[Question #2631] unprotected sex concerns

43 months ago
Hello, I made a very foolish mistake 18 days ago while in Hawaii. I visited a Korean massage parlor admittedly looking for something bad but wasn't expecting what happened. The woman said she was very attracted to me and wanted to do more with me. I was drunk and before I new it we were having unprotected vaginal sex. I have been sick with worry and guilt ever since largely because I have a pregnant wife and I am terrified I have done something to endanger her and our baby.
I submitted a urine sample for Chlamydia/Gonorrhea the other day and am still waiting for results. The lab tech said it was too early to check for anything else but I suppose I could have found somewhere to do a rapid HIV early detection. I had been planning to start doing Oraquicks at 4 weeks, maybe every couple weeks.
I have no symptoms at all, but I suppose the next think I should be concerned about beyond Chlamydia/Gonorrhea/HIV is Syphilis. Is 3 weeks after possible exposure sufficient for Syphilis? I guess I am looking for opinion of actual risk in addition to recommended course of action. Sorry if this is a bit incoherent, I am shaking writing this which clearly I deserve. Thank you very much in advance.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thank you for your confidence in our services.

This was a pretty high risk exposure:  one has to assume the lady's behavior is the same with other customers, and it's pretty astounding she wouldn't use a condom. That said, even among the most active sex workers, at any point in time most aren't infected with most STDs. And STDs are not transmitted with high efficiency:  that is, most exposures to infected partners don't result in transmission. So the odds are strongly in your favor; and especially so, since most of the common STDs (gonorrhea, chlamydia, nongonococcal urethritis, herpes) cause symptoms in a few days  -- at 18 days you're not quite out of the woods, but it's very unlikely you caught any of those infections. Onset of a primary syphilis lesion takes longer, but more than half would show up before 18 days; and heterosexually transmitted syphilis is currently rare in this situation (including data from Hawaii).

Numerical odds at this point? I would guess the chance you have gonorrhea or chlamydia at well under 1%; syphilis under 1 in several thousand; and HIV almost zero. Even in active sex workers, under 1% (more like 1 in 1,000) are infected, and the average HIV transmission risk from a single episode of unprotected vaginal sex averages 1 in 2,500. So your HIV risk calculates as no higher than 1 in 25,000 and even that is likely on the high side.

Therefore, I'm quite confident your urine gonorrhea/chlamydia test will be negative. Three weeks is OK for initial syphilis testing, but not conclusive; you should have another test at 6 weeks. The oral fluids home HIV test (OraQuick) is the least reliable of all available HIV tests following a particular exposure:  at 4 weeks it will detect 60-70% of infections and takes 3 months for conclusive results. Instead of that test, have an HIV antigen-antibody ("duo", "4th generation") lab based test at 4 weeks (98-99% reliable) and again at 6 weeks (100%).

In the meantime, you may be considering whether or when to continue sex with your wife. If somehow I were in your situation, I would resume unprotected sex with my wife when the gonorrhea/chlamydia results return negative. For me, the odds of having the others is low enough to take the chance. But I'm not you, and you'll have to make your own decision on that score.

Bottom line:  The chance you have any of these infections is extremely low, and will be even lower if the gonorrhea/chlamydia results are negative. Don't confuse your concerns over a sexual decision you regret with infection risk from that decision:  they aren't the same. Deal with the former as you need to (maybe even discuss with your wife?), but try not to worry about the latter.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
1 in 250,000 for HIV, not 25,000. Pardon the typo.---
43 months ago
Dr. Handsfield,
Thank you very much for your detailed and thoughtful response. Admittedly, it took me a while to accept odds in my favor, but that's mental anxiety and this is not the appropriate forum.
I got my Chlamydia/Gonorrhea results back today, both negative. I will plan on getting tested for syphilis and hiv when those tests would be accurate, but hopefully I am largely out of the woods now.  At least I do not have to wait for months with anxiety as people used to have to do.
I genuinely appreciate your taking the time to lend your expertise. It boggles my mind to have such easy access to a top mind in your field, but please know that it does not go unappreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Thanks for the thanks. I'm glad to have helped and appreciate your comments about our services.

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