[Question #1649] CSW Sex and STD Risk Questions

44 months ago
Hi doctors. I have some doubts. My biggest problem is anxiety, they come back again. So whats is a problem - before 4 months I have unprotected oral and protected vaginal sex with CSW (cheap street walker). I didnt realize then that I can be in risk for some STD but after that i search I lot online and create much anxiety and guilty and I know that is a problem. So she give to me short unprotected oral, less than minute and then she put condom on and we continue with vaginal sex. I never experience broken condom so I dont know how its look like but seem that condom is ok. Vaginal sex was short too. I dont bother you with my fears but in last 4 month I dont develop any symptoms or anything which can seems like STD-STI. Dont have any discharge, no herpes lension no chancre or anything. My fear was HIV too and at 46 days I took 4th generation test (Elisa Antibody/Antigen HIV1 HIV2 that is 4th generation?) which was negative and at 60 days rapid finger test I think that was 3rd generation and that is negative too. In last monht anxiety is back and I fear of syphilis now, I didnt go for test because I shame and dont know how to ask for it (HIV test was pretty hard to me too) but there is any symptoms of primary and secondary syphilis present. My quesitons:

1. I read here that 4th generation hiv test at 4 weeks is conclusive? So i can believe in my HIV test results?
2. I read about syphilis and if I have syphilis then chancre MUST be on my penis right? I have fear that somehow I miss chancre. Is that possible?

I dont develop any kind of rash or anything in last 4 monhts and I dont know when secondary syphilis rash can occur?

Also, 7 weeks after exposure I have some ear infection (I have history of ear problems). Doctor give me two rounds of antibiotics for that (erythromycin) I dont know what that much but that is 40x500mg pills in 14 days. I read that syphilis chanrce show at 3-4 weeks, I dont have any but if I have syphilis would that dose of erythromycin kill bacteria? Or p
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your question.

Of course this is not a psychological support forum and I can't do anything about your "biggest problem", i.e. your anxiety about HIV and STDs. However, I can assure you that you were at low risk for HIV and other STDs and that your test results all are conclusive, and can provide some of the scientific evidence for those conclusions. First, the exposure was low risk, since HIV is rarely if ever transmitted by oral sex, and all other STDs are low risk; and condoms work, so the vaginal sex was low risk as well. (Congratulations for having safe sex in this situation!) Second, although HIV and many STDs can be asymptomatic, it is still true that most infected people develop obvious symptoms -- especially if they are anxious and on the lookout for even mild symptoms. Therefore, absence of STD symptoms is very reassuring. Further, the HIV tests you had are conclusive. To your specific qustions:

1) Correct:  The 4th gen HIV tests are conclusive any time 4 weeks or more after exposures and you can believe your negative resutls. Your description of the 4th generation test is accurate. Your 3rd gen fingerstick blood test at 2 months also was conclusive. You can believe the results.

2) Chancres can occur at any sexually exposed site. But since this event mostly involved your penis, that's where a chancre would be expected. You would not be likely to miss a chancre if it had occurred. Further, erythromycin is active against most strains of syphilis -- so if you had been infected, you would now be cured. But since you're worried, go to a clinic or ask your doctor for a syphilis blood test (or look online for testing options). This is up to you -- I really don't see a need -- but since you are anxious, you might find a negative test would give you more confidence.

And by the way, the doses of erythromycin you had also would cure gonorrhea or chlamydia if you had caught them. So you don't need any further STD testing.

Bottom line:  All is well and you can be sure you caught none of these STDs. But feel free to have a syphilis blood test if the negative result would help reassure you further.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes and stay safe--  

HHH, MD
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43 months ago
Hi dr. HHH

Thanks for your anwsers. Can you please summarize this for me:

1. My penis is only exposed so chancre would be on my penis. But can primary stage pass without chancre or I must have a chancre? Still, I didnt see any change at my penis and I inspect it every day in last 4 months. I will stop doing that.

2. Its 4 month after exposure and I also didnt notice any sign of secondary syphilis. What is average time for secondary syphilis rash to show up? I assume that in 4 months I should have some symptoms of secondary syphilis. Is that right?

I will not post more question after this. Thanks a lot.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
1) It is rarely for primary syphilis to occur without an obvious chancre. 2) Secondary syphilis also can pass without symptoms.

However, there is other evidence against syphilis. First, few female sex workers these days have syphilis. Second, erythromycin is active against most syphilis strains and would have aborted syphilis if you ahd been exposed. Third, absence of sympotms as just discussed is strong evidence. So the chance you have syphilis is zero for all practical purposes. BUt if you remain obsessed with that idea, have a syphilis blood test. When you get the negative result, believe it and move on with no further worry about it.

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