[Question #10237] STI testing/exposure risks
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24 months ago
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I'm 39, male with no STIs (my wife has HSV1). 10 weeks ago, I went for a massage. To my surprise, she removed the towel and licked my anus briefly (10 seconds). I turned over minutes later and she put a condom on with her mouth and proceed to give me protected oral for 30 seconds. Then she squatted over me and we had protected (shallow) intercourse for 1 minutes. I then had sex from behind for another minute until I finished. Condom was intact. I wasn't expecting anything like this and I should have stopped it. I have never done anything like this in my life and won't ever again. I believed the risk to be zero. However, 10 days later, I trimmed my pubic hair and used a razor on some hairs near the base of my penis shaft. A day or two later I had a red bump right where I used the razor. It looked like an ingrown hair. I didn't think anything of it and tried to pop it a few times. I've had these before and it can take a month for the hair to release. I started having intense anxiety and convinced myself I had a chancre since the perceived ingrown hair was at the base and might not have been an area covered by the condom. I took Dox for 2.5 days (around day 27 post exposure )and stopped because I realized it might impact my testing. Ironically, the morning of the test the hair finally released from the bump. At day 32 my EIA Trep test and HIV test were negative. The ingrown hair bump quickly went away, and the redness (probably from squeezing it) resolved in 1-2 weeks. The ingrown hair never scabbed or ulcerated. Since then, now day 67 from exposure, I've grown anxious about still being infected with Syphilis or something else. I've had no symptoms, other than some anxiety driven symptoms (sensations in my genital area). I think I'll get one more Syphilis test to ease my concerns (would a test at 70 days out be conclusive?). Do you see a need to test for anything else? Herpes? I'm terrified of harming my wife.
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24 months ago
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Also, I have read you do not recommend Herpes testing for those in my situation because of the risk of false positives. Is that true? The IGG type specific test offered at Quest labs is not something I should consider or do you know if that has fewer false positives? Assuming the ingrown hair was an ingrown hair, I've had zero potential herpes symptoms. Thanks so much for your advice and all that you do for people in similar situations.
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Edward W. Hook M.D.
24 months ago
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Welcome to our forum. Thanks for your questions. I’ll be glad to comment. First let me comment on your exposure which was virtually no risk:
1. It is statistically unlikely that your masseuse had any STI. Most commercial sex workers do not.
2. Even if your partner did have either an oral or genital STI, only a small portion, typically less than one and five, of unprotected exposures to infected partners lead to infection.
3. Most importantly however, is that a condom was used throughout the encounter, transforming what was a low risk exposure to a virtually, no risk exposure. Condoms are highly effective for preventing STI‘s as long as they don’t break. FYI when condoms fail, they did not leak just a little but brake wide-open leaving no doubt that they have failed. That your condom appeared intact is in assurance that it did its job.
In addition, the location and description of the bump that you describe, is most compatible with folliculitis (a hair bump). Folliculitis is common after persons shave.
As you have already figured out, taking doxycycline was not a particularly good idea, although taken nearly 4 weeks after the event, it would not necessarily change your test results. Regarding your test results, your negative blood test for syphilis nearly 5 weeks following. The results are ivery strong, but not perfect evidence that you did not acquire Syphilis (syphilis blood tests would not be entirely conclusive until 6 to 8 weeks after an exposure). On the other hand, as I’ve already mentioned, this was a very low risk exposure and Syphilis is a relatively uncommon disease. Based on your test results and descriptions, I would not be worried about Syphilis.
Indeed, we do strongly recommend against blood tests for herpes. If you had acquired herpes and were going to develop lesions as most people do, they would have appeared within 10 days of an exposure. The folliculitis you describe the sounds no way like herpes. In situations such as yours, Herpes blood tests are typically more often a source of confusion than helpful.
Finally, regarding further testing. This is a personal choice. The risk of having acquired any STI from the encounter you described is very, very low. On the other hand for many people negative tests are reassuring. If you choose to test, the most important test for you to have would be a urine test for gonorrhea and for chlamydia. Personally, I would not bother to test.
I hope the information I provided is helpful to you. EWH
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24 months ago
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Thank you so much for the quick reply. I did test for gonorrhea and for chlamydia and those were negative. However, it was 2-3 days after I stopped taking the dox (I consumed 5 pills over 2.5 days). My understanding is that could have impacted those test results (but again, no symptoms and protected oral and vaginal). So perhaps I should retest for those if I decide to retest for Syphilis? I'll never repeat this mistake given the mental anguish over the past two months. I never anticipated things getting so out of hand so quickly and I now know that some massage places aren't what they seem. So stupid. I just wish I stopped it and hopefully I can move past the guilt. Thanks again Dr. Hook for replying so quickly on a Sunday. With tremendous gratitude.
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Edward W. Hook M.D.
24 months ago
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Even after 2 1/2 days of doxycycline, if you’d been infected at the time of your encounter, your test would’ve been positive. I encourage you to believe those results. EWH.---