Trichomonas and Bacterial Vaginosis question

[iwasstupid20]

my encounter in Nov '10 I had a fling with an ex, we tried to have sex condom was on before he and i started to do anything. we were trying to get it in and him up and was rubbing his penis around my vagina from clit to opening trying to get it in. He couldnt get it up all the way to get it in and have sex but he came, so we stopped and he disposed of the condom.. As far as I know it never penetrated or if it did only the head went in... I am married btw.. so I continued to have sex with my husband without condoms nothing seemed to be wrong and as far as I was concerned no real risk?.. Jan '11 I went for my annual and was diagnosed with Bacterial Vaginosis. I had burning. itching, foul smell and dicharge.. so I got tested as well.. Everything was negative except a "few" clue cells... Which from my understanding is a sign of BV. I had a trichomonas rapid test done (OSOM) which detects atigens..I know this because I called the lab. When i was talking to the lab she said that if I had a positive test she was 95% sure I was positive and If i had a negative test she was 83% sure it was a true negative.. The test has a sensitivity of 83% and Specificity of 95%.

I have a negative test for trich (by that test) can I be more sure than 83% that I dont have this and are they just being conservative and I didnt get a false negative test?
2. is BV a normal thing to happen to females in some part of their life?
3. from my risk, is there anything really, like trich I should have been more at risk for? ( as I think about the encounter with him not being fully erect the semen might have gotten out of the condom.
4. if semen did get on my vagina/in what is the likely hood of one time encouter as I describe to become infected with Trich?
5. Can I live with my test results and be 100% confident that i dont have this and continue non pretected sex with my husband?

The reason i am questioning my negative trich test is because BV is often linked to Trichomonas from what I read.

[Edward W Hook, MD]

I continue to suspect you are perseverating on this.  We need to bring this exchange to a close.

That said, the Gen Probe Pace-2 is dated technology and detects only about half of chlamydial infections, if present.  Better tests are nucleic acid amplification tests such as the Gen Probe Aptima tests.  

Family doctors can however do PAP smears just as well as OB/Gyns.  EWH

[iwasstupid20]

I am now concerned my family doctor did my pap i didnt go to a gyn. Do they have know the technices as well as the gyn. Also I had a DNA probe test for chlamydia and gonohrrea.. the test was a gen-probe PACE 2 test.. is this a reliable test?

[iwasstupid20]

thank you so much... I appreciate everything. and your last sentence made me giggle. I am taking your word and my negative test result and moving on.

[Edward W Hook, MD]

This is a complex issue that is unfortunately not completely understood even by some doctors but is essential to understanding how tests work.  Sensitivity and specificity are terms that refect test performance but do not really give you all that you need to know.  This is because how accurate tests really are in real life is also a function of how likely it is that, in your case, the infection one is looking for is to be present.  In your case, even before testing, the likelyood that you had trich was very, very low- most men do not have trich, you did not get penetrated and that is needed for you to get trich, a nd a condom was used.  Then when you add to all of those factors which make trich so unlikely, a negative test, even a test whose sensitivty is less than perfect but which has a high specificity, a negative test makes it even more likey that trich is not present.

Tests are there to help doctors but are not absolute.  you do not have trich, really.  EWH

[iwasstupid20]

Last and final question.
First off never ment to offend you one bit. I am completely sorry.
I am not understanding what you mean about prevalence and negative predictive value. I have looked it up and still not understanding.
I have found an article on research from '08 about OSOM (the trich rapid test) and that gives it a 99.9% negative predictive value but I was sure that the sensitivity 83% told how many tests were true negative... so with that please understand my confusement.
I never question normally my negative test results but since I had BV and had all the symptoms (they resembled trich) I just want to make sure i am covered.
also clarifying question that i have read in many posts- you said that "most people dont have STD's" with that being said why is there millions of people with STDs in the US.

sorry for the ongoing process I just want to know how reliable this test was that i had done. I over analize things and with my symptoms I had, has my mind racing.
Thank you for everything, I have much respect for you and dr HHH for answering these posts.

[iwasstupid20]

did not mean to offend you... but thank you for your response, it makes me feel at ease.. thank you so much doctor

[Edward W Hook, MD]

Your being a bit silly and have not read my response correctly.  The performance of tests is context and prevlaence specific.  The negative predictive value of your negative test is more than 99%.

  "If you were my patient" (do you think I have different answers here than I would have for my own patients??  I find that a bit offensive) I would tell you that you did not get an STD from the encounter with your ex and that you did not need to worry and do not need further testing.  EWH

[iwasstupid20]

More concrete answer. If I was your patient and had the negative rapid test like I have. And you know the encounter would you be worried about me having BV and it being linked to trich and I received I false negative as the test only says 83 percent true negative, or would you say percent wise how negative I truely am say 98%. And is trich an easy STD to get without true deep penetration and is it widely common? Also my ex has a girlfriend has had for 7 months prior to us hooking up, she is 31 but he is a younger guy 5 years younger than her. I was tested frequently when we dated and never had anything. Thank you please put a percent wise how negative you think I am?

[Edward W Hook, MD]

Welcome to our Forum.  I see that this encounter has you worried and that you have spent a lot of time seeking information from our community sites.  I agree with the information you have received thus far.  

You need to consider your risk and test results not only in the context of the test results but also in the context of the exposure.  Your ex is unlikely to have an STD (most people don't), you used a condom, and it is unlikely that there was penetration.  Thus, even before testing, it is quite unlikely that you got an STD of any sort.  With this as the background, let's go to your questions:

1.  See above.  The chance of a false negative is low, particularly when considered in context.  Between the test and the context I would not worry about trich.

2.  Women can even get BV without sex although the events of sex seem to help "set the stage".  As you have been told, there is no good evidence the BV is an STD.  Rather it is an overgrowth an unbalance of normal vaginal bacteria

3.  I se no reason for concern.

4.  The risk is very, very low. So low that it really is a waste of time to worry.

5.  See above.  You have no reason to be concerned about having an STD from this encounter that you could give to your husband.  EWH