[Question #11663] Is this testing enough?

13 months ago

Exposure: Visited an escort 11.5 weeks ago. Received unprotected oral sex (60-90 secs), protected PIV sex, Kissed her (<5 secs). Overall less than 15 minutes. 1st sexual experience.

Testing: Week 1 and 2 - Chlamydia, Gonorrhoea (NAAT). Week 3 - Chlamydia, Gonorrhoea (oral swab + urine) + HIV (4th Gen) + Syphilis (Trep. Pallidum Ab; EIA), Hep. B Virus Screen + Hep. C Ab. Week 8 - Same tests as week 4 except Hep. B and C. Week 10 and 11 - multiplex RTPCR (Urine) for Mycoplasma Gen., Ureaplasma Urealyticun/Parvum, Tricomonas Vaginalisis, Chlamydia (Normal + LGV variant), Gonorrhoea (Normal plus Mosaic penA gene). these were in India. All these have been negative.

Week 12 - HIV (4th gen), Hep B Screen, Hep C Ab., Syphilis (RPR + VDRL) - in India. Week 13 - Provincial STI authority (Canada) will test for Syphilis again (not sure if they will repeat other tests).

I will reach out to Dr. Warren for HSV. I wanted to ask if this testing is enough for other STIs. Thank you.

H. Hunter Handsfield, MD

13 months ago

Welcome to the forum. Thank you for your question.

You describe a low risk exposure. Most "escorts" (expensive female sex workers by appointment) are quite safe, with low chance she was infected; and condoms are highly effective. I can understand how your very first sexual experience might make you anxious, but you have seriously overreacted in all that testing. There was no need for any of the tests you had, and especially for a "comprehensive" test panel of the sort you had. And why the repeated tests yet a second time? Do not have any more tests of any kind. You can be 100% certain you were not infected with anything.

If you continue to have occasional sexual experiences like this one, I would advice NO testing after each exposure; and once a year or so have a urine gonorrhea/chlamydia test and blood tests for HIV and syphilis. No other tests of any kind are necessary in absence of symptoms.

There is no point in asking a separate question for Ms. Warren about HSV. You were at zero risk and should not be tested for it. She would simply repeat this same advice.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---

12 months ago

Thank you, this really helps. Have had the worst anxiety. the person was from agency with appointment but don't know what expensive is. Didn't mention my "symptoms" due to the word limit.

1. 6th day, i felt discomfort within my penis (like extra pressure/blood there). also had irritation after peeing, feeling like pee stuck in my urethra after peeing, maybe increased frequency to pee, and 1-2 second stinging sensations in the urethra. this resolved in 4-5 hours. next day i noticed irritation around urethral opening, this definitely lasted 8 weeks and flared up a few times (blotchy raised red rash) and dies down in hours. the stinging happened once 2-3 weeks later. been told this might be dermatitis due to soap. also have phimosis so could be irritation due to exposure/masturbation w/o lube.

2. 10th day - was drunk at a club and had bad pain (back region but inside my body - stomach/kidney area). lasted 2 hours.

3. after 4 weeks, started having tingling in scrotum, random pains, burning, zaps type sensations all over body (prominent in thighs/ face, but also back/chest, tongue, arms, feet, rarely genital region). also a headache that comes and goes when stressed- lasted 4 weeks. at 6 weeks, also developed muscle twitching all over body. all these sensations only last 3-5 seconds and have been here (inconsistently for 6-7 weeks)

4. developed foamy (beer like) urine after 4-5 weeks - still here. and cloudy urine once.

5. 6 weeks - bad stiff neck for around 2 days

12 months ago

please let me know if anything stands out and if i need to purchase more questions. there's someone i have been talking to (which has caused more anxiety) and would like to really leave this behind me for good.

H. Hunter Handsfield, MD

12 months ago

Every one of the symptoms you report (points 1-5) are typical for the physical manifestations of anxiety or are normal body sensations. Every single one! Everybody has foamy urine from time to time; it's not a sign of any infection. Same for cloudy urine -- both these are strictly the result of diet and fluid intake. Everybody experiences various aches, pains and tingling in various body locations. None of these suggests a need for additional testing of any kind.

These are entirely emotional problems, perhaps related to conflicting perspectives or concerns about sex -- and perhaps the nature of your sexual education. If you keep experiencing and/or worrying about all this, I would advise professional counseling. I suggest it from compassion, not criticism. In the meantime, do your best to not confuse such emotions with risk of STI or other infections. They aren't the same!

---

12 months ago

Thank you so much, I really appreciate your help. The moral guilt, health/emotional anxiety, and the conflicting (mis)information i read online (reddit in particular) definitely drove me insane. It is difficult to get out of that whole mindset spending and days reading about STIs and worrying. I've already been availing counselling and will continue to. I just had a last few concerns (please let me know if new subscription is needed):

1. does the point 1 from my symptom resemble prodromal symptoms of HSV in any form? it was not tingling but i can't remember for sure now. i just felt discomfort in my entire penis (inside the penis kind of, not outside on the skin) and the other things already mentioned. could the non-STI related rash have caused this?

2. assuming i didn't already have it, is the risk for HSV1 from the 3/4 seconds of kissing and the 90-100 seconds of unprotected oral high? the oral was partly before and partly after the protected PIV sex.

3. It is fine to be with other people now right? I don't wanna put this girl at extra risk for HSV although she's been more sexually active than me (been active on dating apps).

Thank you so much for the work you do, really sorry for the repetitive questions.

H. Hunter Handsfield, MD

12 months ago

1. There's nothing in your symptoms consistent with HSV, which rarely if ever causes prolonged tingling. Prodrome lasts no more than a couple of days prior to onset of a visible outbreak.

2. There are no data on the frequency of new HSV1 from kissing or oral sex, but it's clearly no higher than one chance in thousands.

3. There is no reason not to have sex with new or current partners.

And why is herpes so on your mind? There is no reason for you to be any more concerned about herpes than any other STD. But as discussed above, you are free to reach out to Terri if you'd like to start a new thread. But I'm confident she will agree with my comments and reassure you there is no reason to suspect you have it -- beyond the fact that a very high proportion of healthy adults (more in your country than mine) have lifelong HSV1 infections, mostly oral. (And genital HSV1 without symptoms rarely recurs and is rarely if ever transmitted sexually to partners.)

That concludes this thread. Best wishes and stay safe.

---