[Question #2970] exposure assessment

41 months ago
I already know what you're going to say (I think), but I need to hear it anyway.  As you know, I practice safe sex because I see CSWs (female) outside of my marriage.  Last Wednesday, I was seeing one through an agency, and the condom slipped off during vaginal sex.  I'm not sure if I was exposed inside her vagina or not, but the duration of exposure was likely less than 30 seconds, and I pulled out without the condom present.  It is possible that the condom slipped off inside not just upon exiting.   I couldn't (or didn't) really discuss it with the CSW because she spoke no English.  I notified the agency manager (pimp?) the next day and he said not to worry, the girls are tested (whatever that means).   I also would like to mention that I was on day 7 of a 10 day course of amoxicillin 500mg BID that I was on for an unrelated strep infection.  

My questions are:  how protective is my course of amoxicillin for garden variety STDs, and should I be worried about HIV?    As of this posting, I have no symptoms of anything whatsoever.   

I know what you are likely to say, but I need to hear it from you.  I play safe(er) but this was an unexpected slippage. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome back to the forum, but sorry you found it necessary.

The risk of STD from any single exposure always is low:  at any point in time, most sexually active persons -- including sex workers -- are not infected; and when a partner is infected, the transmission risk tends to be low. For example, when a partner has, say, gonorrhea, chlamydia, syphilis, or herpes, most exposures with that person do not result in disease transmission. Given the partial condom protection, your risk was lower still.

As for amoxicillin, it's a lousy drug for prevention of most STDs. You were highly protected against syphilis, but that's about all. Amoxicillin is not reliable at all against gonorrhea, chlamyida, nongonococcal urethritis, or trichomonas. And of course no antibiotic ever protects against viral infections like HIV, hepatitis, HPV, or herpes. For the reasons above, your risk is low from this particular event -- but the amoxicillin makes no important difference one way or the other.

As for HIV, the transmission risk for each episode of vaginal sex, if the female partner has HIV, averages about 1 in 2,500.

You are at elevated risk for all STDs. You have made a wise decision to consistently use condoms for your extramarital adventures, and they markedly reduce the risk of some infections, but have only modest prevention effect against some (e.g. HPV, herpes). And condoms sometimes fail, as you have just experienced -- and even when no obvious condom failure is recognized, it sometimes happens. Anyone with your sexual lifestyle should never assume they are risk free, and should be tested periodically (e.g. once a year), at least for HIV, syphilis, gonorrhea, and chlamydia. If you haven't had such testing recently, I suggest doing it now, while it's on your mind -- but not necessarily because of this particular event.

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

HHH, MD

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40 months ago
Wanted to keep thread open. Have dr appt for Thursday worried about throat gonorrhea and/Or chlamydia from cunnilingus... what can I ask for for that he's an internist not an std specialist . Have sore throat w white spots. cunnilingus with 5 different female csws including this one
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
You jumped back just in time:  threads are closed when there has been no activity for 28 days.

Cunnilingus is very low risk for any and all STDs; whatever risk you had was further lowered by the amoxicillin (it's not completely reliable, but would prevent many cases of either gonorrhea or chlamydia); and the vast majority of throat infections with gonorrhea, and all with chlamydia (as far as we know), are asymptomatic, with no sore throat, "white spots", or anything else. So I expect your tests to be negative. (Your doctor might not be able to test for chlamydia. Oral/throat testing is not a common procedure and not offered by many of most ocmmercial labs. But chlamydia of the throat is so rare that it's simply not a consideration. It has never been reported to be acquired by cunnilingus. That doesn't mean the risk is zero, but it's certainly miniscule.)

I'll leave this thread open for another 10 days or so, to allow testing and results to be available. But since each thread has a limit of two follow-up comments and replies, let's wait until the results are available. But stay mellow in the meantime:  I'm confident your test(s) will be negative.

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