Aa
STD or anxiety
Doctors,
I am a 33 year old married male who recently made a terrible mistake and had an unprotected encounter with a woman who I know is very promiscuous. The encounter happened about a week and a half ago and she claims that she doesn't have anything and normally uses a condomn. She performed oral for less than 2 minutes and there was 1 to 2 minutes of vaginal. 5 days after the encounter I got tested by urine sample through a confidetial testing service that uses labcorp. They didn't give me any real instruction but through looking on here I made sure that I hadn't urinated for approximately 5 hours and that I caught the first stream of urine. The tests came back on Monday afternoon as negative for both chlamydia and gonnorrhea. I still have some concern about herpes but that result eased some of my fears. However, the next morning when I was examinging myself (which I've done a lot lately) I noticed what seemed to be redness and slight swelling in the urethral opening. The area is raised approximately 2 mm and is only red at times. After noticing this I started to feel it rubbing on my underwear when I would walk which wasn't painful just a little irritating and worrisome. I haven't had any pain before, during or after urination and there hasn't been any discharge. I also haven't noticed any other sores and there hasn't been any tingling, burning, or itching. I honestly can't tell you if my urethral opening always looked like that because I never really paid attention. I have an appointment with a urologist tomorrow afternoon and I plan to talk to him about this situation but I'm really wondering if I should be worried. Here are my questions.
1. Should I be confident in the initial urine test and resume sex with my wife?
2. Should I be concerned about the urethral issue or some other STD?
3. Will the STD testing affect my insurance?
4. What should I make sure I discuss with my urologist?
I am a 33 year old married male who recently made a terrible mistake and had an unprotected encounter with a woman who I know is very promiscuous. The encounter happened about a week and a half ago and she claims that she doesn't have anything and normally uses a condomn. She performed oral for less than 2 minutes and there was 1 to 2 minutes of vaginal. 5 days after the encounter I got tested by urine sample through a confidetial testing service that uses labcorp. They didn't give me any real instruction but through looking on here I made sure that I hadn't urinated for approximately 5 hours and that I caught the first stream of urine. The tests came back on Monday afternoon as negative for both chlamydia and gonnorrhea. I still have some concern about herpes but that result eased some of my fears. However, the next morning when I was examinging myself (which I've done a lot lately) I noticed what seemed to be redness and slight swelling in the urethral opening. The area is raised approximately 2 mm and is only red at times. After noticing this I started to feel it rubbing on my underwear when I would walk which wasn't painful just a little irritating and worrisome. I haven't had any pain before, during or after urination and there hasn't been any discharge. I also haven't noticed any other sores and there hasn't been any tingling, burning, or itching. I honestly can't tell you if my urethral opening always looked like that because I never really paid attention. I have an appointment with a urologist tomorrow afternoon and I plan to talk to him about this situation but I'm really wondering if I should be worried. Here are my questions.
1. Should I be confident in the initial urine test and resume sex with my wife?
2. Should I be concerned about the urethral issue or some other STD?
3. Will the STD testing affect my insurance?
4. What should I make sure I discuss with my urologist?
MEDICAL PROFESSIONAL
Thanks for this follow-up question. It provides an opportunity to help clear up a confusing topic. Feel free to copy this reply over on the community forum, if you think it will help people's understanding about the effect of urinating on gonorrhea and chlamydia testing.
Recent urination is generally believed by STD experts and lab experts to make no known difference in reliability of testing for gonorrhea and chlamydia by nucleic acid amplicication test (NAAT), such as PCR and related techologies. If your doctor did a culture, not NAAT, maybe recent urination makes a difference -- but even there, probably not.
Beliefs that it makes a difference are logical, in a way. When most of the original NAAT research studies were done, specimens were always collected at least 1 hour after previous urination. Because of that study design, the manufacturers of the tests are required by the US Food and Drug administration (and typically by FDA's counterpart agencies in other countries) to say that testing may be unreliable if done sooner than an hour after previous voiding. The labs offering those tests are also required by law to say the same thing.
Notice that I chose the words carefully: "may be unreliable" doesn't mean the results actually ARE unreliable. It just hasn't been formally studied one way or the other. However, in the 10-15 years since the chlamydia and gonorrhea NAATs have been in wide use, informal research has shown that it makes no difference, and most STD clinics and other knowledgeable providers simply pay no attention to time since previous urination. (Some do so, however.) Millions of tests in many clinics over more than a decade give confidence that the tests accurately detect the bacteria even if done immediately after previous urination. But still the test manufacturers and labs that do the tests must provide the official, FDA-approved information. It would be quite expensive for the manufacturers to do their own additional research to prove that early testing is OK -- and so it stands.
By the way, exactly the same thing applies to other details about how the urine is collected. Officially, it should be only the first 15-30 ml (half to one ounce) of urine, and not larger volumes or a "midstream" specimen. But these details also seem to make no actual difference in test reliability.
So the bottom line is this: Nobody can guarantee that an early test, less than an hour after prior voiding, or that an improper urine specimen is as accurate as a properly corrected one. But if there is any difference in reliability, it is miniscule -- and probably there is no difference at all.
In other words, your urologist did nothing wrong. In any case, all the other information in this thread already provided virtually 100% assurance you didn't have chlamydia or gonorrhea. Frankly, I find it more surprising that your urologist did the latest gonorrhea and chlamydia tests at all and certainly would not worry about the details of specimen collecton.
That will end this thread. Take care.
Recent urination is generally believed by STD experts and lab experts to make no known difference in reliability of testing for gonorrhea and chlamydia by nucleic acid amplicication test (NAAT), such as PCR and related techologies. If your doctor did a culture, not NAAT, maybe recent urination makes a difference -- but even there, probably not.
Beliefs that it makes a difference are logical, in a way. When most of the original NAAT research studies were done, specimens were always collected at least 1 hour after previous urination. Because of that study design, the manufacturers of the tests are required by the US Food and Drug administration (and typically by FDA's counterpart agencies in other countries) to say that testing may be unreliable if done sooner than an hour after previous voiding. The labs offering those tests are also required by law to say the same thing.
Notice that I chose the words carefully: "may be unreliable" doesn't mean the results actually ARE unreliable. It just hasn't been formally studied one way or the other. However, in the 10-15 years since the chlamydia and gonorrhea NAATs have been in wide use, informal research has shown that it makes no difference, and most STD clinics and other knowledgeable providers simply pay no attention to time since previous urination. (Some do so, however.) Millions of tests in many clinics over more than a decade give confidence that the tests accurately detect the bacteria even if done immediately after previous urination. But still the test manufacturers and labs that do the tests must provide the official, FDA-approved information. It would be quite expensive for the manufacturers to do their own additional research to prove that early testing is OK -- and so it stands.
By the way, exactly the same thing applies to other details about how the urine is collected. Officially, it should be only the first 15-30 ml (half to one ounce) of urine, and not larger volumes or a "midstream" specimen. But these details also seem to make no actual difference in test reliability.
So the bottom line is this: Nobody can guarantee that an early test, less than an hour after prior voiding, or that an improper urine specimen is as accurate as a properly corrected one. But if there is any difference in reliability, it is miniscule -- and probably there is no difference at all.
In other words, your urologist did nothing wrong. In any case, all the other information in this thread already provided virtually 100% assurance you didn't have chlamydia or gonorrhea. Frankly, I find it more surprising that your urologist did the latest gonorrhea and chlamydia tests at all and certainly would not worry about the details of specimen collecton.
That will end this thread. Take care.
I don't want to pile on this thread but I was curious about the situation above. I posted in the std community but no one there was sure what your opinion was on this subject. Would a urethral swab be affected by urinating 20 minutes before getting the swab? Thanks.
Doctor HHH,
I saw my urologist and they took a urine sample when I first arrived to check for a urinary tract infection. He did a physical examination and said that everything looked alright. I told him that I was conderned with STDs and he offered to do a urethral swab to check for chlamydia and gonnorrhea which I agreed to. The results came back negative but after thinking about it, would the fact that I urinated 15 to 20 minutes before the swab affect the results. I'm assuming so. I still have the negative NAAT results at 5 days but I was just wondering if the swab is at all reliable and if not, why in the world would he do it after I had just urinated? Thanks again.
I saw my urologist and they took a urine sample when I first arrived to check for a urinary tract infection. He did a physical examination and said that everything looked alright. I told him that I was conderned with STDs and he offered to do a urethral swab to check for chlamydia and gonnorrhea which I agreed to. The results came back negative but after thinking about it, would the fact that I urinated 15 to 20 minutes before the swab affect the results. I'm assuming so. I still have the negative NAAT results at 5 days but I was just wondering if the swab is at all reliable and if not, why in the world would he do it after I had just urinated? Thanks again.
MEDICAL PROFESSIONAL
I meant to say in my original reply that whenever a person suspects his or her own symptoms have a psychological origin (the title of your question, "STD or Anxiety"), usually s/he is correct. That you find it "hard to tell" further suggests a non-physical origin of your symptoms.
I agree it sounds a bit weird, but in the US few urologists get much if any training in STDs. Most county health department offer confidential STD services, even if they don't have an STD clinic per se. Otherwise I would probably lean toward family medicine.
You're about to be seriously overtested. You certainly do not need hepatitis testing.
I agree it sounds a bit weird, but in the US few urologists get much if any training in STDs. Most county health department offer confidential STD services, even if they don't have an STD clinic per se. Otherwise I would probably lean toward family medicine.
You're about to be seriously overtested. You certainly do not need hepatitis testing.
Thank you doctor. It is really hard to tell if I am just being paranoid or if I have a true concern. My original message was a little misleading. I haven't had a blood test yet but I did pay for an STD panel. I did the urine test already and will take the blood test for Herpes, Syphillis, HIV, and Hep A and B. I guess I don't need it but it will ease my concerns. It surprises me that a urologist is not the best place to go in this circumstance. I guess I will discuss the issue with him and if I need to make an appointment somewhere else. I live in a rural area so we don't have an STD clinic that I'm aware of. Would you reccommend a dermatologist or family practitioner more? Thanks again for your help.
MEDICAL PROFESSIONAL
No. 3 is supposed to read "...will NOT have any effect...."
MEDICAL PROFESSIONAL
This was sort of a middle-risk encounter. It is less important that she is "promiscuous" and much more important that she uses condoms and believes she isn't infected. On the other hand, she obviously doesn't use condoms consistently.
Your gonorrhea and chlamydia results are reliable; in newly infected people those tests are positive within 5 days. I'm glad you were reassured about herpes, but there is no way to know that from a blood test. It takes at least 2 weeks for the HSV blood tests to become positive. On the other hand, the chance of catching herpes from a single encounter, with a partner not known to be infected, is on the order of 1 in a few thousand.
For definitive blood test results, see a provider for testing 6-8 weeks after the exposure. Please don't waste money on an expensive "STD panel". You don't need anything more than HIV and syphilis tests -- and both of those are optional, with almost no chance you were infected.
Finally, your symptoms don't suggest herpes or any other STD. But if they continue, get checked by a provider, which apparently you are planning to do. To your questions:
1) You can be confident about the urine test results. No distant expert can guarantee someone isn't infected, but if I were in your situation, knowing what I know, I would resume unprotected sex with my wife with no worries.
2) Most likely you're examining yourself too closely; I suspect nothing is wrong. But let me know if a health professional disagrees.
3) Having STD tests will have any effect on your health insurance.
4) You may have an excellent urologist who understands STDs well. In general, however, urologists aren't highly trained in STDs and often not the best choice in this situation. A family medicine doc, internist, or dermagolotist might be a better choice. Best of all, visit your local health department STD clinic.
Bottom line: Most likely you weren't infected with anything. Next time use a condom -- but I suspect you've already told yourself the same thing.
Regards-- HHH, MD
Your gonorrhea and chlamydia results are reliable; in newly infected people those tests are positive within 5 days. I'm glad you were reassured about herpes, but there is no way to know that from a blood test. It takes at least 2 weeks for the HSV blood tests to become positive. On the other hand, the chance of catching herpes from a single encounter, with a partner not known to be infected, is on the order of 1 in a few thousand.
For definitive blood test results, see a provider for testing 6-8 weeks after the exposure. Please don't waste money on an expensive "STD panel". You don't need anything more than HIV and syphilis tests -- and both of those are optional, with almost no chance you were infected.
Finally, your symptoms don't suggest herpes or any other STD. But if they continue, get checked by a provider, which apparently you are planning to do. To your questions:
1) You can be confident about the urine test results. No distant expert can guarantee someone isn't infected, but if I were in your situation, knowing what I know, I would resume unprotected sex with my wife with no worries.
2) Most likely you're examining yourself too closely; I suspect nothing is wrong. But let me know if a health professional disagrees.
3) Having STD tests will have any effect on your health insurance.
4) You may have an excellent urologist who understands STDs well. In general, however, urologists aren't highly trained in STDs and often not the best choice in this situation. A family medicine doc, internist, or dermagolotist might be a better choice. Best of all, visit your local health department STD clinic.
Bottom line: Most likely you weren't infected with anything. Next time use a condom -- but I suspect you've already told yourself the same thing.
Regards-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
