt response Dr.

My thoughts previously following my wife's admittance to hospital have been that she may have PID which is why I tested 1 week later on both occasions and was negative for all std's incl Chlamydia. The last time she was admitted was in 2005.

I tested negative for gonorreah on my last std test which I got the results from yesterday and I have had no discharge.

I am in the UK so I'm not sure what type of testing is done. I believe its urine although a swab test was taken but I understand this was for gonorreah.

The UK clinics now text message you with your results. If they text negative you celebrate. If they text ring us then you know you have a problem which is what they did yesterday.

Once again I am grateful for your response, I find this site extremely helpful.

[H. Hunter Handsfield, M.D.]

The first episode of PID predisposes a woman to recurrent episodes, generally not directly due to STD.  Instead, scarring or other damage to the Fallopian tubes makes her susceptible to pelvic infection with normal vaginal bacterial.  Therefore, recurrent PID often does not imply anything acquired from her partner.

The UK GUM clinics generally are high quality, run by well trained specialists.  While I cannot comment on any particular clinic's communication style, you can be confident you are receiving quality care, at least at a technical if not personal level.

[Mr_Equivocal]

Hi Dr,

I wanted to drop you a line to let you know that the results came back negative as you suspected they would!

I feel it is now right to drop the whole thing and start to put the effort into my relationship with my wife instead of seeking relations elsewhere.

Also I would like to say that to all those who search the web looking for answers on std related issues their is no substitute for testing! I have put a lot of things on hold over the last 9 months due to my fear of std's and HIV and it simply isn't worth it when a test will tell you the answer. That said I have not come across a more honest and useful site as this so thanks doc.

[H. Hunter Handsfield, M.D.]

The outcome isn't a surprise, but congratulations.  Thanks for the nice comment about the forum.