[Question #12630] Regretful encounters, whats my risk

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6 months ago

I’m a 40 year old M, hsv1 positive asymptomatic, negative for everything else, as of last check 6 months ago. On sunday i made a couple of Alcohol fueled mistakes I regret already. Did a doxy + azithro + cipro 3 day course to prevent any bacterial STIs, finished the course today 

1. What are my std risks from these encounters (particularly HIV and HSV2)and when and what tests should I get, can I test for all at 3 weeks? # 1: sunday: received protected oral and brief protected intercourse with female of unknown history. #2: same evening: received unprotected oral and brief protected intercourse with another female

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H. Hunter Handsfield, MD
6 months ago
Welcome back to the forum; it's been over five years.

I looked back at your older threads. As at that time, you describe very safe exposures. 

The first exposure was entirely risk free for all practical puroses, having used a condom for both vaginal and oral sex. The second was slightly higher risk because of the unprotected oral exposure, but the risk from that still was very low. I would have advised against the antibiotic treatments you took. Doxycyline alone would have protected you against chlamydia and syphilis, but both of these were essentially zero risk because syphilis is so rare in women and chlamydia isn't a risk from oral sex. The azithromycin and ciprofloxacin provided only partial protection against gonorrhea. There was no risk for HIV and virtually none for HSV2. There really is no point in testing for any STDs. Having taken the doxycycline, there is no point in testing for chlamydia or syphilis, and gonorrhea without symptoms almost never occurs -- no test needed if you're not having painful urination and discharge of pus from your penis. But if you feel you need negative test results in addition to my professional judgment, you can have a urine gonorrhea/chlamydia test now, no need to wait. As for blood tests, there are none that are valid as soon as three weeks; you could have syphilis and HIV tests (again, only if you feel compelled) at 6 weeks. I would strongly advise against testing for HSV in this situation. But as I think you already know from previous testing experience, the HSV2 blood test needs to be at 3 months or later.

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

HHH, MD
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6 months ago
Thanks, Dr.Handsfield.
I went back and read my previous posts, looks like I have an encounter that requires your opinion every 5 years.
I value your and Terri's advice in the past, it has been always on point.

QQ: Should I be worried about HSV2 at all for either encounter?, To be clear: I am worried about the scenario where I get infected at the base of the penis or elsewhere in that general area that is not covered by the condom. 

The only tests I intend to do are the HIV early detection 2 week test (just for peace of mind) and Chlamydia/ Gonorrhea at 2 weeks and the eventual HSV2 test >2 months out, if you tell me there was a risk.

In your long career, how many times would you say you saw someone get HSV2 WITH a condom on, I'm just curious, I will take your final advice on all these tests and proceed accordingly.

Separate scientific question, only if you have the patience: Does HSV1 provide any cross protection against getting HSV2, or is it a myth?


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H. Hunter Handsfield, MD
6 months ago
No, there was no realistic chance of HSV2 from either event. I think the reasons were pretty well covered, even if your previous threads were long ago. (And I really don't know why HSV2 is such a prominent concern for you....)

If somehow I were in your situation, I would skip those tests at 2 weeks or any other time.

I don't recall ever seeing a patient who acquried HSV2 in the circumstances you describe.

There is no "myth" about cross protection between HSV types. The data are pretty solid that HSV1 has little if any effect on likelihood of a new HSV2 infection; but that it does reduce the severity of symptoms if HSV2 is acquired.
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