[Question #13924] STI concerns

1 months ago

Hello Doctors. Let me first give you my history. Last Saturday(eight days ago), I went to an Asian massage parlor. I ended up laying on the table and getting only a hand job. I washed up and left. As far as the girl she seemed nice, but I did not check her hands or anything to see if there were any open sores on them. On Tuesday, maybe Wednesday I started having right groin pain that kind of radiated into my testicle area as well as pelvic area. On Friday, I went to LabCorp in the morning and gave a urine sample for gonorrhea, chlamydia, trich. In the afternoon, I went to an urgent care and got a 500mg shot of Rocephin in the butt as well as started taking doxycycline 100 mg twice a day for two weeks. As of this morning, I got my tests back and everything was negative. There has been no discharge, burning or pain on urination, but I continue to have some groin/pelvic pain.

1)are my tests in your opinion accurate or do they need to be repeated? I've heard six Days maybe way too early to detect. Could I have a false negative?

2) if I was having symptoms from an infection would the urine test, be typically positive?

3)can sometimes the reception shot not be effective?

4) would the doxycycline also prevent syphilis from occurring? All treatment started six days after the exposure.

5) apparently before she saw me she was using the restroom. What if she did not wash her hands or had cuts/sores or some sort of vaginal discharge on her hands. Would that put me more at risk and be more concerning??

6)do I need to do follow up testing after finishing the antibiotics or even before?

Thank you

Edward W. Hook M.D.

1 months ago

Welcome back to the Forum. Thanks for your continuing confidence in our service. I'll be glad to comment. I happened to be on the Forum when your question arrived so you are receiving a response more quickly than is typical. Any follow ups may take longer to receive a response.

This was a virtually no risk encounter. The transfer of STIs through had to genital transfer of infection through mutual masturbation is virtually unheard of which is the reason that experts (including us), the WHO, and the US CDC all consider exposure to secretions or blood in the context of mutual masturbation a virtually no risk event. In response to your specific questions:

1)are my tests in your opinion accurate or do they need to be repeated? I've heard six Days maybe way too early to detect. Could I have a false negative?

I would encourage you to believe your test results. The tests are very reliable, the tests were taken at a time when tests are conclusive, and the chances of a false negative test are quite low.

2) if I was having symptoms from an infection would the urine test, be typically positive?

Yes- see above.

3)can sometimes the reception shot not be effective?

The treatment you received would have almost certainly cured gonorrhea if it were present.

4) would the doxycycline also prevent syphilis from occurring? All treatment started six days after the exposure.

Both the ceftriaxone and the doxycycline would prevent syphilis as well if you'd been exposed.

See my comments above. If she'd not washed her hands, your risk for infection through transfer on contaminated hands would be virtually zero.

6)do I need to do follow up testing after finishing the antibiotics or even before?

I se no need for further testing. I suspect that your discomfort was due to something other than an STI.

EWH

I hope this information is helpful.

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1 months ago

Thank you for answering. What troubles me is that many sources that are credible say that a six day test for gonorrhea is not conclusive. Says you have to wait two weeks typically.

1) does that mean that I should test at two weeks even though I was treated to make sure it worked?

2) my symptoms are kind of about the same with more pain in the angle/pelvis. I don't feel much relief at all from the shot. Would another shot be appropriate 5 days later(11 days post exposure )even though it's aggressive treatment or would there be any harm in taking another shot?

3) does not having discharge, pain on urination, or burning reinforce the fact that even if I had it, it's been aborted. I read somewhere like 15% of people don't get the primary symptoms.

4) how can I be 100% sure that I don't have it after testing and treating on day six and beyond? I don't want to put anybody in harms way.

5) if I took another test at 11 days post exposure, would that be conclusive without a doubt?

Thank you

Edward W. Hook M.D.

1 months ago

I presume the “sources “ you refer to is the internet. This is incorrect. We spend much of our time on this forum trying to correct misinformation picked up on the Internet..

1. Unless you develop new, typical symptoms ( penile discharge), there is no need for follow up testing.

2. What are the treatment benefits, a waste of time as I have already suggested. I suggest you look for another cause of your discomfort.

3. The proportion of persons who did not develop symptoms as far lower, somewhere around 5%. Your absence of symptoms and your negative tests are strong evidence that you are not infected. I suggest you believe the evidence.

4. Yes

5. The results would be just as inclusive as a result you already have.

EWH

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1 months ago

So timeline recap:

3/21 exposure

3/24 scrotal and testicular pain started but no pain on your nation or burning or urethritis or discharge

3/27 tested gon/chlamy/trich- neg

3/27 got 500 mg Rocephin and started doxycycline 100 twice a day

3/31 tested gon/chlam/tric/myco-neg

4/1 got another 1 g of Rocephin and also took azithromycin 1 g for two days and then 500 for three additional days

4/8 got tested again for all, and it was negative. Finishing my doxycycline in about four days and that way I will have been on it for two weeks and 5 days.

1) do I need a test of cure at this point because of window periods and potential false negatives while being on treatment or maybe suppressing below detectable levels

2)would if at risk for syphilis, would that treatment have a aborted it?

3) my pain went away on 8 April on and after starting and being on treatment, so I'm concerned that I had some sort of infection(that I could have acquired during my exposure) so that's why I'm wondering about if it is safe to have sex with my wife or when would it be reasonable to resume it.

4)CDC says i should wait after treatment two weeks to get a final test. Do you agree?

5) on the April 8 test, with the testing I've had miss true infection if indeed infected?

6) at this point false positives are not an option. Is that correct?

I just wanna make sure I've tested completely to rule everythingout. And don't have to wait another number of weeks to have certainty.

Edward W. Hook M.D.

1 months ago

You are over-reacting to a virtually no risk event, wasting your time and resources, accumulating unnecessary expense, and exposing yourself to the complications and side effects of unneeded antibiotics. You were not at risk and the treatments you have taken would have prevented/cured any bacterial STIs you might have been exposed to. Final responses:

1) do I need a test of cure at this point because of window periods and potential false negatives while being on treatment or maybe suppressing below detectable levels

No!

2)would if at risk for syphilis, would that treatment have a aborted it?

Yes!

As I said before, it is entrely safe for you to have unprotected sex with your wife. That answer is unchanged.

4)CDC says i should wait after treatment two weeks to get a final test. Do you agree?

Yes of cure treatment for PROVEN infections (you have NO evidence that you were infected) is recommended and serves little practical purpose in asymptomatic persons. At the meetings on the CDC Guidelines (which we have both been advisors for for over 40 years) the need for TOC testing is strongly debated. The CDCs suggestions reflect a very conservative perspective.'

5) on the April 8 test, with the testing I've had miss true infection if indeed infected?

No!

6) at this point false positives are not an option. Is that correct?

You've not had a positive test. If you mean false NEGATIVES, they are not an issue.

This completes this thread. EWH

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1 months ago

#6 point was supposed to mean--Is there a chance that tests could still turn positive at some point where I tested too soon and bacterial load suppressed by antibiotics/treatment enough not to show on tests, and then as antibiotics wear off, bacterial load could produce a positive result?

That's the clarification I need.

That's all....thank you and I know the thread will be over now.

Edward W. Hook M.D.

1 months ago

This is restating questions that have been answered. Your results are conclusive. EWH---