[Question #11503] Question /risks 2

14 months ago

Dear docs!

I didn't want to write another question but anxiety gets the best of me….

I am back with some questions and requests for clarifications:

I did the gonorrhea and chlamydia PCR DNA test 4 days after the last exposure. It is negative. I hope it is conclusive after 4 days…

A. worries me now is syphilis because I understood that it can also be taken with a condom. I forgot to mention that after the last exposure I took 200 mg of doxycycline. I read on certain medical websites that it is possible to be effective if it is taken within 72 hours after exposure. I took it 20 hours aftet the exposute.How effective it is in preventing syphilis.I read that it is somewhere at 80%.

B. What does syphilitic chancre look like? It is hard like a nodule or it is like an exfoliation of the skin? And how long after exposure does this chancre appear?

Is it possible to get infected with HIV if the condom is used during all sexual relations, both oral and vaginal? What is the possibility of infection if we assume that the partner is infected?

C. Three weeks after the last exposure, how conclusive is a 4th generation hiv test?

4. I read on the forum that at 4 weeks it is 98-99%, but there is a possibility that it will be negative at 4 weeks and then become positive. Have you heard/seen something like this?

Thank you for your understanding and patience! I wish you all the best and I await your answer!

14 months ago

Another clarification: It has been 15 days since the last exposure and there are no symptoms of genital herpes, lice .. Do you think that the period in which these infections manifest has passed?

Edward W. Hook M.D.

14 months ago

Welcome back to our Forum although I'm sorry you felt the need. I have reviewed your recent interaction with Dr. Handsfield and agree with him 100% that the exposures you describe are not associated with meaningful risk for any STI. I congratulate you on your practice of safe sex. I think your concerns are medically and scientifically unwarranted although I also understand the guilt and embarrassment sometimes lead us to worry unnecessarily.

For informational purposes I'll go straight to your questions:

The doxycycline you took, in the dose you took, has been proven to dramatically reduce the risk for syphilis (and chlamydia) when taken within 72 hours of exposure. It is recommended for persons at high risk for these infections and while you are not at high risk, it virtually eliminates any remaining tiny risk for infection due to syphilis or chlamydia.

B. What does syphilitic chancre look like? It is hard like a nodule or it is like an exfoliation of the skin? And how long after exposure does this chancre appear?

Is it possible to get infected with HIV if the condom is used during all sexual relations, both oral and vaginal? What is the possibility of infection if we assume that the partner is infected?

Syphilis chancres are painless open sores, more than 80% of which occur towards the end (last 25%) of the penis. They are open, not nodular and not exfoliative.. Your condom use provides complete protection against HIV even in the very unlikely situation that your partner had HIV. There are NO proven cases of HIV acquired from receipt of oral sex- you will not be the first.

C. Three weeks after the last exposure, how conclusive is a 4th generation hiv test?

Figures at 3 weeks are imprecise, certainly more than half of infections would be detected at 3 weeks. At four weeks, as you note below, the figure is more than 98% of recent infections would be detected.

4. I read on the forum that at 4 weeks it is 98-99%, but there is a possibility that it will be negative at 4 weeks and then become positive. Have you heard/seen something like this?

We have never seen or heard of a person with a negative 4th generation HIV test at 4 weeks go on to develop a positive test.

If you were going to develop herpes lesions, this would have occurred within 10 days of your exposure. Lice would also be apparent by then

I hope you'll be able to move forward. You are worrying needlessly. EWH

---

14 months ago

Dear Dr.Hook,

Thank you for your prompt and kind answer. Thank you!

However, I still have certain uncertainties: it was not only protected oral sex, there were 4 exposures with 4 different escorts, oral sex and vaginal sex 100% protected both oral and vaginal First exposure 2nd of June and the last 5th of June.

A.Can you, if you are kind, approximate what the chances of HIV infection would be if one of these escorts were infected?

B. Is gonorrhea and chlamydia PCR DNA test 4 days after the last exposure conclusive. I did the test and It came back negative..

C. I understand that even in the circumstances i’ve described the I can infect myself with syphilis more theoretically??? Amy thoughts???

Thank you doctor!!!!

Edward W. Hook M.D.

14 months ago

Your follow-up questions are a bit repetitive. I'm not sure why you think the answers might change. That there were 4 different partners makes no difference- these were still no risk encounters. Thus:

A. Can you, if you are kind, approximate what the chances of HIV infection would be if one of these escorts were infected?

There are NO proven cases of HIV due to receipt of unprotected oral sex. Your exposures were condom protected. As Dr. Handsfield and I have both said, these were NO RISK encounters.

B. Is gonorrhea and chlamydia PCR DNA test 4 days after the last exposure conclusive. I did the test and It came back negative..

Already answered as well- your results are reliable and conclusive.

C. I understand that even in the circumstances i’ve described the I can infect myself with syphilis more theoretically??? Amy thoughts???

Even before you took the doxycycline the risk of syphilis for you was virtually zero. The doxycycline only adds to my complete confidence that you did not get syphilis from the exposure you describe- even theoretically

EWH

---

14 months ago

Dear Dr.Hook , thanks a lot for you answers.

Being the third question, I want to make sure that I understood correctly.

I quote from your answer. I think there is a misunderstanding or it is my mistake to understand correctly.

I quote from your previous answer:

“There are NO proven cases of HIV due to receipt of unprotected oral sex. Your exposures were condom protected. As Dr. Handsfield and I have both said, these were NO RISK encounters.”

Please don’t get upset on me but my encounters were only one ORAL protected and 3 (three) were VAGINAL protected and oral protected with 3 diferent escorts ( so not only oral) , and doxy was taken after last one.

Please tell me if your assessment remains the same for HIV and syphilis , I mean No RISK encounters taking into acount that 3 of encounters were VAGINAL protected . I am male heterosexual.

Thank you very much l, and I really appreciate your patience and dedication.

Best wishes dear doctor!!!

14 months ago

And one more thing:

What is the treatment for syphilis :

14 day of doxy 100 mg twice a day or 10 day of doxy?

Thanks a lot for answering me!

Edward W. Hook M.D.

14 months ago

Sorry I did not mention the vaginal sexual encounters as well. Because these were condom protected, they two were virtually no risk although there is a minuscule risk of syphilis from condom protected vaginal sex IF your partner had syphilis ( statistically very unlikely). HOWEVER you also took doxycycline after exposure reducing your risk still further. You are more likely to be struck by lightning than to get syphilis from the encounters you describe. Your concerns are misguided.

My assessment is the same for HIV. NO RISK!!!!

The recommended treatment for established syphilis with doxycycline is 100 mg twice daily for 14 days.

This thread is now complete and will be closed. EWK

---

14 months ago

Thank you very much! Doctors, you are doing a wonderful job. Thank you !