Asymptomatic STDs: Causes, Symptoms, and Testing

Asymptomatic sexually transmitted infections (STIs)

Hello Dr.
Hsu,
About two months ago, I had a sexual encounter, and approximately two days later, I started experiencing some discomfort in my urethra and glans (a burning sensation, but it is not persistent).
Additionally, I have not had any other symptoms (such as yellow or white discharge or pain during urination).
I went to a urologist for a routine urine test, and tests for Trichomonas and Chlamydia were conducted, which revealed the presence of Trichomonas.
I was prescribed Flagyl for two weeks, and subsequent tests returned negative, but my condition has not improved.
I consulted another hospital where the doctor examined my genital area and found no issues.
They only performed a routine urine test, which also came back normal.
The doctor mentioned that most sexually transmitted infections (STIs), aside from HIV and syphilis, typically present with noticeable symptoms.
Since my Trichomonas test is now negative and Chlamydia is also negative, the doctor suggested that there should not be any issues, and I could test for HIV and syphilis later.
However, in the past week, I have been experiencing some pain in my right testicle, as well as pain in my groin and right abdomen.
I would like to ask:
1.
Which STIs can potentially present without obvious symptoms?
2.
What could be the cause of my symptoms?
3.
Do I need to retest for Trichomonas and Chlamydia?
4.
How accurate are the tests for gonorrhea, Trichomonas, and Chlamydia?
5.
Can I proactively request the doctor to conduct the aforementioned tests or a bacterial culture?
6.
Can bacterial cultures detect any STIs and their antibiotic resistance?
My condition has persisted for almost two months, and during this time, I have been unable to sleep well and have lost my appetite.
I am nearing a breaking point.

I apologize for the numerous questions, but I am genuinely worried.
Please provide me with some advice.
Thank you.

ji jin beng kui de ren, 30~39 year old female. Ask Date: 2016/02/05

Dr. Xu Weikai reply Urology

1.
As that physician mentioned, most sexually transmitted infections have specific symptoms.

2.
Regarding your swollen lymph nodes, it is advisable to seek medical evaluation, as there are many potential causes.

3.
You can undergo testing again.

4.
If the specimen collection is adequate, it is quite accurate.

5.
Bacterial cultures can provide some clinical reference.
Note: Only about half of infected patients can have bacteria cultured.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Answers from the internet should only serve as a reference; it is essential to seek care at a medical facility if necessary.

The Ministry of Health and Welfare Taitung Hospital cares about you.
This response is provided by Dr.
Hsu Wei-Kai, Director of the Urology Department at our hospital.

Reply Date: 2016/02/05

More Info

Hello,
Thank you for reaching out with your concerns regarding asymptomatic STDs and your current symptoms. It’s understandable to feel anxious about your health, especially after experiencing discomfort and undergoing various tests. Let’s address your questions one by one.

1. STDs with Asymptomatic Presentations: Several sexually transmitted infections (STIs) can be asymptomatic, meaning they may not show noticeable symptoms. Common STIs that can present without symptoms include Chlamydia, Gonorrhea, and Human Papillomavirus (HPV). In some cases, individuals may carry the infection without experiencing any signs, which can lead to complications if left untreated.

2. Possible Issues with Your Condition: Given your symptoms of discomfort in the urethra and now pain in the right testicle and abdomen, it’s crucial to consider that you may be experiencing complications from an STI, such as epididymitis (inflammation of the epididymis) or orchitis (inflammation of the testicle). These conditions can arise from infections, including those caused by Chlamydia or Gonorrhea, even if initial tests were negative. Additionally, other non-STI related conditions, such as a hernia or testicular torsion, could also be contributing to your pain.

3. Need for Further Testing: Since your symptoms have persisted and evolved, it would be prudent to discuss with your healthcare provider the need for further testing. Even though your previous tests for Trichomonas and Chlamydia were negative, if your symptoms continue, it may be worth repeating these tests or considering additional testing for other STIs, including Gonorrhea and HPV.

4. Accuracy of Tests for STIs: The accuracy of tests for Gonorrhea, Trichomonas, and Chlamydia is generally high, especially when using nucleic acid amplification tests (NAATs). However, no test is perfect, and false negatives can occur. If symptoms persist despite negative tests, further evaluation is warranted.

5. Requesting Specific Tests: You absolutely have the right to request specific tests from your physician. If you feel that your symptoms warrant further investigation, including bacterial cultures or additional STI screenings, don’t hesitate to express your concerns. A proactive approach can help ensure that any underlying issues are addressed promptly.

6. Bacterial Cultures and Resistance Testing: Bacterial cultures can be performed to identify specific pathogens and determine their antibiotic sensitivity. This is particularly useful if there is a suspicion of a bacterial infection that has not been identified through standard testing. Discuss with your doctor the possibility of conducting a culture, especially if you have ongoing symptoms.

Given that your discomfort has lasted for nearly two months and is affecting your quality of life, I recommend following up with a healthcare provider who can perform a thorough evaluation. It may also be beneficial to consult a urologist, who specializes in male reproductive health, to explore your symptoms further.

In the meantime, try to maintain open communication with your healthcare provider about your symptoms and any changes you experience. It’s important to address both the physical and emotional aspects of your health, especially if you’re feeling overwhelmed.

Take care, and I hope you find relief soon.

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