[Question #10608] Follow up-[Question #10537] Risk Assessment & Next Steps
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21 months ago
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Dear Experts,
I am following up regarding my post since I had some urine test.
At day 12, I got checked and she did not see any clinical symptoms but still wanted to test me.
I tested negative for gono and chlam in urine. It has been 16 days since exposure and had no clinical symptoms of blisters or pain in the urine. Although my swab did turn positive for E coli and other intestinal bacteria. . So I have the following questions:
1. It is day 16 and have no blisters after the incident, in this case herpes should not be an issue, correct?
2. Can E coli be sexually transmitted? Could it be possible that I had it before?
3. I did wear a condom and did not break, could I have caught it from the safe sex?
4. Yesterday I did have sex with my partner but wore a condom? would she be safe from this e coli bacteria found in the swab?Please let me know what you think of this situation, I did start some antibiotics course for the next week.
Thank you for all your help.
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H. Hunter Handsfield, MD
21 months ago
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Welcome back. This question was assigned to me, but I reviewed your recent discussion with Dr. Hook and agree entirely with his evaluation and advice.
As Dr. Hook said, your risk of any STD was very low, both because it is unlikely your new partner had any transmissible infection and absence of symptoms. Taking Dr. Hook's advice a bit further, in my view even seeing a doctor and getting tested was optional. If somehow I had been in your situation, I would not have sought care or be tested and would continue unprotected sex with my wife without any worry about infecting her with anything. That said, having now been evaluated, having no symptoms, and having been tested with negative results, you should be even more confident you don't have anything. To your specific questions:
1. Yes, it's too late for onset of herpes symptoms. (On very rare occasions symptoms can be delayed up to 3 weeks, but I've never seen such a case myself. Every new herpes in my personal experience had symptom onset within 10 days.)
2,3. E. coli is an entirely normal bacteria in our intestines -- and because the genitals are near the anus, contamination of the genital area with E. coli is common. In absence of symptoms, this test result is meaningless. With or without a condom, a positive test never indicates it was acquired from a sex partner.
4. I see no need to use a condom for sex with your regular partner. E. coli is the most common cause of UTI in women, but UTIs are not sexually transmitted; when it causes UTI, it always is from the infected person's own intestintal E. coli strain(s).
I do not understand why you are now taking an antibiotic. There could be an exception if a urine culture was done and found substantial numbers of E. coli plus other evidence that you have a UTI. For the reasons above, simply having it show up on a urethral culture is not abnormal and does not need treatment. Did your doctor actually recommend it, or was treatment at your request or insistence? What antibiotic?
HHH, MD
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21 months ago
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Dear Dr. Handsfield,
Thank you for your reply and yes I do agree with Dr. Hook, but just wanted to follow up since this positive test.
I spoke to my urologist and she suggested the urine test and a swab to check for things. She saw my on my 12 day mark and said that all looks good. Today (day 16) I got a call that I was positive in the E coli and another bacterial from the Intestines so two bacteria. I did not talk to the urologist but they called me to pick up some medicine. Its called Nitrocolin Forte (Nitroxoline). I did not request the antibiotic and started with the first pill. Do you think I should stop taking it? In this siuation, I had no clinical symptoms or pain of anything. You think the swab was just normal bacteria?
Also, even if the e coli and other bacteria is there, as long as it wa snot Chlamydia or Gono I can have a noraml sex life?
Once again, thank you for all you help!
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H. Hunter Handsfield, MD
21 months ago
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This is peculiar management, unless urologists' training and usual practices might be different wherever you are (not the US, I believe). If I were your doctor and had the report of E. coli on a urethral culture, I would have asked you about typical UTi symptoms (urinary urgency, painful urination, etc); if present (or if any doubt), I would do a urinalysis to check for increased white blood cells; and if any of these were abnormal, would do a standard urine culture, which would not only detect E. coli but would quantitate it -- that is the number of bacteria per ml of urine. I would have prescribed treatment only if the urinalysis were abnormal and the culture showed at least 10,000 E. coli per ml.
Nitroxoline is not an approved antibiotic in the US and I've never used it. It's primarily an anti-cancer drug. I don't understand its use in this situation.
Based on all you have said so far, you can and should safely continue unprotected sex with your partner.
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21 months ago
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Dear Dr. Handsfield,
Thank you for your answer and I am a bit curious: I am living in Germany and my Urologist has I am assuming (russianUkranian medical education background. I found here in Europe this medine is used for UTI and as an Antibiotic.
https://www.apotheken-umschau.de/medikamente/beipackzettel/nitroxolin-forte-weichkapseln-6960250.html
That is the website in German for this medicine. As well, thanks for the ressurance it has been 17 days and feel somethings in the penis, but could only be anxiety, i am sure after the 20 days and Nothing it will be gone.
Since this is my final post and due to the Terms and conditions last question for the next 6 months. I would like to take the time to ask some more questions.
1. Do you believe I should stop taking the medicine? I do have a urethral swab for next Friday.
2. Just for future reference if I ever start a new relationship or having something causal? The risk of lets says HSV/Syphilis would likely appear outside of the condom area right for HSV you would say 10 days and for Syphilis A sore would have to be present??
3. Is hand to genital risky, lets say person X takes off condom and masturbates person Y?
4. Oral sex without symptoms carries a risk?
Just for peace of mind I will take 3 more days until I pass the 20 day mark and have unprotected sex.
Thank you so much for this forum and help. You and Dr. Hook are great and just wanted to praise both of you for your knowledge, If any of you are ever in Munich, let me know. I will be more than happy to get yall a round of beer!
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H. Hunter Handsfield, MD
21 months ago
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I am aware the drug is an antibiotic, as well as having anti-cancer properties.
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1. We do not provide direct medical care and never would advise someone to change their treatment based only on our input. I've raised issues for you to consider discussing with your doctor. I will add that it would surprise me if it is standard practice in Germany to treat for E. coli without confirming a UTI, as I described above. (You could cut and paste from my comments and let him or her know my perspectives as an ID/STI specialist.)
2. I see no need to avoid sex, regardless of the nature of your partner(s). (Anyway, if there were any risk, would it somehow be OK to put a new or casual partner at risk but not a regular partner??)
3. No STI is ever transmitted by hand-genital contact.
4. Oral sex carries some STI risk, but a lot lower risk than unprotected vaginal or anal sex. The E. coli test result makes no difference.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.
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