[Question #12855] Risk of STIS including HIV from unprotected single exposure

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4 months ago
Hello - Last night I had unprotected sex with a girl on a first date. I did not know her very well but we ended up having unprotected sex for about 20 minutes. I am now worried about having caught an sti and I'm worried about passing it on to my partner. I have ordered Doxycycline which arrives tomorrow. My questions are below.

1 - What are the chances of catching Syphilis, Chlamydia, or Gonorrhea or HIV?

2 - Will taking Doxycycline be effective to reduce against any STI'S?

3 - Do I need to be tested ? If so what are the timelines for the above infections?

4 - Should I refrain from having sex with my partner until tested.

5 - Do  need any other medications to prevent infection?

Thank you
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H. Hunter Handsfield, MD
4 months ago
Welcome to the forum. Thanks for your confidence in our services.

You say nothing at all about your partner. Do have a sense of her sexual history? Most sexually active women have no transmissible STI at any point in time; and even when infected, most single vaginal sex exposures do not result in transmission to the partner. Without more information to suggest she is likely to be infected, I would strongly advise against doxycycline. A far smarter plan would be to first, learn more about your partner's risks; wait a few days to see if you develop symptoms like penile discharge, painful urination, or genital sores. Alternatively, speak with her about her risks, and perhaps go together for testing for gonorreha, chlamydia, syphilis and HIV. Maybe you'd find she is just as concerned as you are:  after all, in general women are at higher risk from there male partner than you are from her. If you both test negative, you would know neither could have infected the other.

1. Chance of infection with these STIs? Probably low, but need more information to judge the risks. (For HIV, probably under one chance in a million.)

2. Doxycycline would reply prevent only syphilis and chlamydia.

3. Need for testing also depends on better understanding of the chance your partner is infected.

4. Same problem -- can't judge the risks to you or your regular partner without more information.

5. I would advise against doxycycline and any other antibiotics at this point.

I'll be happy to comment further if you would like to provide the crucial missing information.

HHH, MD
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4 months ago
Hello - apologies for lack of information. The woman is 27, Chinese. She appears to be of goodstead and well educated. Although i worry as she was very keen to have sex which makes me think she may do this a lot. 
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4 months ago
Apologies I forgot to ask.. Why would you strongly advise against taking doxycycline .. I assumed taking it may prevent some infections just in case
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4 months ago
Also we are from the UK
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H. Hunter Handsfield, MD
4 months ago
It would seem your one-off partner is at low risk for active STI. If I were in your situation, I would just have a urine gonorrhea/chlamydia test 4-5 days after the event; if negative as expected, I would then continue unprotected sex with my wife without worry. The chance of either syphilis or HIV is too low for me to worry about and I would not be tested at all.

But I'm not you and you'll have to make your own decision. Another option, knowing where you are, is to get in touch with your nearest NHS GUM clinic for world-class evaluation and advice from experts who undoubtedly understand the local epidemiology of STIs and risks for an exposure like yours far better than I can judge. Or one of the excellent private sexual health clinics, like London's Freedom Health.

My advice about doxy is simply that it isn't necessary. But if you'd like to do it, please take only a single dose of 200 mg. That's all that is needed to reliably prevent or abort incubating infection with syphilis and chlamydia. After that, there will be no point in testing for either of these STIs. You still can be tested reliably for gonorrhea; the urine test is valid any time more than 3-4 days after exposures. (On the other hand, absence of pus dripping and painful urination within 5 days is nearly 100% proof against gonorrhea, even without testing.) You can have a conclusive HIV antigen-antibody (AgAb, 4th generation) blood test at 6 weeks.
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4 months ago
Thank you Dr
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H. Hunter Handsfield, MD
4 months ago
You’re welcome. Best wishes and stay safe.---