[Question #1658] Had protected sex with sex worker in morocco

43 months ago
Hi I had protected sex with a sex worker. This included anal oral and vaginal, condom was used throughout and didn't fall off or rip. I didn't kiss her. Shaft of penis wasn't covered and at the end I felt a bit of vaginal fluid there. After I simply removed condom and without cleaning put on my shorts and went to bed. What is my risk for chlamydia/gonorrea and other stds? Can I take a urine test for chlamydia gonorrea after 10 days? My clinic says it has to be 14 but I've read on here 10 days should be OK.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question. Congratulations for using a condom for this potentially high risk exposure.

Condoms work well, especially against chlamydia, gonorrhea, and other STDs transmitted primarily through genital fluids. Simply removing the condom as you did does not significantly raise the low risk, and washing after sex probably doesn't help either. In other words, those aspects do not elevate your risk. Presumably you have had no symptoms (penile discharge, uncomfortable urination) -- that fact is nearly 100% assurance that you didn't get gonorrhea and fair evidence against chlamydia. For further reassurance, you can be tested at any time:  the standard gonorrhea/chlamydia tests are valid any time more than 3-5 days after exposure. The clinic you asked is flatly wrong about 14 days. A test now will be conclusive.

Condoms are less effective against STDs transmitted by skin-to-skin contact, including syphilis. If you don't develop a sore (chancre) of the penis within 2 weeks of exposure, it will be goo evidence against syphilis. But you also should have a blood test; those tests are valid at 6+ weeks after exposure. Also have an HIV test -- risk is virtually zero after a condom protected exposure, but HIV testing is routine for anyone tested for other STDs.

I hope this information has been helpful. Let me know if anything isn't clear. Best wishes and stay safe.

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
An additional thought about gonorrhea/chlamydia testing at 14 days:  If the clinic you are seeing is in Morocco, make sure they do nucleic acid (DNA) testing for gonorrhea and chlamydia -- not blood tests, which take longer and are far less accurate.


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43 months ago
No I am back home now. The clinic I use use urine testing, will the 10 day time frame be sufficient to produce a 100% accurate test? 
43 months ago
By the way I'm from the UK, will that be the same testing as the US?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
"will the 10 day time frame be sufficient to produce a 100% accurate test?" Yes, see my reply above, which was geared to urine (or urethral) testing. The UK has world class STD services, no different than the US and other industrialized countries. If you're going to an NHS GUM clinic, you can be sure of accurate testing (although I would be surprised if they really think it is necessary to wait 2 weeks for accurate results).

Forum procedures permit two (sometimes 3) follow-up comments and replies with each question. So I suggest we hold off further discussion until you have been to the clinic. I'll be interested to hear what they advise and, eventually, your test results. But I won't have anything more to say until then. OK?

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43 months ago
Hi doc. I forgot to say, around three-four days after the exposure I got diarrhea. I've been back in the UK now for three days so that's maybe a total of 8-9 days I've had it for now. Is that a sign of hiv or would that be too soon for that? I've been non stop stressing really badly could this be a reason why my diarrhea hasn't stopped?
43 months ago
Also is the 10 day hiv test reliable?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Diarrhea can accompany acute HIV infection, but almost never diarrhea alone without several other symptoms. And certainly stress can cause or contribute to diarrhea -- but the best bet may be that you acquired traveler's diarrhea in Morocco, perhaps made worse by stress. There are several HIV tests:  a test for viral RNA in the blood would detect almost all infections at 10 days, but is expensive and not recommended in this setting and I very much doubt your clinic will do it, even if you ask. The 4th generation (antigen-antibody) test, which is routine in most UK clinics, would detect 60-70% of infections.

That will hae to conclude this thread. Follow the advice of your clinic. Assuming negative results for HIV and other STDs, which is what you should expect, there is no point in posting the results here. I would just nod (symbolically) and say "Yup, negative, stop worrying."

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