[Question #176] Complex STD question

37 months ago
Hello Doctor!

I have a complex STD question.  I have tried to keep the details as clear as possible.

Background
I am a 34 year old man in a committed relationship.  I have never strayed before this day.

On April 29, 2015, I was prescribed a z-pack as a preventative measure against whooping cough that one of my co-workers had.  The z-pack was a total of 6 250 mg pills to be taken over the course of 5 days; 500 mg on day one and 250 mg on each day after that, for a total of 1.5 g.

About 5 hours after I consumed 500 of Azithromycin, I stupidly and drunkenly had unprotected sex with a partner of unknown status.  I was inside for approximately 5 or 10 seconds and there was no thrusting.  I had 500 mg of Azithromycin on board at the time of this exposure.

The next day I self medicated by taking 3 pills of amoxicillin laying around the house.  I don't remember how many mg's they were - either 250 or 500 mg tablets.  For the sake of being conservative, lets assume they were 250 mg.  I continued to take the z-pack as prescribed and the amoxicillin 3 times daily for the next 4 days.  I completed the z-pack on Sunday, March 4.  That evening, after having consumed a total of 1.5 g of azythromycin and 3000 mg of amoxicillin orally over the previous 5 days, I had sex with my fiance.  Yes, I know this was a bad decision.

The next day, Monday, March 5, I went to my PCP and took a rapid NAAT test for chlamydia and gonorrhea, which came back negative.  This test was just over 5 days after the exposure.  I asked her if the antibiotics I took would have prevented any std's and she said that they would not have because it was not the proper dose.  She prescribed me 1 g azythromycin to be taken at once, just in case.  

After the negative results, I had sex with my fiance about 2 - 4 times a week for the next 3 months.   On August 7, over 3 months after the incident, I went to the department of health instead of my PCP to get retested.  They informed me that I was in fact at risk for multiple STDs, not just chlamydia or gonorrhea.  On that day, I got tested for chlamydia, gonorrhea, syphilis, and HIV (combo test).  All of the tests came back negative.

Timeline
Here is a condensed timeline of events, followed by my questions:

Day 1, April 29:  Consumed 500 mg of azithromycin.  5 hours later had unprotected sex with unknown partner lasting 5 - 10 seconds.

Day 2, April 30:  Consume 250 mg zithro, 750 amoxicillin.

Day 3, May 1:  Consume 250 mg zithro, 750 amoxicillin.

Day 4, May 2:  Consume 250 mg zithro, 750 amoxicillin.

Day 5, May 3:  Consume 750 mg amoxicillin, have sex with fiance.

Day 6, May 4:  Get tested for Chlamydia and Gonorrhea with an NAAT test.  Results are negative.  Doc gives me 1 g. zithro just in case.

Next 3 months:  Have sex with fiance regularly, lets say between 18 - 26 times.

3 months and one week after exposure:  Test negative for chlamydia, gonorrhea, syphilis, and HIV.

Questions
Here are my questions:

1) What are the chances that I could have contracted chlamydia or gonorrhea from a 5 - 10 second exposure with 500 mg of azithromycin in my system?  Keep in mind that I continued to finish the 5 day z-pack and took 3000 mg amoxicillin orally over the next 4 days.

2) Would the azithromycin and the amoxicillin that I took over the next 5 days have prevented chlamydia or gonorrhea infection from "taking hold"?  

3) Was it possible that I contracted chlamydia or gonorrhea despite the antibiotics, transmitted it to my fiance 4 days after exposure, but still tested negative for both on day 5 -  the very next day?

4) If I did somehow transmit chlamydia or gonorrhea to my fiance before my negative May 4 test, wouldn't she have given it back to me at some point over the next 3 months? (we had sex about 18 - 26 times).  Remember that I tested negative for gonorrhea and chlamydia again at three months, as well as negative for HIV and syphilis.

5)  What is the likelihood that I ever had anything to begin with?  I would suspect that it would be hard to contract a bacterial STD while on azythromycin and amoxicillin, but I suppose anything is possible.

Conclusion
This indiscretion was the direct result of a drug habit I had at the time.  I have been sober since and it is going on 5 months after the incident.  I know that I should not have self medicated or had sex with my fiance after the incident.  I have learned from my mistake and will never, ever, ever do something like this again as long as I live. 



Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Welcome to our Forum.  I will be pleased to answer your question however, I will ask you to re-state it in about 1/3 the length.  Our intent on the Forum is for persons to state their questions using 2000 characters (not words) or less.  In years of working in this medium, we have found that there any questions which take more space to state cannot be satisfactorily answered on line.  Further, in skimming your question, I think you can simply things as well.  Further, as one additional caveat before we address your question, please understand that we permit the question and then no more than three follow-up questions for clarification.  These rules are essential for our ability to effectively serve as many clients as possible in the limited time and space we have.  Thanks for understanding.  EWH
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37 months ago

Hi Doctor!

 

I am a 34 year old man in a committed relationship.

 

Day 1, 4/29:  I was prescribed a 5 day z-pack for an unrelated issue.  Consumed 500 mg of azithromycin.  5 hours later I foolishly had unprotected sex with another woman lasting 5 - 10 seconds, no thrusting.  I had 500 mg of zithro on board at the time of the encounter.

 

Day 2, April 30:  I decided to self-medicate with some amoxicillin I had in addition to the zithro.  Consumed 250 mg zithro, 750 amoxicillin.

 

Day 3, May 1:  Consumed 250 mg zithro, 750 amoxicillin.

 

Day 4, May 2:  Consumed 250 mg zithro, 750 amoxicillin.

 

Day 5, May 3:  Consumed 250 mg zithro, 750 amoxicillin.  After having consumed 1.5 g of zithro and 3000 mg of amoxicillin since the incident, I have sex with Fiance.

 

Day 6, May 4:  Tested negative for chlamydia and gonorrhea at my PCP.  Doc gives me 1 g. zithro just in case.  I asked her if the antibiotics I took would have affected the test or made me noncontagious and she said no because they were not the recommended dose.

 

Next 3 months: Thinking I am in the clear, I have sex with fiancé between 18 - 26 times.

 

3 months and one week after exposure:  At Dept. of Health I test negative for chlamydia, gonorrhea, syphilis, and HIV.

 

Questions

1) What are the chances that I could have contracted chlamydia or gonorrhea from a 5 - 10 second exposure with 500 mg of azithromycin in my system and all of the antibiotics I took.  Would the antibiotics I took over the next 5 days have prevented / aborted an infection?

 

2) Was it possible that I contracted C or G while on the antibiotics, transmitted it to my fiancé 4 days after exposure, but still tested negative for both on day 5 -  the very next day?

 

4) If I did somehow transmit chlamydia or gonorrhea to my fiance, wouldn't she have given it back to me at some point over the next 3 months? (we had sex about 18 - 26 times).  

 

5)  What is the likelihood that I ever had anything to begin with?  


Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Thanks for your efforts to shorten your question, I appreciate it.  Before I answer your question.  A few comments.  First, most people do not have STIs.  It is unlikely your casual partner had an STI that you were exposed to.  Oven if they did, the presence of azithromycin in your blood would reduce the likelihood of infection (it takes less antibiotic to PREVENT infection than to cure it).  Finally, while the amount of antibiotics you took were less than what is recommended, they would still cure many, even most cases of both gonorrhea and chlamydia.  Now, let's go to your questions.

1.   See above, there is little chance that you were infected and, even if you were, it is likely that you would have had your infection cured

2. Lower still.  Odds of being infected are far less than 1%.

4.  Yes, if you had somehow infected her, she would have likely given it back to you and you would have likely become infected.

5.  The likelihood you were infected at all is close to zero.

I hope these comments are helpful to you.  EWH
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37 months ago
Thanks for your help Doc.

I have a couple of clarifications. 

The more I think about it, I might have had sex with my fiancé on day 2 or 3 after the exposure, not day 4.  I legitimately can't remember, it's been 5 month's and it was a difficult time.

1)  would it change your calculus if I had had sex with my fiancé on day 2 or 3 as opposed to day 4 or 5?  Would I have been likely to transmitt a bacterial infection to her under those curcumstances?  

2) had I been infected and cured, would the naat test have picked up dead chlamydia or gonorrhea on day 5?

3) I am 90% sure my casual sex partner was a woman, but I could be wrong.  It was dark and I was drunk.  If my casual sex partner had been a man, would that change your calculus?  Are my chances of infection still low?

I apologize for not including this info in the first post but I am second guessing my recollection. 
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
I think you are over thinking this.

1.  No difference in 2-3 vs 4-5 days.  Still no realistic risk of transmission.

2.  Yes, if you had be infected and cured it is likely that the NAAT test would have detected the infection (dead bacteria).

3.  Yes, chances of infection are still effectively zero.

Please put your "what if" questions aside and accept that you were not infected.  It is time for you to accept this and move on.  EWH
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37 months ago
Thanks Doctor!

1) So, I assume that you believe my risk for contracting and transmitting syphilis was low too, if I am reading your answer correctly. 

Anyway, this is my last available follow up question, so thanks again for you help you cleared many things up.
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Correct.  Your exposure was very, very low risk for syphilis and, had you been exposed, the amoxicillin and possibly azithromycin as well, would have prevented syphilis.  You can (and I hope will) move forward without further concern.

I'm pleased I could help.  Take care.  EWH
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