[Question #2046] FAO: Dr. Handsfield (relates to posts from him) - Trich/MG Concerns

47 months ago
Hello Doctor,

I am a happily married man in London, England. In June last 2016 I stupidly strayed in a drunken one night stand with a girl in the US before marrying . This was unprotected vaginal sex multiple times throughout the night - ie. 10+ separate incidents. 

I tested at 2 weeks post this exposure for Chlamydia and Ghonnoreah and at 6 weeks for HIV and Syphillis. All were negative. As i was concerned about other STIs not tested for as standard I tested via a private online clinic for infections including Mycoplasma Genitalium and Trichomoniasis - this urine test was done at just under four weeks post exposure. This was from a very reputable supplier using the same laboratory as many of London's leading private clinics, including Freedom Health who i know you're aware of. The results were all negative. 

My concerns have been raised following reading several posts from Dr. Handsfield that bacterial infections, including trich, clear up without treatment 'within a few weeks' - my conern then is that given it was almost four weeks since my exposure when i tested for MG and trich that i could have passed one/both of them to my wife and it clear by the time i was tested. 

Questions
1. Do you think my concerns are warranted and should my wife be tested for trich and MG as a precaution?
2. Given my wife and i have regular sex (2 - 3 time per week), if I test again and I am negative would it be safe to assume that my wife isn't carrying the infections as i surely would have picked them up and we would be co-infected?
3. Is trich in females anything to worry about? - my concerns are PID in my wife. We are not planning to have children so risks in pregnancy are less of a concern. I read a post from Dr. Handsfield from several years ago stating that Trich has historically been viewed as a trivial condition but that perception is now changing - in what way? What are now seen to be the risks?

Thanks for your help 









H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome to the forum. Thanks for your question.

You really needn't worry. While it is true that many (most? all?) bacterial STDs clear up on their own, typically this takes much longer than 4 weeks. There has been no careful research on this for M genitalium of Trichomonas, but these typically are very prolonged infections and probably any spontaneous cure is over months or years, almost certainly not within 4 weeks. I would also judge that you were at fairly low risk of catching either of these. Most women, even sex workers, are not infected at any point in time; and STDs are transmitted inefficiently, i.e. most exposures don't result in transmission. In all honesty, I would have recommended against testing for these -- you were wise to be checked for gonorrhea, chlamydia, HIV and syphilis, but I would have skipped the others.

To your specific questions:

1) I see no reason for you to mention this episode to your wife or for her to be tested. There is no realstic chance you transmitted either of them to her.

2) I don't see any need for repeat testing. If you do so, it will confirm you aren't infected. However, it will say nothing about whether or not your wife had become infected. In the exceedingly unlikely finding of a positive result, it would not tell whether you were infected originally and the earlier tests missed them, or if you were re-infected from your wife.

3) There is controversy about the medical importance of trichomonas. The vast majority of infections are trivial, causing vaginal discharge only (most infections are entirely asymptomatic) and it isn't known to cause any direct complications, such as pelvic inflammatory disease. It increases the risk of HIV if exposed, which is probably the main serious outcome of concern. There are uncertainties about whether it might trigger early labor in pregnant women. On balance, it can be considered one of the minor STDs.

You did the right thing by being tested for the 4 big/important STDs in this situation. You can go forward with confidence your wife is not at risk for these others. Certainly if I were in your situation I would not have been tested for MG or trich.

I hope these comments are helpful. Best wishes and stay safe--  HHH, MD

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47 months ago
That's great Doctor, thank you for such an informative response. 

So just to confirm my understanding that even the number of separate incidents that night being somewhere between 10-20  would have no bearing on anything and not increase the risk. Essentially i can trust my test results?

Thanks again




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Risk of course rises with number of exposures, so you were at greater risk than if there had been a single episode of intercourse. However, your tests remain equally reliable regardless of the number of actual contact events. You definitely can trust them.

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47 months ago

Thanks Doctor that’s great. My final questions relates to cunninlingus risks from the exposure I have mentioned and one other historic one.

1. Performed unprotected cunnilingus and analingus on two separate sex workers on different days (one each night) in Ibiza, Spain on multiple occasions (girls were eastern European and south American) including tongue going in vagina and probably also into the anus opening in June 2014, so almost three years ago. I didn’t test after this for pharangyeal ghonnoreah or syphilis. I had just got together with my now wife at the time and we had tested previous to this encounter all negative so I couldn’t suggest we be tested again post this exposure

-       2. I also performed unprotected cunnilingus multiple times on the girl in the one night stand the rest of this thread relates to and didn’t test for pharanygeal ghonnoreah as I thought the risk was too low to worry

 Questions

1.      1Is my understanding correct that the risk of ghonnoreah from cunnilingus is too low to worry about from the above exposures? (Please don’t assume that because I didn’t get ghonnoreah from the vaginal sex with the one night stand girl I wouldn’t have picked it up from cunnilingus as on reflection whilst I know we had sex multiple times it could be anywhere from 3 to 20 through the course of the night and I could have performed cunnlingus a lot more than vaginal sex). Or is the number of times cunnilingus was performed irrelevant and there is no realistic risk of ghonnoreah from cunnilingus? (appreciating it’s not zero risk in the same way not getting struck by lightening is not zero risk)

2.       2. Re. syphilis from the sex worker encounters – I was incredibly drunk and couldn’t remember barely anything the following day, let alone whether I noticed any chancres. Can I assume that if I would have contracted syphilis I would have felt a chancre on my tongue (I never looked out for it)

3.      3.  If on the very slim chance I had contracted syphilis I assume it would have shown on the test I took last year – two years after the escort encounter - or could it have cleared without treatment or would I have been reinfected from my wife had I given it to her?

4.     4. All things considered, do you think I can just put all this behind me and move on without worry about risk to my wife?

 Thanks for your final words doctor. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
1) Your analysis is correct. Cunnilingus and analingus are believed to carry very low STD risks. Even if you acquired gonorrhea in the 2014 exposures, it would be long gone by now (gonorrhea self cures in weeks to a few months). I cannot say the risk was zero from the more recent exposure, but vaginal to penile transmission probably is a hundred times more efficient than vaginal to oral. It would be statistically very unlikely for you to have acquired it oral but not have genital infection. Of course you are free to visiti a clinic for a throat swab for gonorrhea culture if you want even more assurance. But if somehow I were in your circumstance, I wouldn't do it.

2,3) For syphilis, if you have had a blood test any time more than a 6 weeks after the last such exposure, you were not infected. So if I correctly understand the timing, neither you nor your wife need any further testing for it.

4) Yes, indeed:  all things considered, you can move on without worry and with no significant risk to your wife. As implied above, that's what I would do if it were me.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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