[Question #13506] Unprotected oral from street walker
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5 days ago
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I received unprotected oral sex from a street walker 2 days ago, most likely a drug user. It was about 5 minutes long. I’m worried about exposure to chlamydia, gonorrhea and possibly syphillis. I don’t have any symptoms currently but I know it’s too early for them. I kind of freaked out and told my primary care doctor who prescribed me doxycycline for 14 days to hopefully prevent the infections if there are even any. I think I should have waited 5 days and took a pee test for gonorrhea and clamydia but I panicked and now I’m on day 2 of the antibiotics. Should I continue to take them then after they are finished wait 2 more weeks then go take the pee test? Also if for some reason I was exposed to syphillis or chlamydia should the doxy take care of that. Also do you think I should test for anything else? Thanks
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H. Hunter Handsfield, MD
5 days ago
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Welcome to the forum. I'm happy to help.
You and your doctor have seriously overreacted to a very low risk event. I would have advised against treatment with doxycycline or anything else. And when preventive treatment is used, the recommendation is a single 200 mg dose of doxycycline, which effectively prevents both syphilis and chlamydia. However, the risk of syphilis from such an event is exceedingly low (under one chance in thousands, although this depends in part on where you are, i.e. the background frequency of syphilis in partners like yours); chlamydia is very rarely transmitted by oral sex; and no dose of doxycycline reliably prevents gonorrhea. We never advise forum users to go against their own doctors' advice or treatment, but you might discuss stopping doxycycline with your doctor. You absolutely do not need to continue it; after a dose or two you were entirely protected against syphilis and chlamydia.
In absence of symptoms, I would not advise testing at all. But if you decide to do it, have a urine gonorrhea test a few days after your last dose of doxycycline. Almost certainly the result will be negative. You don't need testing for anything else.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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4 days ago
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Thanks for your reply Dr. Handsfield. To be fair my Dr. is a good friend of mine and he advised me to not take anything and wait 4-5 days to see if I have symptoms but I kind of freaked out and asked him to write me the prescription anyways so that was a bad judgement call on my part. Per your recommendation I am going to discontinue the doxy tonight and I’ll just take a urine test for gonorrhea next weds or Thursday even though your probably right and it will be negative. It will just be peace of mind for my for my stupid mistake by getting unprotected oral from a high risk stranger. I feel like many people on this forum including myself get very nervous and anxious about possibly contracting an STI but we are here to learn from you and take your advice, you are the expert and I will listen to you. Thank you
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H. Hunter Handsfield, MD
4 days ago
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Yes bad judgment on your part -- but also your doctor friend. He did not have to go along with your irrational request for unnecessary treatment. But what's done is done and your current plan makes sense. However, testing for gonorrhea still is optional. Over 99% of urethral (penile) gonorrhea causes obvious symptoms, i.e. pus dripping and painful urination -- so absence of these is strong evidence by itself you did not catch it. But you are of course free to also be tested if it will help you stop worrying!---
