[Question #1385] Should I Get Tested

46 months ago
Six weeks ago I had unprotected insertive oral intercourse with a girl I've known for a while.  Exposure was only this one instance and nothing else occurred other than deep kissing just before (not after). I've known this girl for a while and she's the only partner I've had since the third week of August. I know she's dated other men but I don't know her prior sexual activity. She said she was STI free and gets tested annually as part of her annual exam. Six weeks later I have had no obvious symptoms such as painful urination, discharge, lesions, canchers, blisters, or discharge from my penis. I have had an occasional rash on the inside of my thighs where they meet my scrotum and my scrotum will occasionally become red and itchy. 

I tried not to worry too much about this because I have been known to get these rashes before and attribute them to sweat and heat, Cortisone cream also helps alleviate this when it happens.    Given this, I am still concerned about the chances of having caught an STI. With the information provided, do you think I need to get checked for an STI before resuming sexual activity?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome to the Forum. Given the information you've provided and the time since exposure you are almost certainly in the clear.  Your partner sounds rather low risk and even if she was not, most single exposures do not lead to infection.  The major STIs acquired from receipt of oral sex are NGU and gonorrhea.  In both cases the infections are typically symptomatic, causing burning on urination or a penile discharge, and these symptoms would have occurred long before now.

I also agree with your assessment of your rashes.  They certainly do not suggest and STI.

In my opinion, while it is always reasonable to be checked for STIs following sex with a new partner, given the time since your exposure, the nature of your partner, and the time since exposure I do not feel strongly that you need testing at this time before your next sexual encounter.  I hope these comments are helpful.  EWH
---
46 months ago
Thank you Dr. Hook. I appreciate your expertise, experience and answer. One additional thing, what about herpes or warts? Do you think either of those would have manifest themselves already at 6+ weeks?
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
If you had acquired herpes and we're going to have an outbreak, it would have occurred within two weeks of your exposure.  Genital warts on the other hand can take up to 3-6 months to appear.  That said, your likely hood of having acquired either of these infections from the exposure you describe is tiny and not something to worry about.  Once again, I'd urge you to put your concerns aside and move forward.  EWH---
46 months ago
Thank you, doctor. I shall take your advice and stop worrying. 
46 months ago
Hi, Dr. Hook. I'll use my final follow-up question for this: I got tested via Quest Diagnostics through tSTD.org. I wasn't really worried that I had all these STIs but I do plan on being sexually active again and thought it might be a good idea to get a comprehensive test since I've never had one before. 
They ran the following tests (with results)
  • HIV-1/2 Antibody - non-reactive Negative
  • HIV-1/2 4th Generation - non-reactive Negative
  • HIS-1 aB IgG - <0.90 Negative
  • HIS-2aB IgG  - <0.90 Negative
  • Chlamydia Trach DNA, SDA - not-detected Negative
  • Neisseria Gonorr DNA, SDA - not-detected Negative
  • HAV Antibody - non-reactive Negative
  • HBsAg Screen - non-reactive Negative
  • HCV Antibody - non-reactive Negative
  • Syphilis RPR (Monitor) w/Refl Titer - non-reactive Negative
My last question is at seven weeks, and given the incident that started this thread, would you say these tests are conclusive or do I need to follow-up? You mentioned you thought my risk for Herpes and Warts was tiny, do you still think that's the case? I'll await your answer and sign off withe a huge thank you!

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Given the nature of your exposure, the lack of symptoms and your test results, I would certainly consider these results conclusive.  There is no need for follow-up.

My suggestion that your exposure did not put you at meaningful risk for warts or HSV is unchanged.  I presume that the HIS-1 and -2 aB IgG test you mention are antibody tests for herpes (the usual abbreviation is HSV-1 or -2) and your results are negative.  With regard to your concerns about HPV/warts, I think you are thinking about this the wrong way.  As a sexually active man you have or will almost certainly have HPV in the future.  It may be manifest as genital warts or may be asymptomatic.  This however should not concern you as virtually every other sexually active person who has not had the vaccine will be infected too.  This is part of the reason that we do not feel it is necessary for everyone who has had genital warts or HPV diagnosed to tell sexual partners- the infection is too common for anyone to think that they are not infected, of little consequence, and poorly understood.The concern about HPV infections is their long term association with pre-cancerous lesions and cancer.  These problems can be address in two ways- first if you develop lesions on your genitals, get them evaluated and appropriate, treated.  Secondly, you could consider getting the HPV vaccine which, although costly (about $300-400) if you need to pay for it yourself, his highly effective for preventing genital warts and reduces the small existing risk for cancer by over 90%.

I hope these comments are helpful to you.  this will end this thread.  Take care.  EWH

---
46 months ago
Yes, that was a typo, it was HSV. Thank you Dr. Hook.