[Question #1467] Exposure - Anxiety and Risk

94 months ago

Hi There,

I’m desperate for someone to provide some information that might help to offset some of the intense anxiety I’m experiencing…

8 days ago I was unfaithful and another man rubbed my penis with his hands without a condom before I had insertive, protected anal sex with him.

Based on our conversations I know this guy is very promiscuous but he’s told me that he’s negative for STD’s (as far as he knows) and HIV and on is apparently on PrEP. As far as I’m aware the condom I wore remained in tact (he later told me as much as well).

Despite this I’m freaking out that I have contracted something, I have no symptoms as far as I can tell, beyond a dull ache in my groin on the left hand side, which doesn’t seem to fit anything from what I’ve read…

My biggest fear is that my girlfriend is going to catch something from me that I don’t know I have. I am planning on getting tested for everything ASAP to try and alleviate some of my concerns but my problem is that we will almost certainly have sex before then.

I then intend on getting another test at 21 days for peace of mind and then a final test at 3 months. I know that is probably a bit much but i’m a super anxious person and I’m hoping that will go some way to make me believe that I haven’t caught anything.

my questions are:

1. How likely is it that I could have contracted something from this encounter? I know that my biggest risks are probably herpes or syphilis? (though I think that’s fairly rare?)

2. If I test negative for chlamydia, gonorrhoea, syphilis, and HIV at 10 days when I have an appointment (NHS don’t seem to offer tests for much else) can I trust the results?

3. could this ache in my groin be a symptom?

3. Is it possible to transmit an STI if that infection is still undetectable in tests? i.e. before window period

4. how risky is it to have protected, insertive, vaginal sex before the window period of an STI?

5. Is my testing plan sensible? is it overkill or is there anything else I should be looking for?

Thanks for your help,

H. Hunter Handsfield, MD

94 months ago

Welcome to the forum. Thanks for your question.

This was a low risk event in regard to any and all STDs. You can dismiss the masturbation part without further thought. No STDs ever are transmitted by hand-genital contact, with or without a condom. For anal sex, condoms are highly effective against those infections transmitted through fluids (gonorrhea, chlamydia, HIV, viral hepaitis), with virtually 100% protection, assuming it was in place before penetration and did not break wide open, which obviously you would have known at the time. For those transmitted skin-to-skin (syphilis, HPV, herpes), there is a potential for transmission by skin contact above the condom. However, even here, protection is very good and your risk is very low.

The overall risks are low enough that from a medical standpoint, I would not recommend testing at all -- if somehow I were in your situation, I wouldn't do it and would continue unprotected sex with my wife without worry. But I'm not you, and you certainly are free to be tested for reassurance, expecting the negative results to increase your confidence that all is well.

Those comments address some of your questions. To the rest:

1) Almost no risk. And correct that syphilis and herpes are higher risk than some others, but also that both would be rare after such an exposure.

2) Those are the usual tests worldwide for such an exposure, not just by NHS or UK GUM clinic standards. These are what we would do in most US STD clinics, including mine. Ten days will be conclusive for gonorrhea and chlamydia, but won't say anything about syphilis or HIV except to provide a baseline showing you weren't infected before the exposure.

3) No STD causes groin aching. If this has anything to do with this exposure, it's psychological -- i.e. anxiety elevating minor sensations to a point of discomfort -- and not from infection.

4) (also your second question 3): Yes, some STDs can be transmitted before symptoms. However, not syphiils; and you'll know about the gonorrhea/chlamydia results within a few days after testing. The overall risk you have anything is extremely low, and the chance of transmission to your partner still lower, even without a condom. With protection, you can be confident of zero risk to her.

5) As noted above, almost any testing could be considered overkill in this situation. Your plan is reasonable, except that there is no point in testing at both 10 days and 3 weeks; the last is too soon for many tests to become positive. Concluisve HIV tests can be done at 4-6 weeks (for 4th gen and 3rd gen blood tests, respectively) and 6 weeks for syphilis. Other tests? The reason others (e.g. HSV, viral hepatitis) aren't routine is that the need is low in the absence of symptoms; and the HSV tests aren't perfect and can give misleading results.

If your appointment is in an NHS GUM clinic, or with any STD knowledgeable provider, you can expect them to pretty much agree with all this. In the meantime, I hope these comments are helpful and reassuring. Let me know if anything isn't clear.

HHH, MD

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94 months ago

Thanks so much for your quick and thorough reply, that's helped a lot. Amazing what your brain can do to you when you're worried.

just a couple of quick follow ups...

1. I've seen a lot of information that says something along the lines of "when used correctly, condoms offer high levels of protection" what do the experts consider correct use? As far as I know I'm using them right but it would be good to know for sure as I've not found a simple explanation of what that means in relation to all the stats!

2. Syphilis can't be transmitted before symptoms, is that because without a chancre it can't be passed on?

3. Slight caveat in that It looks like syphilis is becoming a bit less rare where I'm from:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/547072/london_syphilis_report.pdf

but can I check if I'm correct in thinking that the risk remains relativity low, lower if you're the insertive partner, lower still if you wear protection?

Basically I'm just going to try and forget about it and stop worrying, easy in theory, harder in practice...

Thanks again for your accessible answers, despite my overactive imagination they're going a long way to put me at ease.

H. Hunter Handsfield, MD

94 months ago

1) I agree that some resources make condom use seem more complicated than it is. You can find discussions about how to unroll and apply them, for example; and that the lubricant should be on the outside (duh). But by far the main issue is that some people may think they need be used only during ejaculation, hence might have penetration before withdrawing and putting it on. (This technique probably slightly reduces the chance of conception, but not STD risk.) (You're obviously an intelligent, educated person, whereas health education literature is often simplistic, aimed at the population broadly.)

2) It's both, really. Syphilis bacteria are slow growing and require a couple of weeks to reach numbers that cause the chancre and that are required for transmission. And there is no transmission without some sort of skin inflammation in the infected person.

3) I think you misunderstood my comment about syphilis transmission being rare from an exposure like yours. It didn't mean syphilis is rare. In fact it remains rare to uncommon in most heterosexual populations in industrialized countries, but for a decade syphilis has been skyrocketing in men who have sex with men in urban areas worldwide. Indeed, the rates of syphilis in MSM in general, and HIV infected MSM in particular, are now higher than ever documented in any defined population worldwide in the entire history of the disease. The rise in London is somewhat less than in many US cities, but the trend is the same. (Thanks for the document, which I hadn't seen. But as just implied, on quick scan it shows exactly what I would have assumed and predicted.)

Thanks for your kind comments about our services.

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93 months ago

Hi Dr Handsfield,

Just wanted to touch base with a couple of final questions...

So as you predicted my test results came back negative after 10 days so I'll take that as absolute confirmation that there's no chance I've contracted chlamydia or gonorrhea.

Obviously my anxiety won't let me off the hook so easily when it comes to worrying about syphilis though! I'm hoping your answers can calm me down until I make it to the 6 week mark when I can get a final test done and be done with this business.

1. Do my 10 day test results indicate anything at all beyond me not being infected before this event? Lower my odds further for example?

2. I know that the main symptom of primary syphilis infection is a chancre, is that always the case?

3. Is there any chance that I would not notice a chancre? Based on my limited understanding if by some chance I did develop one it would have to be on my penis, testicles, or groin. I understand that if it were located internally then that would change things.

4. Proper condom use must protect against transmission, but with areas a condom doesn't cover, is there a lower chance of transmission anyway? I'm thinking because those areas aren't mucus membranes?

5. I know this is my last response but I was wondering if I'd be able to post my final results? I know that reading other peoples has kind of helped me evaluate my chances, I won't expect a response from you, it would just be a way to tie a knot in the thread.

finally a big thank you to you and this website, your responses have really helped me through this.

H. Hunter Handsfield, MD

93 months ago

1) The current results don't say anything one way or the other about syphilis risk.

2,3) You've got it right. When a chancre isn't seen, it's usually because it is internal, e.g. in the rectum in someone bottomed by an infected partner. In your case, the penis -- hence almost certainly you would notice the sore. It almost always appears at sites of significant friction during sex, hence usually head of the penis, uncommonly scrotum etc.

4) Correct. Intact skin, without massage of secretions into the skin, is a good barrier against syphilis.

5) OK, I'll leave this open for you to post your a syphilis blood test result in a few weeks. In the meantime, stay mellow. There's almost no chance you caught syphilis. The other thing you can do, by the way, is contact your partner, if you are able to do so, and ask him to be tested for syphilis. If negative, you will know you weren't expsoed and couldn't have been infected.

Thanks for the thanks. Take care.

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93 months ago

Hi Dr Handsfield,

Just wanted to give a final update to this thread to say that I tested negative for chlamydia, gonorrhoea, syphilis, and HIV when I tested yesterday, which was 42 days since I had the experience I was worried about.

So I'm going to take that as final, conclusive proof that my worry was for nothing, so it's time to move on and get back to normality. Having read so many of the threads on this website I would urge others to attempt to do the same if you've had similar results.

Thank you again for all your help, and all the best.

H. Hunter Handsfield, MD

93 months ago

Of course I'm not surprised by your test results, but glad to hear them. Thanks for the thanks, and for your supportive advice for other worried forum users.

Take care and stay safe.

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