Thank you Dr. Gian, I hope you can help me. Very worried. Made a big mistake but learned a valuable lesson about what is important to me. Don't want to hurt my wife. Should I get retested for Chlamydia and Gonorrhea?

Background History:

51 year old male with history of a few gout symptoms (big toe pain). Never tested for Uric acid levels. What I figured to be typical urinary problems of a guy in his 50's, low volume stream, sometimes slow to start, slight dribble. Monogamous relationship for 27 years. One time mistake, drunk and had exposure to unprotected sex w/coworker 7 mo. ago.

2 mo. ago, (5 mo. after unprotected encounter) sudden tingle, irritation in penis, frequent urge to urinate, little volume, slight burning in head of penis. Volume seemed to increased during this time, could be due to increase in water intake. Self treated with cranberry pills and D-mannose but UTI has not cleared. Within the week full STD panel through Labsafe .com, LabCorp collection point, negative results for all tests. Chlamydia and Gonorrhea urine test (nucleic acid amplification), however because of my urgency to urinate after holding urine for 4 hrs. the sample used was actually a midstream catch. First oz or two went in the toilet. I ended up providing 3 or 4 oz sample. I have since read that with this type of testing, first catch is required. What are the chances I would have a false negative. After all, I have had minimal exposure. One time.

Question:

1. Is it likely that a false negative would happen given the midstream catch I supplied? 

2. I have not gone to the Dr. (family friend) for fear I have STD. Self treated with 500MG of Cephalexin 12hr. for 5days now. Penis irritation and urgency has gone away but back pain is still there. I know that Cephalexin can be effective against Gonorrhea but not Chlamydia. I want to discontinue self medication and see my doctor but want to be reasonably sure that I don't have an STD. My wife does not have any symptoms, the co-worker I was exposed to does not have any symptoms. What is the possibilities that both would be symptom free, and my symptoms without discharge, would show up 5 mo. after one time exposure? Does my symptoms sound more like a UTI either from obstruction Kidney stones, etc.? 

Thank you for any help you can provide.

Hi,

the first urine catch is the proper way to collect urine for a Chlamydia and Gonorrhea amplification test. This is done after withholding urination for at least three hours to obtain the maximum concentration of DNA particles of the infective agent. So a mid stream catch may reduce the test sensitivity.

Your history suggests however a garden variety urinary tract infection ( E. coli, etc.) and this is best treated with Bactrim (Trimethoprim-sulfamethoxazole) a Sulfa medication. Bacterial cells produce folic acid, a chemical necessary for their growth. Sulfamethoxazole kills the bacterium by interfering with the enzyme that helps form folic acid. The combination of a sulfamethoxazole with trimethoprim is effective because high levels of the drugs are achieved in the urinary tract and urine, which kills bacteria directly at the site of the infection.

If it gives you peace of mind you may want to retest for Chlamydia

Be well.

Dr. Gian