Okay the short version of the scenario is:

On October 9, 2007 I had unprotected oral sex (receptive and insertive) and PROTECTED receptive anal sex with another man. It was a first and only time event and since then I have abstained from all sexual contact pending the completion of testing.

Underwent the following testing:
October 24, 2007 (15 days post contact) urinalysis for gonorrhea, Chlamydia, RPR and FTA-ABS for syphillis -- all test were negative.
October 27, 2007 (18 days post contact) blood test for HIV - negative
November 1, 2007 (23 days post contact) urinalysis for gonorrhea, Chlamydia, RPR for syphillis -- all negative.
November 26, 2007 (48 days post contact) FTA-ABS for syphillis - negative
January 28, 2008 (111 days, 15 weeks 6 days or 3 months, 2 weeks and 6 days) RPR, HIV antibody, and Hepatitis panel -- all negative.

Recently, I read that chlamydia might have a window period as long as six weeks. However, although both county health department clinics I attended for testing (urinalysis for chlamydia and gonorhea) said anything about coming back for a follow up test.

Question: Can anyone advise? Can you tell me authoritatively whether I should retest for chlamydia before resuming sexual relations?

In addition, what is my risk of Lymphogranuloma Venereum? Although rare in US (only about 1000 cases a year), I was reading recently that it could take as much as six months to show up.

Thanks for your help.
needadvice

Hi Needadvice,

Second thing first. You have to be infected with chlamydia to get Lymphogranuloma Venereum which is caused by three different subtypes chlamydia trachomatis and, as you know, it's pretty rare anyway.

Based on what you've written here, it's not likely you have chlamydia because:
1. you tested negative and
2. transmission is not likely to occur the way you described.

However, after all this testing, if you're still concerned, you can always test again to make sure. If it's negative then, you should be able to move on feeling pretty confident you didn't get anything.

Dharma

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ASHA Moderator

Thanks for the information and the assessment.

Can you tell me directly if there is a window period for chlaymdia testing? If so, what is it? As I wrote before, different references quote anywhere from a few days or week (including the STD clinics I attended), while others quote up to six weeks. This is very confusing, in considering whether to seek retesting. Retesting is a nuisance, a fact compounded by at least one provider who has suggested that I stop wasting resources and seek professional mental health counseling for what he sees as an obsession.

Also, if I understand your reply correctly, if I have a "valid" but negative chlamydia test via a urinalysis there is no possibility of my having been infected with lgv. Is that an accurate interpretation?

Any help or information you can provide would be greatly appreciated.

Thanks,
needadvice

No need to restest. If it's negative for chlaymdia at this juncture, you can move on.

What's happening that has you second guessing your health care providers? Also, since lgv is so rare, why the concern there?

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ASHA Moderator

Thanks for getting back to me Dharma.

Okay, your reply of April 22 has confused me more. In it you say, "No need to restest. If it's negative for chlaymdia at this juncture, you can move on."

First you say, "No need to retest." I take that to mean my tests for Chlamydia in October and November 2007 at 15 days post exposure and 24 days post exposure, respectively, were definitive results indicative that I WAS NOT infected with Chlamydia. If so, then I have no reason to retest today so long as I've had not other exposures, which I have not.

Then you go on to say, "If it's negative for chlaymdia at this juncture, you can move on." I interpret that to mean that I need to rest again NOW and if it's negative, today six months later, that at that point I can conclude that I WAS NOT infected with Chlamydia.

Not to sound ungrateful for your assistance, which I greatly appreciate, and perhaps it's a by product of the CYA syntax that permeates our society, but which is it?

Were the tests I had for Chlamydia in October and November at 15 and and 24 days post exposure, which were negative, definitive? And, therefore, indicative that I was not infected with Chlamydia, and since I've had no further exposures thus not infected now?

Or, do I need to test again now in April in order to get a definitive result?

I was hoping you could address each question point by point.

As to what's going on now, you know the basic scenario. But, what is not mentioned is the fact I'm in a very long term monagomous relationship, with this one incident of straying outside the bounds of that relationship. Now, I have been able to avoid sexual relations because as a consequence of my work, I was able to "invent" an exposure that might have infected me with HIV, etc. that occurred in the course of my work. I know I'm not proud of it but I'm not prepared to sacrifice my relationship nor risk infecting my partner, if I can avoid it.

As we approach the six month testing point, I'll be going to get a "final" Hiv test soon. Actually, I could get it now, but well let's just say it will be soon. So, I want to be sure I can safely resume sexual activity with my partner. Yes, we haven't had sex in six months, but that's because we're afraid a condom won't work because I have some other issues that might preclude the effective use of a condom.

Now, if we can put moral judgments aside for a moment:

Back in October and November I left the STD clinics confident I was not infected with Chlamydia, Gonnorhea, Herpes, Syphilis, or HIV in the weeks immediately following this "event." At that time I believed Chlamydia and Gonnorhea were done deals, definitive negatives with no further follow up testing needed. I was NOT infected with either of those two bugs, period.

In January, I tested again for HIV, Syphilis, and a Hepatitis Panel as I mention in my first synopsis. Again, everthing was negative. Of course, according to the CDC that HIV test is very reliable, I think they mention 98% DEFINITIVE, but to be 99.9% (no one ever says 100%) definitive I needed to test again at six months. Now, my research indicated that at 100 days the Syphilis test was definitive, so I manipulated the test dates to ensure that the RPR done in January was at 111 days, a 10% margin for error. Also, I learned the Hepatitis panel was definitive enabling me to know for certain that I had not been infected with any of the strains of hepatitis. Okay, so Syphilis and Hepatitis joined Chlamydia, Gonnorhea and Herpes on the list of NOT INFECTED.

On April 10 I noticed some irritation in the crease of my left groin where the upper thigh joins the torso. Not a big deal I'm a recreational athlete and regularly suffer from "jock itch." But, when I went to apply medication to relieve the "jock itch" I noticed a small papule about 5mm in diameter. Now, being the kind of person who does such things, I squeezed it. The "stuff" that came out was like what comes out of a "zit" anywhere else on your body, but there was also a significant amount of irritation around it and it was a little painful when I touched it. I had never had a papule associated with "jock itch" before and given the earlier history I went back to the books to determine whether something might have been missed.

Along with other printed references, I was using a book that has flow charts leading to differential diagnoses. It was too small to be a chancre associated with Syphilis, nor did it have any of the other characteristics of a chancre. The fact the lesion left a hard knot and there was only one ruled out Herpes. Plus, lab results had ruled both of those diseases out.

In researching lab results, I came across some language that indicated a Chlamydia test might not be definitive until six weeks post infection. Now, that flies in the face of some other references I've used and a number of people including two doctors, a physician assistant (all three of whom are in some way STD Specialists), and std counselors (either by phone or email) I've contacted.

So, I started doing some more homework and kept coming across either equivocal answers regarding the "window period," if you will, for Chlamydia testing, or something on the order of six weeks. Now admittedly, those sources that said four to six weeks were largely commercial labs that have an interest in covering their asses. But, other than the two STD docs and the STD counselors it doesn't seem that anyone is willing to commit themselves to anything other than "annual Chlamydia testing for women under 25 and over 25 for women who sexually active and not in a committed relationship.

Also, my primary reference work, mentioned LGV as a possibility. However, my lesion seems to fall outside the incubation period for that disease which is 3-30 days for the initial lesion, which may pass unnoticed according to the CDC and an additional four to six weeks for the secondary symptoms of enlarged inguinal lymph nodes and the formation of a "bubo." But, one reference did mention the possibility it could take as long as six months. Coinicidentally, I found the lesion in my groin exactly six months after the exposure.

One other thing. Because of some surgery I had in the area years ago my inguinal area is atypical meaning I'm not sure if my nodes are enlarged or not. They also don't seem to be painful. Today, three weeks later the little knot is still there under the skin, but does seem to be getting smaller everyday.

I also learned that without Chlamydia, LGV is not a possibilty.

So, given the equivocal answers regarding Chlamydia testing and the symptoms in my groin, I'm concerned and to answer your question "that's what's happening." I'm just trying to figure out if I need to get involved in yet more testing.

So, as I said above were those Chlamydia tests I had in October/November at 15/24 days definitive as I asked above?

Sorry about the length of this post but you asked. Hopefully, I haven't bored you to death. Again, thanks for any help you can provide.

needadvice

Needadvice,

In reading back through this thread, it seems your major concern is that you read somewhere "that chlamydia might have a window period as long as six weeks". One thing that's important to understand is that you'll always find information (especially in the scientific community) where they give the absolute worse case scenario. However, our information is that it would be rare for it to take that long and labs feel pretty secure with negative tests performed at 2 weeks. It would also appear that both of your test sites EXCLUDED chlamydia infection on October 24 and November 1, 2007.

However, given your adament concern about that 6 week time frame, I was simply saying that you could test for it again any time now and that test should reassure you enough to move forward from the chlamydia concern.

The ONLY way to know anything about that papule is to have a health care provider take a look at you. We love to answers all kinds of questions here but we're limited when it comes to helping people diagnose
conditions.

I hope the other information was helpful.
Dharma

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ASHA Moderator