[Question #3954] Risk and Treatment

31 months ago

I am a 36 year old male and I recently had an encounter with a masseuse, in which she performed brief intermittent oral on me while also giving me a handjob and she rubbed her genitals on mine.  There was never any vaginal penetration and no condom.  The oral and the genital to genital contact where both pretty brief (maybe 3-5 minutes in total).

I became increasingly paranoid and decided to get tested about 2.5 weeks after the encounter.  The only symptoms I had up to that point was some itching in my pubic area.  When the clinic told me results would take 7-10 business days, I kind of freaked out!  So I went home and found an unopened prescription of Augmentin 875 mg, 20 pills.  I have completed that course, however about day 7 or 8 of that treatment, I began feeling what feels like UTI like symptoms (frequent need to urinate, irritated urethra, and somewhat "hot" genitals).  I got a prescription of Cipro for these symptoms, 500mg 14 pills, which I have just started.  Still waiting for test results!


My questions are:  (1)  What do I have a risk of exposure to from the encounter described above?  (2) Would Augmetin course described treat any of these?  (3) Is there an explanation for the UTI like symptoms during the Augmentin treatment?  (4) Will Cipro help get rid of any lingering infection?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Thank you for your question and for your confidence in our services.

I'm afraid you have done just about everything exactly wrong. I don't mean to be critical, but there are lessons here for you in the future and for others who may be reading this exchange. You overreacted and have now made things worse than they would have been otherwise. This was a virtually zero risk event with regard to STDs. No STD causes pubic area itching. Augmentin was a poor choice of antibiotics:  it would have treated gonorrhea or syphilis if you had it, but there was no chance you did. It is not effective against chlamydia or other bacterial STDs. There is a chance your "UTI like" symptoms were due to a yeast infection, triggered by the Augmentin -- in which case, ciprofloxacin is the last thing you need, it would just make a yeast infection worse. And cipro is ineffective against chlamydia, making it the second antibiotic that could not help that STD. (But the risk of chlamydia was nil, so maybe this doesn't matter much.) Also, waiting to be tested until after a course of any antibiotic screws up any chance of knowing for sure whether or not you actually were infected.

Those comments partly answer your specific questions, but to be explicit:

1) There was no significant risk of any STD from this event.

2) See above: effective treatment for gonorrhea or syphilis, nothing else.

3) Yeast infection, as noted above. Or perhaps it's mostly psychological, i.e. anxiety magnifying trivial symptoms or normal body sensations that otherwise wouldn't be noticed.

4) Ciprofloxacin won't treat anything that Augmentin didn't, and could make things worse.

My advice is to not take the ciprofloxacin, wait 1-2 weeks, then if you still have symptoms of any kind, see a doctor. And in the future, don't try to treat yourself without professional medical advice!

Having said all that, I'll return to the simple fact that the events described carried no significant risk for any STD. If you have a regular partner, you should continue or resume your normal sexual relationship and practices without worry.

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

HHH, MD

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31 months ago
Thank you for the reply Dr. Handsfield, it certainly helps put my mind at ease.

One small distinction, I did get tested before Augmentin .  And one follow up question:  in regards to the potential yeast infection is there a recommended treatment for that or do I just let it run it’s course?  Thanks again.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Sorry I misunderstood the timing of your testing. (Apparently treated after testing but before results available.) Presumably those tests were negative, right? Assuming urine or urethral swab testing for gonorrhea and chlamydia, those results are conclusive; and absence of symptoms at that time pretty much rules out any other STDs as well. And presumably the clinic examined you as well, and noted no abnormal urethral discharge, penile sores, or other abnormalities. Right? If so, you should have stopped there, with 100% confidence you caught no STD.

Be clear, I don't know you have a yeast infection -- it's just one possibility for symptoms that develop while on antibiotics. But if yeast, it will probably clear on its own once off antibiotics. If your symptoms fade away, you don't need any further evaluation or testing. But return to the clinic if your symptoms continue. And lay off the ciprofloxacin.
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31 months ago
Still waiting on results.  They told me 7-10 business days, so should get results any day now.  Was a urine test and no visual inspection because I told them I was asymptomatic.

Understood on the Cipro.  Thanks again, this has been very helpful.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
That's a reasonable policy -- indeed, the one in use in my STD clinic. Lack of symptoms is almost as good evidence of no infection as is direct exam showing no discharge. It will be very surprising if your test for gonorrhea or chlamydia is positive -- in fact so unlikely, that if positive, it would be from some previous sexual encounter, not the one described above.

That completes the two follow-up replies included with each question and normally would end this thread, but I'll leave it open in case you want to tell me your test result and if you have any final questions at that time. I won't have any further comments or advice until then.

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