[Question #2843] STD risk

42 months ago
Greetings.  3 weeks ago I had protected oral, protected vaginal, and protected oral sex again with an escort.   The condom was changed between each act, and the total time for vaginal was less than 10 min.  I was tested this week for chlamydia, gonorreah, and Trichomoniasis through a urine test.  All 3 tests came back negative.  My only concern revolves around trich.  From other websites, they make it sounds like trich is a risk even with appropriate condom use.  One website sites under the foreskin as a possible infection site.  I’ve also read that trich is difficult to test for in males.  My questions are basically do I have any remaining basis for concern given the use of condoms and the negative test?  Thank you!
42 months ago
One additional note, the trich test was  TMA, the others were NAAT.    I’m embarrassed to admit I am married and just want to ensure I do not put my wife at risk.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question.

This was an entirely safe exposure and I would have recommended against any STD testing, assuming this was your only risk recently. Of course if your sexual lifestyle beyond this particular event put you at risk for STDs, it was reasonable to be tested. In any case, your negative gonorrhea, chlamydia, and trichomonas tests are highly reliable (more about trich testing below).

I have never heard that condoms are not excellent protection against trichomonas. But even without a condom, trichomonas would be very unlikely after any single sexual exposure. As for testing, it is true that through the years until recently, it was difficult to test men accurately for trichomonas. Transcription mediated amplification is a kind of nucleic acid amplification test (NAAT) and is equally reliable as all NAATs. This test was developed primarily to test women and has not been studied too much in men, but all STD and trichomonas experts are confident it reliably picks up all infections in men. You can rely on that result.

As noted above, I would not have recommended any STD testing. However, since you have started down that path, I would think you would want to be tested for the more serious STDs as well, namely HIV and syphilis. These risks also are nil for this sort of exposure, but if you would like the reassurance from negative testing, have an HIV antigen-antibody ("4th generation") blood test and a syphilis blood test. Both are conclusive 6 weeks or more after exposure.

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

HHH, MD

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42 months ago
Thank you Dr.  Handsfield, I appreciate the info.  There have been no other exposure risks for me, as this was a one time lapse in judgement and not a regular lifestyle.   To be honest, I wasn’t worried about my risks until I read how trich is so prevalent and saw there was comparatively little info on it.  One website (maybe the cdc?) had a blurb saying something to the effect that “condoms don’t cover all areas so trich infection is still a risk” which made me more worried than I otherwise was.   I realize that most sources err on the side of extreme caution, which is why I appreciate you putting risks in layman’s terms.   I had read your info on the old medhelp forums and was thrilled to discover you still answer questions such as mine here.   I was not really considering any further testing in the absence of any symptoms unless you would recommend it, as the trich test was due to my uncertainty based on what I was reading, and there was negligible cost difference to include the other 2. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Your quote about trichomonas transmission would imply that it is transmitted by skin-to-skin contact, like herpes, syphilis or HPV. Not true; trich is transmitted through sexual fluids, like gonorrhea, chlamydia, and HIV. Accordingly, condoms work. And to the  extent that in uncircumcised men trich may be present under the foreskin, that part of the penis is completely covered by condoms. So I have to believe you misunderstood that website, or it was not a reliable one. Hard for me to believe CDC would say such a thing.

In any case, trichomonas ia trivial problem in men, wiht no known ocmplications. It's more important in women and indeed very common, but still the complication rate is low. It's really not something to be worried about. I would advise most sexually active people to devote their prevention energies to chlamydia, gonorrhea, herpes, HIV, and syphilis. Although some STD experts will disagree with me, I really wouldn't worry much about trich.

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41 months ago
At exactly 4 weeks post encounter I was in my doctors office for an unrelated matter and after discussion he ended up ordering the hiv antigen-antibody test for me.    I received the results, which were negative, but I read that recently you had moved to recommending 6 weeks instead of 4 for the test.  Ignoring the already minuscule possibility of exposure from my protected encounter, what level of confidence can reasonably had from the test at 4 weeks?  To my mind, the worst case scenario of the escort being positive and my contracting it through a protected encounter is 1/10,000 (if those numbers are correct).  If there is a fairly high level of confidence in the results at 4 weeks it makes my chances of having contracted but not showing positive at 4 weeks pretty much nil.  Thanks for all your assistance doctor, I fully realize my worry and paranoia is due to guilt, and I’m looking forward to having this entire experience behind me.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Sorry about the more than 3 week delay in responding to your last comment.

As we have mentioned numerous times, a few months ago we became aware of the most up-to-date summary of the performance of the currently available HIV tests. That report has now been published, along with a CDC commentary on it. Based on that report, rare cases require 6 weeks for the antigen-antibody tests to become positive. However, the vast majority of newly infected people have positive results by 4 weeks, and your statement is exactly right that your very low risk combined with the negative test at 4 weeks reduces the chance you are infecte as "pretty much nil".

https://www.ncbi.nlm.nih.gov/pubmed/29140890
https://www.ncbi.nlm.nih.gov/pubmed/29140891

Apologies again for the delay in responding. In any case, that completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the disucssion was helpful.
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