[Question #10268] Risky Exposure Questions

24 months ago

Hi doctors. Im a male and 1.5 year ago I had a very risky sexual encounter with a street CSW (no high end high cost escort). It was condom protected vaginal sex and condom protected oral sex (fellatio). After the encounter Ive had numerous symptoms and even more tests, all with negative results. I'll just summarize the last tests because Ive taken a lot more:

7 months post exposure I got urine test for Gono & Chlamydia and other bacteria = all negative

12 months post: syphilis and HIV negative (VDRL, HIV 4th gen, Western Blot & HIV RNA)

Ive been having a lot of unexplained symptoms on this last year like penis and anal pain, pelvic pain, reduce ejaculation, perineal pain and much more. Still no answers about what is causing the pains.

What is troubling me more right now is that my regular partner is experiencing some discomfort as well. A few months ago she started having some severe pain during menstrual periods, some spotting after sex (a few days before period starting), certain increase in urine frequency. Her gynecologist now believes she could have endometriosis or some inflammatory condition (PID?)

1. Is there any way I could have any STI and still be undiagnosed?

2. Important: after the encounter I waited 6 months before having sex with my partner again! Ive read in this forum that man cures chlamydia and gono by itself, is this true? how long does this takes?

3. Could I somehow be causing her to have this symptoms and issues like endometriosis or PID? Doctor also found some cysts in there. Did I infect her?

4. Could Ive been infected with Syphilis with 12 months post negative VDRL? How good is this test?

24 months ago

Hi doctors, just wanted to add that my partner is also experiencing strong headaches and nausea from time to time.

As stated by doctors Handsfield in question #10244:

“or you had something undetected but that was successfully treated with the antibiotics you were given, as indicated by clearing of your cervicitis.”

“The lab tests done are very accurate but not perfect. Your symptoms, and their timing after that event, indeed were of concern that she had introduced an STD to your husband, and it was reasonable for you to seek medical care and STD testing, which you did”

This is my main concern, what if my labs tests havent found anything but Im indeed infected and I passed something to her? How would I know?

Edward W. Hook M.D.

24 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment. Let me start by stating that you almost certainly did not acquire an STI from the encounter you described. I say this for several reasons including:

1. Although your partner was a higher risk CSW, the risk is relative and even most street CSWs do not have STIs.

2. Even if your partner had an STI, even most single unprotected encounters do result in transmission of infection.

3. A condom was used for the exposures and condoms are highly effective for prevention of STIs. If your condom appeared intact, you can be confident that it worked- when condoms fail they break wide open.

4. You had negative tests. The tests you had for STIs and HIV are highly reliable and you tested at a time when, if you were infected, the test would have been positive.

In response to your specific questions:

1. Is there any way I could have any STI and still be undiagnosed?

From what you say, there is virtually no chance that you acquired an STI- your exposure was virtually no risk as I described above and you tested at a time when the results are reliable.

Asymptomatic STIs can clear with time. About a month after a positive test for chlamydia about 20% of persons no longer have positive tests. Despite that, given the no risk nature of your expsoure, your negative tests and the absence of typical STI symptoms, you can be very confident that you did not acquire an STI.

3. Could I somehow be causing her to have this symptoms and issues like endometriosis or PID? Doctor also found some cysts in there. Did I infect her?

If the doctor suspected PID she/he would have started antibiotics. The presence of cysts, as well as the possiblity of endometriosis are much more likely causes of her discomfort. I suspect the doctor may have tested her for STIs if he was concerned at all.

4. Could Ive been infected with Syphilis with 12 months post negative VDRL? How good is this test?

If you had syphilis and have not received antibiotics you can have complete faith in this test as having proved that you do not have syphilis.

The symptoms you describe are not those which would cause someone to worry about an STI. They could be caused by prostate condition however. I'd discuss them with your own doctor.

I hope this information is helpful. Please don't worry that you acquired an STI from the encounter you described, nor should you worry that you have infected your partner. EWH

---

24 months ago

Thanks for the answers. A few follow up comments and questions:

I made a mistake, my last urine test for STIs was not 7 months but actually 11 months post exposure, all negative. In total in 1.5 years Ive had 2 urethral swab and 2 urine tests looking for STIs, all negative.

1) About STIs curing without treatment, you say 20% within a month, is this that only 20% would have cure without treatment or only 20% in such a short time? Is the self cured higher in a few more months? How long can a average man expect to be cured from chlamydia and gono by itself.

2) My partner's gyn havent made any STI test, should she do so? I dont know why she hasnt

3) As I understand if my partner is infected and has reached to cause issues higher up her system, is probable that the bacteria would not be found by a urine test, how would she get the right treatment then if she has chlamydia or gono from me?

4) For other reasons (strep throat / tonsilitis) I had two treatments of antibiotics in the last year. One time I got 1g of azythromycin and a few months later I got 10 days of augmentin. How would this affect my case?

5) Ive been having a lot of genitourinary issues for the last year, now my partner seems to be having as well. Dont this cause any concern from your side? Do you truly believe is all just coincidence? We were totally fine and after my encounter somehow Ive been in pain and discomfort for more than a year and now my partner as well. What can you think of this?

6) My condom didnt break wide open, but Ive read in numerous interactions in this forum that condoms sometimes just failed to protect against STIs. Isnt this a possibility? I really dont understand when doctors tell me I have no symptoms for STIs if everything I have started after the encounter, how is this possible?

24 months ago

Just to add a list of everything I took for your knowledge:

2 months post exposure: 400mg of Cefixime, 1 dose per day, for 10 days

5 months post exposure: Augmenting for 10 days

6 months post exposure: 1G of Azythro

Edward W. Hook M.D.

24 months ago

I really feel that you are overthinking this. Very low risk encounter, no typi9cal symptoms, multiple negative tests and antibiotics (which you neglected to mention) that would have cured nearly all STIs.

Self-cure rates increase over time. Best documented for chlamydia which unlike gonorrhea can not uncommonly be asymptomatic. Most people with these diseases will become symptomatic (which you have not been). Further, you have had treatment which would be curative on several occasions.

2) My partner's gyn havent made any STI test, should she do so? I dont know why she hasnt

I won't 2nd guess why your partner has not been tested. Most probably however, there is nothing that suggests anSTI on her history or examination.

You misunderstand. When persons have complicated/upper genital tract infections, genital tests are typically positive as well.

The cefixime would kill nearly all gonorrhea infections, the augmentin would cure about half of gonorrhea and chlamydia infections and the the azithromycin would cure about 60% of gonorrhea and over 95% of chlamydial.

As I told you above, the GU symptoms you describe do NOT suggest an STI but are compatible with prostate problems, Repeating the question will not change the answer.

The STIs which condoms are NOT highly protective for are HPV, herpes and syphilis, not the STIs you are concerned about and have proven you don't have. Coincidences do occur and are sometimes amplified when accompanied by guilt and/or anxiety.

My sense is that you have gone down a "rabbit hole" here, perhaps fueled by guilt, and are having trouble getting out despite no typical symptoms, negative tests and therapies for other problems which would have cured STIs. I'm not a betting person but I would bet a lot of money that you do not have an STI from the encounter you describe becuae I am confident I would win the bet.

You have 1 more question remaining. EWH

---

23 months ago

Hi doctor

1. Is it possible for Syphilis symptoms to be appearing almost 1.5 years after exposure? Ive been getting small bumps in fingers and top of my feet. Just like 2-3 independent bumps.

2. Sometimes I feel my penis to be kind of "numb" like almost no sensitivity. This is making "finish" and ejaculation harder. Is this a possible symptom of any STI?

3. Sometimes the skin of my penis gets swollen after masturbation. This does not happen during sex but only when hand masturbating, the skin around the shaft gets pretty swollen. Is this possible by any STI?

4. I understand there's a possibility that I have an undiagnosed infection but most likely not due to my tests results and exposure. But I'm guessing there's no way to be 100% sure?

5. I'm terrified something like HIV can just make an appearance later on, even tho I had several Ag/Ab tests, 2 RNA PCR tests and 1 Western Blot. (The last two I had it because I had a false positive Antigen P24 result). Is there any way any of these tests could be wrong and HIV just turning positive later on? I decided I wont get another test besides my regular general health screening every 1-2 years, but I really dont want to be surprised

Edward W. Hook M.D.

23 months ago

As you know, we provide up to three responses to each client’s questions. The following brief responses will be the final responses as part of this thread. The the thread will be closed without further responses.

1. No, syphilis lesions occur within six months of exposure.

2. No!

3. No!

4. There are no absolutes in science or medicine. You could be struck by lightning while reading my response. The likelihood that you have an STI is about the same. Neither is something you should be worrying about.

5. You are. It going to be surprised. You need to move on.

EWH

---