[Question #12355] Reason for Concern?
 |
8 months ago
|
Docs, thanks for all you do. Typical story, male here visited CSW on Friday night (pretty drunk). Received protected oral and inserted protected into vagina. No evidence of condom break or tear and CSW says she would've freaked out more than me if it had. On Saturday got bad STD anxiety and got and took DoxyPEP. On Sunday, I asked CSW to take OraQuick for peace of mind and it came back negative. Wore tight pants through the weekend & Monday & Monday night noticed bottom of scrotum (like that would touch chair) was irritated and not bleeding but red (maybe blistered). Have had this before from bike riding and tight pants though. Today (Tuesday evening) I have a scratchy throat and minor discomfort when I urinate sometimes (though also had this before from previous prostatistis) My questions: 1. What is realistic HIV risk here? 2. What about other common STIs like gonorrhea or chlymadia? 3. If my scrotum was blistered on Friday night would that materially increase my STD risks? 4. Anything I can or should do now like start long term doxy or take Z-Pack? Thank you!
 |
H. Hunter Handsfield, MD
8 months ago
|
Welcome to the forum. Thanks for your question -- which indeed describes very typical story. So are my answers.
Your anxieties indeed are the driving issue here. This was as close to a zero risk exposure as you could get, not counting self stimulation. I would have advised against doxyPEP, which is not advised for any sexual exposures of such low risk. But it did no harm, unless you consider it "harmful" that it negates the meaning of any tests for chlamydia, syphilis and gonorrhea. To your numbered questions:
1. "What is realistic HIV risk here?" Zero. I would not even advise HIV testing. You had a partner who probably doesn't have HIV; even if she did, condoms work and oral sex is no risk (there's never been a proved case transmitted oral to penis.
2. "What about other common STIs like gonorrhea or chlymadia?" Also no realistic risk, and doxyPEP prevented syphilis, chlamydia, and at least half of all gonorrhea cases.
3. "If my scrotum was blistered on Friday night would that materially increase my STD risks?" No, not at all. It was your penis that was exposed, not your scrotum. I have no doubt your self-diagnosis is correct: another episode of the irritation you experience from tight clothing and bike riding.
4. You definitely should not take any more doxycycline, and azithromycin (Z-pak) would not improve the protection you've already had from doxyPEP.
All is well; don't worry about it. If somehow I were in your situation, I would not be tested and would continue unprotected sex with my wife with no worries at all.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
--- |
8 months ago
|
Thank you! I know this is the irrational, fear driven part of the brain but what are the changes the CSW was recently infected (such that it wouldn't show up on OraQuick test) and was in the infection window? And would that greatly increase risk? Additionally, is the hypersensitivity regarding ever throat itch, tingle in groin, etc. psychosomatic? Lastly, from your experience are there general tips you advise in your practice to help those suffering from this type of anxiety? Thank you again for such a helpful community.
|
H. Hunter Handsfield, MD
8 months ago
|
People rarely are infectious for HIV before they test positive -- a common misunderstanding. Even if she had been exposed recently, her negative test shows virus levels in her blood or genital fluids would not be sufficient to be transmissible. Or if they were, the odds are in the same range as you being struck by a meteorite.
"Psychosomatic" is a loaded term. Such symptoms generally are real and physical, not manufactured by emotion. However, anxiety definitely can greatly magnify trivial symptoms or even normal body sensations that everyone experiences almost every day and that otherwise would be ignored or not even noticed. However, we don't provide psychological support, other than offering factual, science based assessments. It's up to the questioners to apply them in a way that helps them understand and move on without worry.
--- |
8 months ago
|
Appreciate that context. Final question, do you recommend getting tested for anything at all such as gonorrhea since DoxyPEP prevents lesser amount? Or for HSV?
|
H. Hunter Handsfield, MD
8 months ago
|
As I said above, "If somehow I were in your situation, I would not be tested and would continue unprotected sex with my wife with no worries at all." The chance of gonorrhea is very low, and if you have it despite doxyPEP, you will have obvious symptoms (pus from your penis, painful urination) within 4-5 days of the event. The risk of herpes probably is even lower -- and nobody should ever be tested for HSV in absence of symptoms that suggest herpes (blisters or sores).
That completes the two follow-up comments and replies included with each question and so end this thread. I hope the discussion has been helpful. Best wishes and stay safe (as you have been!).
---