[Question #1796] Per incident exposure and STD testing window

43 months ago
5 weeks ago I had a personal shower, a massage, then I had oral and I believe protected vaginal sex but the condom slipped down the shaft to the head of the penis once.  I was pretty drunk but I remember her stopping and pulling it up and at the end of everything I believe she removed the condom by hand with a towel. This was with an Asian CSW in TX at a massage parlor.  This is the first time I've done this...I had all base line testing done and all were negative at 7 days post exposure.  Urine negative for Chlamydia and Gonereah.  I'm scheduled for more testing at 6weeks.  I was wondering a few things:

What is the window for testing for all STDs; is 6 weeks conclusive for HEPs, Syphillis and HIV?

Should I have a blood draw for Chlamydia and Gonereah since I performed oral and the urine does not indicate this type of exposure?

What is the increased odds of vaginal HIV transmission since she was a CSW,  I see Dr. Hook mentions this non-CSW exposure to be 1/1000 but I see the CDC  mentions 1/2500.  Which is correct and what is the difference due to possibility of her being a high risk individual?

Are there other STDs I should test for i.e. HTLV-1, Donovanosis, or the Cytomegalovirus?

What do you consider my odds of contracting any STI or STD from this exposure; please note I'm mostly concerned with HIV and HEP B.  

I'm very scared and can't have sex with my wife until I know.  If you were me would you be sexually active with a loved one given my circumstances? I see you often give feedback that none of you would recommend testing for HEP and HIV from a single heterosexual exposure of this nature?
43 months ago
I performed oral on her for a minute or so, sorry for not being specific.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to our Forum.  I'll be happy to comment.  This was a very low risk encounter- most CSWs do not have STIs, most exposures to infected partners do not lead to transmission, you used a condom for vaginal sex, the highest risk part of the encounter (and condoms that slip down still work as long as they cover the head of the penis), your unprotected oral sex on her rarely leads to infection of any sort and, apparently you are asymptomatic.  there is little chance that you are infected.  further, your urine test for gonorrhea and chlamydia at six days provides definitive evidence that you did not acquire those infection during your genital contact.   As for your specific questions:

What is the window for testing for all STDs; is 6 weeks conclusive for HEPs, Syphillis and HIV?
the window for definitive testing for STIs varies.  Your tests for gonorrhea and chlamydia are definitive and do not need to be repeated.  A throat swab for gonorrhea (and chlamydia although such infections are quite rare) will likewise provide you with definitive information at this time.  A 4th generation HIV test at this time will be definitive and while theoretically while syphilis and hepatitis can take up to three months for tests to become positive, realistically at this time testing would identify nearly all recent infections and can be considered effectively definitive.  We do not recommend blood tests for herpes in your situation- that you have not had an outbreak is strong evidence you were not infected.

Should I have a blood draw for Chlamydia and Gonereah since I performed oral and the urine does not indicate this type of exposure?
No, blood tests for these infections are not useful.  See above about at throat swab.

What is the increased odds of vaginal HIV transmission since she was a CSW,  I see Dr. Hook mentions this non-CSW exposure to be 1/1000 but I see the CDC  mentions 1/2500.  Which is correct and what is the difference due to possibility of her being a high risk individual?
Realistically, there is not much difference between estimates of HIV risk between 1 in 1000 and 1 in 2500 and if you look you will see that I say the risk of a single, unprotected vaginal exposure with an infected person is less than 1 in 1000.  In your case, a condom was used as well.  The odds that you have HIV, all things considered are less than 1 in a million.

Are there other STDs I should test for i.e. HTLV-1, Donovanosis, or the Cytomegalovirus?
No need for these tests.

What do you consider my odds of contracting any STI or STD from this exposure; please note I'm mostly concerned with HIV and HEP B.  see above, I am relatively confident, even without all tests mentioned above, that you were not infected with any STI, including HIV and hepatitis.

I'm very scared and can't have sex with my wife until I know.  If you were me would you be sexually active with a loved one given my circumstances?
If I were you, at this time I would have no hesitation to have unprotected sex with your wife. 

I hope these comments are helpful.  EWH
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42 months ago
Dr. Hook how can you and Dr. Hansfield be so confident in your response of no testing from a single hetero male insertive  vaginal exposure for HIV and HepB?  I know it is 1/2500 on the CDC for HIV and with HepB being 100x more affective in infecting a party which would be 1/1250, it still seems a little off for HepB because kids can get from parents, athletes get it from athletes, it seems if it can be transmitted that easily then 1/1250 seems very liberal.  In my case it was with a Asian CSW, age between 19-27 and from my reading on the CDC there are approximately 1.4 million chronic HepB carriers and 50% are of Asian heritage.  That a lot for a US population of 18 million.  Noting from other sights that 25% of chronic carriers are highly contagious hsbage (something like that) that leaves 700k Asian Chronic HepB carriers, and 175k highly infectious.  Of this 43%  are women equaling 70k and if there is 9 million Asian women then the rate per 100k would be 777/100,000 of infectious female Asian.  Please offer feedback on how you would feel comfortable sleeping with a loved one with this high of a pet 100k rate.  Please note that I'm not looking to discredit any of your previous information I'm only looking for feedback to look at this  more like you do with less anxiety.   Please share some positive feedback relative to what I feel was a high risk situation...PLEASE!
42 months ago
I failed to ask does anyone ever come back to board with a response of being positive?  If so what is done at that point?
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
You are being argumentative. The fact remains, you used a condom which, although it slipped, still covered the head of your penis and therefore did its job.  Your statistics do not address the fact that the majority of persons with congenital hepatitis are not infectious to others.   Further, your estimates of the infectivity are higher than those of most experts.  The U.S. CDC tends to use very conservative estimates.  This was not a high risk situation.   If I were you, I would not be the least bit worried that I had been infected and would not hesitate to have unprotected sex with  your wife.  EWH
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42 months ago
I was pretty intoxicated, what if it did slip and expose my for-skin or oven the tip does  my risk change significantly?  Please keep the thread open as I have testing on Monday I would like to share the results afterwards.
42 months ago
My hepB statistics were based off of the fact that 2 billion have been infected worldwide, 300 million people worldwide are chronic carriers and 100 million of them are infectious which is 25%.  Using that information with the CDC number I came up with Asian women being HepB infectious 777/100,000.  The numbers used were 1.4 million chronic carriers in the US, half of them if Asian heritage (500k), 40% being women, that's 200k women. Of which 25% are infectious that's 50k.  That info with the Asian population in the US being 19 million and half being women I come up with 50,000/9,500,000x100,000 which actually equals 555 and that would be 555/100,000.  Am I doing something wrong in my math.  Is there a lot lower amount of chronic infections that are infectious carriers?  I know I asked this similar question but I wanted give a better discription to my math.  In your experience do you ever see acute infections from 1 heterosexual exposure, male insertive vaginal?  
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Sigh.   Your anxiety is just out of control isn't it?   Similar to Dr. Handsfield's earlier comment to you, I will not get into a debate with you over your statistics and interpretation of them. You ask for expert opinion and got it. In over three decades of practice and communication with other experts,  neither of us have ever seen transmission of hepatitis B following condon protected sex.   If you are condom had slipped off the head of your penis it would not have been on your penis to be pulled up later but would have been left behind in your partner's  vagina. 

 This will be my final reply to you. Should you post additional anxiety-driven, repetitive questions your question will be deleted without comment and your funds will not be returned. I will not close this thread until  The middle of next week so that you can post your test results if you choose to. At that time your thread will be closed. EWH
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42 months ago
Dr. Hook I received my test back today and all hep negative, hiv negative, syphilis negative...are these conclusive?  I did get a postive test for Herpes 1&2 IgM but a negative herpes 1&2 IgG.  I'm confused, I used a condom but I do have a few pimples on my pelvic area and my back itches after showers and when I'm nervous. Do I have Herpes???
42 months ago
Please help Dr. Hook, do I have Herpes since the IgM is positive at 1.20 and the IgG is negative under .90.  Additionally should I be testing out any further for the Heps, HIV 4th generation, or Syphilis?  This test was at 43 days.