[Question #3740] Protected oral

34 months ago
I had protected oral with csw in Czech as well as fingering. All seemed to be good with the condom. The lady was from Russia.

8 days later. Had test. Negative on gonorrhea and Chlamydia and syphilis. No symptoms or signs for all three.

Paranoid about syphilis took 2g azithromycin based on Hook study. HIV negative.
1. Neg results for gonorrhea and Chlamydia. Assume final. Correct. No need to retest
2. Syphilis. Retest when and will the azithromycin impact the results.

Any other risks or concerns I should be aware of.

When is it safe to have sex with my partner? 

Thx


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. Thanks for your confidence in our services.

Congratulations on your devotion to very safe sex. You've actually gone a bit overboard, and the bottom line is that there is no chan ce you have any STD and it is now entirely safe to have sex with your regular partner.

Oral sex is safe sex. Without a condom, the overall risk of STDs far lower than for vaginal or anal sex, with low risk for all STDs and zero risk for some. In fact, I would have recommended against against the testing you have had and the antibiotic treatment. Fingering is no risk for any STD.

1) Chlamydia is one of the STDs for which there is essentially zero risk from oral sex. Even unprotected, there have been NO scientifically reported cases of urethral (penile) chlamydia in anyone who apparently caught it from oral sex. In any case, the negative test shows you didn't have it when tested, especially if you had not already taken the azithromycin. Gonorrhea is possible from oral sex but the negative result shows you didn't have it (once again assuming you had not yet taken the azithromycin). Azithro 2 g usuallly is highly effective in either curing or preventing gonorrhea, although not quite 100%.

2) You have somewhat misinterpreted Dr. Hook's research. Some syphilis strains are resistant to azithromycin. His well regarded azithromycin syphilis study was done in parts of the world where such resistance did not (yet) exist. However, it is quite common in western Europe. Last I heard, such strains were uncommon in Czech or Russia, but that could change and likely will; probably it's just a matter of time before it's an important issue. That said, the chance of syphilis from this exposure was zero anyway, for all practical purposes, because of condom use and that even in places like Russia where syphilis is prevalent, the large majority of sex workers don't have it.

If you would like to follow-up with another syphilis blood test about 6 weeks after the exposure, feel free. (Personally, if I were in your situation, I would not feel any need for it.) If negative, you'll never know whether you were never infected or if, as theoretically could happen, you were inclubating syphilis that was aborted by the azithromycin. If so, the test would never be positive. There is no need for repeat gonorrhea or chlamydia testing. A lot of people would have a final HIV test (at 6 weeks) in this situation, but here too the risk was nil and I see no need. As noted above, you can safely resume your normal sexual practices with your regular partner.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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34 months ago
Thanks. So on the testing was an early detection HIV at 8 days. Is that good for this event. 

Also azith was taken after the testing

As for syphilis and oral protected or not, can you describe why the risk is nil for protected and what it is for unprotected.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Thanks for the thanks. I'm glad to have helped. Good to hear you took the azithromycin after the gon/chl testing.

"Early detection" means you had an nucleic acid amplificaiton test (NAAT), i.e. looking for HIV RNA/DNA in the blood. At 8 days it would pick up somewhat over half of all new infections. It takes a couple of weeks to approach 100%. 

My reply above includes the reasons for very low syphilis risk:  "...the chance of syphilis from this exposure was zero anyway, for all practical purposes, because of condom use and that even in places like Russia where syphilis is prevalent, the large majority of sex workers don't have it." Also, although oral sex can transmit syphilis, it is less efficient in doing so than vaginal or anal sex.
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34 months ago
Thanks again. Does the azith dose impact the testing window.

I also have a small red area away from my penis about half inch to an inch. If this goes away in a day or so can I be sure it is not syphilis. Would the azitb make it disappear quicker.

Again. Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
There are no drugs or medical conditions that affect the testing window of the standard (3rd or 4th generation) HIV tests, and azithromycin. I agree the "red area" isn't syphilis or and I doubt it is an infection of any kind; so I would not expect azithromycin to have any effect on it.

That completes the two follow-up comments and replies included with each forum question and so ends this thread. I hope the discussion has been helpful.
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