[Question #12147] STI exposure and risk - with preventative medicine

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9 months ago
Male who performed oral on female stripper, less than 2 mins. Recognize this is very low risk event but had a few questions. In unlikely event female had gonorrhea, clamydia, syph, 5 days after exposure I took 800 mg cefixime single oral and 1 azithromycin single oral. Follow up questions: 1) Would medicine abort all 3? How high is confidence for all 3? 2) How soon after taking meds can I have unprotected oral and regular sex? Read conflicting 7 days vs 3 days. 3) With syphillis avg incubation at 10 - 90 days, is there already bacteria present immediately aft exposure which is why cefixime works? I thought cefixime only stays in body for <  24 hours.


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H. Hunter Handsfield, MD
9 months ago
Welcome to the forum. Thanks for your question.

Correct, this was very low risk. STIs rarely are transmitted by cunnilingus (oral-vaginal contact), even if the female partner is infected. As it happens, my forum colleague Dr. Hook was the lead researcher on one of the mains studies showing little gonorrhea risk in this situation. You really didn't need the antibiotics. But to your specific questions"

1) While there are no formal studies on prevention effectiveness of these drugs, almost certainly they would have effectively prevented gonorrhea, chlamydia and syphilis. Probably 100% effectiveness and I would advise you not be tested for any of them.

2) It should be entirely safe to have sex immediately with your regular partner.

3) Duration cefixime remains in the body is irrelevant. The 24 hours would abort any incubating gonorrhea or syphilis. And azithromycin lasts 10 days after a single dose, and would abort any and all chlamydia.

You're home free. I really wouldn't give any of this another thought. Let me know if anything isn't clear.

HHH, MD
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9 months ago
Thank you that's really helpful.  I tried to find Dr. Hooks research on this topic but couldn't. As a clarifying question and out of curiosity, even if the female was infected, what is considered "very low" risk of transmission  of gonorrhea in this case. A ball park even as a % would be helpful although I know that may be silly to ask. Out of curiosity, why is transmission so much lower via cunnilingus? Is it a lower concentration of fluid, something to do with saliva, combination of the two? I don't think I'll have follow up besides these questions. Thank you
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H. Hunter Handsfield, MD
9 months ago
There is no standard definition of low versus high risk. The same figure could be construed as high or low depending on context. Even in the highest risk settings (e.g. STD clinic attenders), no more than 5% of women have gonorrhea. If we assume a 5% chance your partner was infected and 1% transmission risk for any single exposure, your chance of infection was 0.05 x 0.01 = 0.0005. That's one chance in 2,000. If we then say there's a 1% chance the drugs you took did not abort gonorrhea to which you were exposed, the likelihood you now have oral gonorrhea becomes 1 chance in 200,000. Probably even this is too high an estimate. In other words, zero for all practical purposes. You should just put these concerns aside and move on!---