[Question #2135] STD Risk

46 months ago
Hello Doctors,

Greetings from Mexico.  I am a 40 year old married male who had been on a monogamous relationship for close to 10 years. Five Months ago I made a terrible  alcohol-driven decision and had unprotected sex with a 28 year old girl I know from work. From what I can remember, it were 2 short episodes of vaginal sex.  Since then, I have been avoiding sex with my wife while I figure out how to deal with this. In this five months period we only had sex twice, both times I wore a condom but the last time, a few days ago, the condom broke.  I have not had any symptoms of any STD, just recently, after the condom broke I am feeling things in my urethra but I believe those might be anxiety driven.   Could you please help me figure out what would be the risk of having an STD   from my extra marital encounter and what would be the chance of passing anything to my 31 year old wife?  Could you also please suggest a course of action from a medical perspective?

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome to our Forum.  I will be glad to comment.  From what you tell me, it is most unlikely that you were infected but your guilt and anxiety over this misstep is having many negative effects on you.  Thus,. I will tell you why I suspect you are not infected and then make a suggestion as to how to make sure you are not. 

First, I suspect you were not infected.  My guess is that your partner was not infected to start with and even if she was, most single or even two acts of intercourse with an infected person do not lead to infection.  These facts, along with the fact that you have not developed symptoms all make it unlikely you were infected.  I agree with you that the abnormalities you have noticed since your condom broke could be due to guilt-related anxiety and heightened sensitivity. 

Having said that, at this time you can very easily prove to yourself that you were not infected.  You could do this by seeing a health care provider who can order tests and request a urine test for gonorrhea and chlamydia and a blood test for HIV and syphilis.  When these tests are negative, as I suspect they will be you can be confident that you were not infected and therefore do not pose a risk for your wife with unprotected intercourse going forward.  You could also speak with your partner (since you work with her) and ask if she has been tested and if not, suggest that she seek testing as well, again just to be sure.

I hope these comments are helpful.  Take care.  EWH

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46 months ago
Thanks for your insight Doctor, this indeed has been very helpful.

I appreciate your guidance and will schedule an appointment late this week with my health provider for proper testing.

In the meantime and in order to help me assimilate this  could you please expand a bit more on what makes you suspect I am at a low risk of STD?  I do pretty well with numbers, could you please provide a rough estimation on the odds of getting infected on this kind of encounters and also the odds of infecting my wife?

Finally,  after my misstep I got treated twice for other kind of infections with Amoxicillin (I wasn't very good taking the pills on time though). Would this be of any help in the case I got infected?

Kind regards.

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
My assessment of your low risk for STI is based on a number of pieces of information.  The first is your situation:
1.  Unless there is something you have not mentioned, it is unlikely that your partner has an STI- most people do not (less than 1-2% of the population).
2.  You are now 5 months out from your exposure, if you were going to develop symptoms (admittedly, not all persons with STIs do), symptoms would have appeared by now.

Secondly, there are the statistical issues:
1.  Even if your partner had an STI, most exposures are not transmitted with one or even two acts of intercourse.  The most common STIs such as gonorrhea or chlamydia are transmitted at a rate of something less the 20% per act of intercourse.

I doubt that he ampicillin you took would have any influence on this.  Hope this further information is helpful.  EWH
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46 months ago
Hello Doctor,

Since this is my last opportunity I would like to take the chance to clarify a few more doubts I have.

1) I Just been tested for chlamydia with negative results. Given the time that has passed (5+ months) and the recent results for Chlam. , would still make sense to test for Gonorrhea? 

2) In a scenario in which I was exposed to infection, will 5 months would be enough for my body to clear these infections up with no treatment?

3) As explained before, I did not have any symptoms until recently and although I initially thought were anxiety driven however, it actually feels very real.  Have you seen this in other patients?  Is it common under situations like mine that patients actually feel the symptoms? Would it make sense to have any real symptom after 5 months?

4) I read a lot about Trichomonas, is this something I need to worry about?

Finally, just want to thank you very much for your help, I am happy I was able to find such an expert advise on the web.

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
1.  Usually when labs test for one STI such as chlamydia they test for gonorrhea at the same time.  I would ask the lab if you were tested and not aware of this.  if you were not tested, I would not feel it necessary to test as over 90% of gonorrhea causes symptoms and would have done so long before now.  If I were you, I would not feel the need for testing  but of course you will have to make that decision.

2.  Yes, the majority of common STIs such as gonorrhea, chlamydia and trichamonas would have been eliminated from your body even without treatment by now, had you been infected (which I doubt).

3.  When STIs cause symptoms they typically do so in a matter of days, not weeks or months.  On the other hand, when persons start to look for symptoms, it is not at all unusual for them to notice normal sensations that they would otherwise overlook and think they might be symptoms. This may well be what you are experiencing.

4.  When men get trichamonas, the infection is most often transient and can clear without therapy.  I would not be worried about trich if I were you. 

Thanks for your confidence in our site.  I'm glad my comments were helpful.  This thread will be closed in a few hours.  Take care and please don't worry.  EWH
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