[Question #11571] Answers 2 ITS

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13 months ago
Dear doctors, I'm coming back so quickly with another question because in the previous dialogue that was closed I didn't receive an answer to the last question but only to the additions, so I will retransmit the last question and I qquote:
“Thank you very much for the reassuring answers!
1. For HIV assessment I think 1 in 6 mil is 0 for all practical purposes !!!
2. I read on your forum that condoms reduce the risk of syphilis infection by 60%. I understood well? And the fact that I took doxycycline reduces that risk to almost 0? and for chilamydia? Is my rating correct?
3. For Hepatitis B, is it necessary for bodily fluids to come into contact, and if I used a condom for all exposures, is there a possibility of these fluids coming into contact?  Or can hepatitis B be transmitted in another way?
4. For genital herpes, what is the incubation period and what is the maximum time until it should appear? I also read on the forum that it is somewhere around 10 days. Correct? and what should I pay attention to?
I know that after the first question you answered that if you were in my place you wouldn't take any test, and at the risk of asking one more time and please don't be angry with me, do you still think that no test is necessary?”
Thank you very much for your expertise dear doctors!!!
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H. Hunter Handsfield, MD
13 months ago
Wow -- you're really overreacting given the data we have discussed. I'm guessing you have OCD, right? These thought processes are not normal!

1. Agreed. That was my point.
2. Condoms are much more effective than 60% in preventing syphilis. I've never heard that figure.
3. Blood needs to enter your bloodstream to transmit hepatitis B virus. Anyway, probably you were immunized against HBV in your youth, in which case you're immune.
4. Typical symptom onset is 3-5 days, sometimes up to 3 weeks. Blisters and sores at an exposed site.

I see no reason to repeat myself. I haven't changed my mind.

Do not ask anything else that has already been answered, or whose answer is obvious from our discussions so far. Thank you.

HHH, MD
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13 months ago
Thank you very much for the answers!!
I probably suffer from OCD, otherwise I can't explain my anxiety and these dark thoughts. I'm sorry and I apologize , and maybe I will seek professional help!!!
1. I was not immunized in my youth for Hepatitis B. 45 years ago there was no immunization at birth, but the escort I was with , for sure was immunized because she is 24 years old and I know that this immunization has been done at birth for about 35 years ago. Any thoughts or recommendations considering what I said? Can I rest easy regarding Hepatitis B?
2. I think that gonorrhea and chlamydia cannot pass through an unbroken condom. I should probably leave them aside, but since lunch I feel a need to urinate more frequently, as if itching in the urethra, or is it just mental? 
3. Regarding HIV, I understood and thank you for the evaluation!
4.Can you please tell me what is the degree of protection (roughly) of the condom in terms of genital herpes?
5.The only thing that worries me is syphilis. Considering that it was protected sex and I also took doxycycline 200 mg in 36 hours, what are the chances that I could be infected. In percentages if possible?
I tried as much as I could not to repeat the questions and at the same time to fully clarify all aspects. I really appreciate the effort to evaluate my situation and the time given to me. Thank you!
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13 months ago
Another informative question Until a few years ago, it was said that the 4th generation HIV test is conclusive after 4 weeks. Now 6 weeks is recommended to be conclusive. Why this change? Have you ever seen or heard someone with a negative test at 4 weeks and become positive at 6 weeks? Or are there certain people who have other comorbidities?
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H. Hunter Handsfield, MD
13 months ago
*Sigh* These are useless or meaningless questions.

1. Without immunization, you weren't at risk anyway. Heterosexual transmission of HBV is extremely rare. Almost all sexually transmitted cases are between sexually active men.
2. It's mental Gonorrhea and chlamydia do not cause frequent urination.
4. Maybe around 90% for any one encounter, but only around 50% over time.
5. Syphilis was nearly zero risk; partners like yours rarely are infected. And having take the doxycycline (unnecessarily), there is no chance you were infected.

Nothing changed in the testa. Newer, more accurate data and clinical experience became available. that's all.
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13 months ago
Dear Dr. Handsfield, thank you very much for the information  and assessment!
I have a few more questions not addressed until now:
1. What is the degree of protection of the condom in the case of syphilis? percentage if possible
2. What is the percentage of symptomatic genital herpes in men? I read that it can also be asymptomatic!!!
I have oral herpes since my youth. Does this fact matter? Can this decrease the chances of contacting genital herpes?
3. From what you answered, I understand that hepatitis B is transmitted through blood, but it can also be transmitted through genital secretions (sperm, seminal fluid) or oral secretions?
Finally, if you have any thoughts or final recommendations regarding my exposures, I would be grateful!!!!
Thank you very much for all the support and involvement!!!
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13 months ago
Another piece of information that interests me a lot. What is the conclusiveness of the a4 generation hiv test and a VDRL/RPR test and treponemal antibodies 5 (five) weeks after exposure?
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H. Hunter Handsfield, MD
13 months ago
1. No data available; I would estimate 90-95%.
2. Too complex for a short reply. Depends on virus type (HSV1 vs HSV2), prior infection with HSV1 (usually in childhood), and how alert people are to mild symptoms. All in all probably ~75% of new genital herpes causes obvious symptoms. And yes your oral herpes matters:  it makes it somewhat less likely you would acquire HSV2 if exposed and probably an elevated chance of asymptomatic infection.
3. True.

The AgAb (4th gen) HIV tests probably are 99% conclusive at 5 weeks; syphilis no good data but probably ~90-95%.

If your exposures continue as I recall from your previous thread, you could have such events weekly for the rest of your life without acquiring any STD, except maybe HPV (which wouldn't matter).

That's two follow-up comments and replies, ending this thread. Please note the forum policy against repeated questions. This being your second, it should be your last; future ones would be subject to possible deletion without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

I do hope the two discussions have been helpful. Best wishes and stay safe.

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