[Question #1453] FAO Dr. Hansdfield

84 months ago
Hi There, At the end of 2011 I had an unprotected one night stand outside of a long term relationship (broke up in October 2013). I continued having unprotected sex after this incident with my regular partner until 3 months later when i tested for Chlamydia, Ghonnoreah, HIV and Syphillis - all of which were negative. My concern has been raised after reading on the Medhelp site that ghonnoreah can clear on its own without treatment within a few weeks and so I could have passed an infection to my regular partner before it leaving my system and testing negative in the March.

1. I have read on the medhelp site that passing the same ghonorreah infection back and forth between the same couple doesn't happen as the thing that clears the infection in the first place prevents it from being caught back. Is this correct as all other 'official' sites and some scientific papers i've read state that it can be passed back and forth. If the medhelp statement is correct I assume i have nothing to worry about as the infection would have cleared in both of us over the next 18 months anyway?

2. After the one-night stand i wasn't checking for symptoms - i'm not circumsized and so don't see the end of my penis when urinating (so wouldn't have seen any pus) and likewise don't necessarily look at my penis when showering and so wouldn't have seen pus present.  I was also wearing loose fitting boxer shorts at that period and wouldn't have felt any wetness from the pus. Would I have still known about it if i'd have had ghonnoreah?

3. Do i need to tell my ex-partner to test for ghonnoreah (please assume she hasn't tested already as i know from mutual friends she hasn't 'seen anyone' since we split.) I don't want to do this unless absolutely necessary as i am now married and whilst my wife wont mind i don't want to cause unnecessary upset to my ex. 
Edward W. Hook M.D.
84 months ago

Welcome to the Forum.  As you probably know, clients on this site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.

Before I answer your specific questions, let me point out that most one-night stands are low risk for acquisition of any STI.  Most people do not have STIs and when they have STIs, most exposures do not lead to infection.  Now, on to your questions:

1.  You are correct, a proportion of most STIs do clear spontaneously without treatment. This is not all that common however.  Further there is no information to prove that if you did clear infection you would not get it back if re-exposed to an infected partner.   Following treatment in which an infected partner is treated but does not inform their partner, so-called "Ping-Pong" infections are relatively common.   The scenario you describe in which you were infected, cleared thi infection after passing it to your regular partner and then managed to not get re-infected following multiple exposures to your regular partner is most unlikely and not something I would worry about, particularly after 18 symptom free months. 

2.  Your circumcision status might make symptoms slightly less likely to be noticed but not much.  For gonorrhea in particular the symptoms are typically quite obvious.

3.  Considering all of the information I have mentioned above, I do not think you need to notify your ex of your mis-step while you were going out.

I hope these comments are helpful to you.  EWH

84 months ago
Thanks doctor. Just to clarify my partner was aware of mh indescretion (I told her) but didn't test as I did three months later and so we assumed there was no  need for her to. My concern is about telling her now to test and causing more upset for her. A couple of follow ups if I may:

1. Having reflected and thought about me passing any potential ghonnoreah infection back and forth , I don't think this would in fact have been very likely as between potentially infecting my partner and breaking up  18 months later we only had sex say five or six times. Up until i potentially infected her we were having regular sex but the relationship changed from that point on. Would this impact your advice as I in fact almost certainly wouldn't have caught the infection back and so wouldn't have had more chance to notice symptoms?

2.  The girl I had a one night stand with was known to be promiscuous and sleep around. Would this change your advice at all? 

Thanks for this clarification. 

Edward W. Hook M.D.
84 months ago

1.  These sort of "what if" questions serve little purpose.  There is little chance that you were infected at all, much less infected, cured it yourself with therapy and then caught the infection back.  Not sure why you continue to perseverate on this.

22.  No change in my assessment or advice, you need to stop worrying about this.  EWH

84 months ago
Thanks doctor.  I've just read and digested your responses properly as I was travelling to New Zealand on honeymoon! Now I've read properly I'm very confused as what initially caused my concern was that dr handsfield states several times on different occasions on the medhelp site that ghonnoreah infections (and chlamydia) 'always' clear without treatment and for ghonnoreah in the pre antibiotic era the average time for ghonnoreah to clear without treatment was 6 weeks. You however state that although a proportion do clear over time it's uncommon. 

1. Would be appreciated if you could explain the discrepancy? (I'm not challenging, I'm just trying to understand) between your and dr handsfield points of view on this subject.

2.  You mention below in my response to my second question in my last post  that the chance of catching ghonnoreah, clearing it and then catching back again is extremely unlikely. However, my point was that due to lack of sexual activity over the 18 month period (had sex probably around 5 times only)  after potentially  infecting my regular partner and breaking up I wouldn't have had chance to catch it back so I wouldn't have had been able to notice any symptoms which would have alerted me to my partner being infected And so the infection could have stayed with her. thus the only chance of me noticing symptoms was after my unprotected incident outside my relationship which I explained I wasn't looking for and may have been difficult to notice due to my circumcision status. Do you think there is any real risk to my ex partner ?

3. You mention in your first response that catching infection from one night stands is relatively difficult however I didn't make clear that we had unprotected sex multiple times over the night and following day - somewhere between 6 and ten times thus I'm assuming the risk would be heightened significantly (bearing in mind she was promiscuous as well). 

Your clarification would be really appreciated doctor as I've just started my honeymoon and the concern about potentially having to raise this all with my ex is concerning me. 

Thanks very much 

Edward W. Hook M.D.
84 months ago

1.  I believe you have mis-read Dr. Handsfield's earlier comments.  I suppose that over time, before antibiotics were available, ultimately most persons with gonorrhea would clear their infections but I can assure you that Dr. Handsfield did not intend to state that STIs such as gonorrhea and chlamydia frequently clear in the manner you describe and "bounce" back and forth between infected persons who take turns clearing, then being re-infected by their partners.   Further, that such might have happened to you is just not a realistic possibility.  You need to stop worrying about this and move on.

2.  I think you are either being argumentative, paranoid or both.  No change in my assessment.  Remember, you do not know that you were infected and I would guess the probability that your were ever infected is very, very low -- less than 1%.  As I explained earlier, the chance that your were infected, that you did not develop symptoms, and that you cleared the infection or that your prior partner remained infected are simply not at all likely.

3.  Increased numbers of exposures would increase your chance of infection but that still does not make it likely that your partner had an STI.

As I said before, you should not be worrying- my advice is to enjoy your honeymoon, not spend it worrying about your ex.

As you probably know, our Forum guidelines permit a total of up to three responses to questions.  As a result, this will be my final reply.  I urge you to not worry about this matter further and move on and focus on your honeymoon.  EWH