[Question #2180] Encounter with CSW in Brazil

47 months ago
I had an encounter with a CSW in Sao Paulo, Brazil 50 days ago.  She was high-dollar, young (23), and met her at a high end club.  I don’t think she was anything other than a girl trying to make a living.  She seemed/looked clean and educated.

She gave me protected oral sex and we had protected vaginal sex.  The condom was secure throughout and did not break.  We did not kiss.  There was no blood or bodily fluids exchanged.

I’ve been checking myself daily since.  I decided to get tested if I saw something or at 90 days.  Outside of a couple of episodes where I thought I had a fever (I didn't) or a random itch, there have been no symptoms.  I have otherwise been normal, except for anxiety. 

At day 33, I noticed a callus-like thing (1/2 cm wide, 2cm long) on my scrotum.  I removed it, and it was normal underneath, no blood, or anything like a scab.  I decided it was a healed fungal infection.  I do not think it was a chancre.

This week, I saw two small scabs on the top of my hand (probably from scratching), and two thumbprint-sized batches of irregular, skin colored bumps on each temple.  Otherwise, my face and body appear normal. I have Rosacea, so irritated skin on the face is normal, but this is new.  I've been taking Oracea 40Mg(Doxycycline).  What if Oracea is hiding/minimizing symptoms of an STD?

I'm avoiding intimacy with my wife for obvious reasons.  She doesn't like me avoiding her, but we don’t use protection, so it would be odd to start.  I was hoping I could test at 60 days.

Your thoughts on above and below are appreciated...

1) Should I get tested?
2) If so, when?
3) If so, what should I get tested for?
4) If my test comes back negative, is that OK?  or is a second test needed?
5) Should I get tested by my PCP or use an online Lab?
6) Would I know if I had symptoms for something like Syphilis?   I'm wondering if I could have missed them.
7) When can I have sex again?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Welcome to the Forum and thanks for your question. Let me start by congratulating you in using condoms for the encounter that you describe. Condoms remain the most effective mean for STI prevention during sex with a new partner.  Further, by way of background, let me mention to you that most commercial sex workers do not have STIs and most single exposures do not lead to infection, even if your partner did happen to have HIV or some other STI which is unlikely.  From what you tell me, it is unlikely that you were infected and the lesions that you describe o not suggest STIs of any sort to me.  Now let's address your questions

1) Should I get tested?
You can certainly be tested for all STIs at this time and this will, I suspect, provide you with peace of mind.  Most HIV tests would be positive at 4 weeks if you had been infected and combination HIV antigen/antibody tests provide definitive results by six weeks (42 days).   Syphilis tests will be accurate at this time and tests for chlamydia and gonorrhea would have been definitive long before.  We recommend against blood tests for herpes (HSV).  Blood tests for HSV have rather common false positive results in persons such as yourself and had you acquired HSV, you mot likely would have had an outbreak within 10-14 days of exposure. 

2) If so, when?
See above.

3) If so, what should I get tested for?
See above

4) If my test comes back negative, is that OK?  or is a second test needed?
Following testing at this time there is no need for further testing if your tests are negative.

5) Should I get tested by my PCP or use an online Lab?
This is your decision.  The advantage of going to your PCP is that he/she can provide context and, if there is concern about your skin lesions, examine you.

6) Would I know if I had symptoms for something like Syphilis?   I'm wondering if I could have missed them.
From your description it is clear you were looking for symptoms and the skin lesions you describe certainly do not suggest STIs.  FYI regarding your scrotal lesion- syphilis lesions do not scar.

7) When can I have sex again?
Given that you have been abstinent till now, once you have negative test results (they should come back in less than a week, sex will be fine. 

My question for you.  Were you taking your doxycycline at the time of the encounter you described  The reason that I ask is that if you were, this would further reduce your already low risk for bacterial STIs. 

I hope these comments are helpful. EWH
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