[Question #402] Confused STDs

34 months ago

Dear Experts

4 weeks ago i had protected vaginal sex and unprotected fellatio and cunillingus with a stripper/sexworker in switzerland. I didnt recognize some discharge, herpes or something like a chancre. The woman (40 from Moldawia) said „you dont have to worry – you did nothing wrong or dangerous“ – i said: „but oral sex. Gonorrhea, Syphillis etc «  She said : «  that doesnt exist anymore..“…ookay so she had no clue. Any way: i’m married, 1 child and I got panic so i took 1gramm (single dose) Azithromycin-ratiopharm after 4 days. After 2 weeks i went to hospital (Dermatology Venerology) to ask for help. They said: HIV, Hepatitis, Syphillis, and all STDs. Everything is possible. So they made a urin test (Gon, Chlamydia), HIV and Syphillis and HEP screening. Now- after a lot reading - i knew that the most thing they said wasnt right. Test to early, or did wrong things for example no swab oft he troath etc.

So im very confused now. All test where negative – but im still confused. I know most things about „sexworker dont have higher STD quotes than normal people“ or „syphillis ist not common (500 cases in switzerland – about 40 fresh infactions with heterosexuals)“

But im still insecure. What do you recommend? My plan was 1.) Do a swab of the pharyny 2.) Going for a Syphillis (TPPA) and HIV test in 2 weeks (45 days after contact)

Or should i just go on with normal life ? Unprotected sex with my wife? im also worried about my child. sharing food and give a kiss etc.

Kind regards  ElDorado

Sorry for my english…tried my best ;-)

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

The exposure you describe was a low but not no risk exposure.  Most commercial sex workers do not have STIs (although they do have somewhat higher STI rates than the general population), your vaginal sex was condom protected and therefore did not put you at risk, and unprotected oral sex (giving or receiving) is lower risk for STIs than unprotected vaginal or rectal sex.  In addition the azithromycin you took would have cured NGU, chlamydia, most gonorrhea and some syphilis.  All in all, I suspect you are most unlikely to have any STI at this time.

If you are worried and desire the peace of mind that comes with negative tests, then I suggest you get a throat swab for gonorrhea at this time and a syphilis blood test.  There is virtually no risk for HIV, chlamydia or hepatitis from the exposures that you describe.  Personally, I doubt that yo need any testing at all but I do understand that negative tests might provide you with some peace of mind.

Finally, there is no risk even if you did have an STI, of transmitting infection to your children or sife through sharing food, kissing or other casual contact.  I would not be worried.  I hope these comments are helpful to you. EWH

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34 months ago
Thanx Doc. 
So you would suggest the throat swab right now and the syphilis test in 2 weeks or also now?
other question: gonocal pharyngitis is mostly without any symptoms- right? what would happen if i didnt make the troat swab and i had gonocal pharyngitis...? is that dangerous not? and Azithromycin doesnt help for pharyngitis?

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

At this time a syphilis test will detect nearly all recent infections.  Since syphilis is so rare, if your test is negative at this time, there is no reason for further concern.

You are correct, most pharyngeal gonorrhea is asymptomatic.  If untreated, most infections will go away by themselves.  Azithromycin will kill most gonorrhea infections at any site but there are few studies evaluating any drug for treatment of pharyngeal gonorrhea.  EWH

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34 months ago
Okay - and now my last question. 
Does it matter if i do a TPHA- or a TPPA-Test (Treponema pallidum-Hämagglutinations- bzw. Partikelagglutinationstest)?
Some do just TPHA some just TPPA Tests - some say TPPA is allready after 4 Weeks safe, some say TPHA is safe after 3 month.
Thanx for your answers and compliment to your forum. I didnt found anything likely here in europe. 
Kindest regards 
34 months ago
But the Lab just say: we do a screening for IgG and IgM. TPPA is not common. But i guess thats safe as well after 4-6 weeks. Hope so.

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Both the TPHA and TPPA tests will provide you with reliable results at 4 weeks.  We would only recommend an IgG test however as the IgM tests sometimes give falsely positive results (i.e. are positive in persons who do not have syphilis)
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