Discordance of Couple STD results: What does it mean, and what should I do

This is a possible scenario that can be seen when a couple undergoes STD screening tests together and notice their results are “not the same”. Often, such medical results can create disharmony and distress between couples. 

What does it mean when a couple’s STD results are different, and how can we proceed with such results?

Reasons for discordance of STD results

Understanding the possibilities of a different STD results in comparison to your partner(s) is key to determine the next course of actions. Here we list down some of the common causes of discordance STD results.

Patient's history

This is unfortunately the commonest cause of discordance STD results. Commonly the tests results are different between the couple due to an increased risk of exposure to the infection in a couple or another, leading to the results differences. 

This is a dicey situation where, arguably, it may mean that there is an 'unfaithful' polygamy going around, someone cheated in the relationship — which is possible. However, it is worth to note that STD infection can live in the body for years unless it is effectively treated with the right medication. Hence, discrepancies in results experienced by couples may merely mean that their partner may have had a 'past' rather than being 'unfaithful' in his or her current relationship.

Immune system

One may not necessarily acquire STDs from intercourse with a person with STD, though the risk of contracting STDs is higher in those with a positive contact history. Some people can become infected and naturally clear off the infection due to better general immunity. One may have received treatment from another health condition (tooth infection/surgery etc) and inadvertently treated the STDs without realising it. In such scenarios, screening tests on the couples may result in different results. 

Laboratory error

While this is a possibility, generally, laboratory errors are not common as accredited and regulated medical laboratory has to undergo very stringent laboratory processing to ensure delivering accurate and quality results as this can affect the treatment plan of a patient . In Singapore, the medical laboratories need to be licensed, accredited and regulated by the Ministry of Health (MOH). 

What should I do if there is discrepancy of my STD results?

If you do get different STD results from your partner, here are some things you can do: 

1. Communicate with your partner(s)

Having an open conversation without being judgmental and accusative is key in dealing with the situation of unexplained STD results. It is useful to always use logical approach than emotional impulsive approach in dealing with such results. It is worth finding proper time and space to discuss such results with your partner(s), rather than over text message or phone call leading to further misunderstanding and communication breakdown. 

Exploring partner(s) current and previous sexual relationship can be useful in correlating the results and the past history of exposure. Rather than blaming, focusing on solution-based approach, consider to treat any infection(s) if need to avoid further co-spread of disease to one another. 

2. Speak to the physician/ clinic on the tests offered

If there remain unexplained answers to the differences in STD tests, you are advised to consult your physician/ clinic who offered the screening tests. Sometimes, bringing your partner along for the consultation may be useful to 'clear the air' on the spot. 

Getting the right medical information regarding STDs is very important in correlating the clinical history and the tests results. This is advisable rather than doing self-research and over-reading on online platforms, causing unnecessary distress and alarm.

3. Correlate your tests results and clinical symptoms

It is always important to correlate the test results and a person's clinical pictures. In this instance, you will require the expertise of your kind trusted healthcare providers. While most of the STD results, we can interpret ourselves based on 'normal' or 'abnormal' or 'reactive' or 'non-reactive', some of the STD results may not be as simple as a 'yes' and 'no' answer. Having a discrepancy results in comparison to your partner's results may be due to a previously treated or exposed infection. 

4. Repeat the test 

In view of the possibilities of a false negative results as the tests may be done within the window period of the STD infection, one may consider repeat the tests again at a later date. It is prudent to check with your healthcare providers on the sensitivity and the time frame required for a particular test to ensure the results are reflecting a true clinical picture. 

Different laboratories may offer different test kits with different sensitivity and window period. Some of the newer generation tests may be able to pick up an infection much earlier from the time of exposure.

5. Consider proper sampling and getting tested by your physician rather than self-testing

While convenience is key, self-performing testing runs a risk of false results due to multiple reasons explained above. One may opt to head down to a physical clinic for proper consultation, evaluation, and appropriate sample test collection (if need) by your health providers. Currently, in Singapore there are a number of convenient, discreet, fuss-free  clinics that can offer such services. Getting tested by your physician reduce the risk of inaccurate results due to sampling error. 

Furthermore, your physician may be able to guide you on what are the relevant infectious tests to address your individual concerns, as STD tests are not merely just ‘HIV testing’. 

Many reasons for regular STD screening tests 

Some may consider regular 3-6 monthly sexual health screening tests. Such practices are good as this will:

• Pick up infections that have long window period and may stay indolent in our body.
  
• Pick up early any new infections due to ongoing and frequent new sexual exposure.
  
• Allow us to understand our baseline health, and reduce couple misunderstanding when there are differences in test results.

Key points to take home

• Discrepancy in STD tests results between couple can occur and frequently can cause friction in the relationship.
  
• Speaking to your health care providers that you are comfortable to understand more about STD infections, tests and tests results can be useful in understanding the discordance in STD results between couples.
  
• Getting tested in accredited STD clinics by your trusted healthcare providers are vital to ensure the tests are done appropriately and the results are reliable. 

This article strives to facilitate patients who have results that differ from their sexual partner and are struggling to make sense of the results. We hope the article is able to help one way or another! Take care! 

References:

1. Ravikumar B, Balakrishna P. Discordant HIV Couple: Analysis of the Possible Contributing Factors. Indian J Dermatol. 2013 Sep;58(5):405.
2. Caruso G, Giammanco A, Virruso R, Fasciana T. Current and Future Trends in the Laboratory Diagnosis of Sexually Transmitted Infections. Int J Environ Res Public Health. 2021 Jan 25;18(3):1038.
3. Adamson PC, Loeffelholz MJ, Klausner JD. Point-of-Care Testing for Sexually Transmitted Infections: A Review of Recent Developments. Arch Pathol Lab Med. 2020 Nov 1;144(11):1344-1351.