[Question #43] Concerned

40 months ago

Morning.

11 days ago had unprotected sex with lady I did not know outside of marriage. Noticed blood on my boxers 3 nights later, I had been obsessing and checking for symptoms regurlaly.  Tested after 3 days came back negative for chlamydia and gonorrhoea. Took azithromycin in intervening period before negative results came back.  All seems ok however on night 8 I again noticed blood on my boxers. No other  discharge even when milking the penis. I am planning on having another test later today. My questions:-

1 If negative again will this be reliable at 11 days

2 I understand after much research that blood is not 'normally' an indicator of an STI, I have been obsessing so maybe all the self checking has caused this?

3 If test is negative I plan to try and move on and put the experience behind me - would you suggest any other testing?


Thank you,

40 months ago
Update - Just had swab taken and negative for both gonorhhea and chlaymdia- Can I move on? - Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to Ask the Expert. I'll try to help.

You don't provide enough information to completely judge STD risk, such as nature of your partner (friend? coworker? bar pick-up? escort? street sex worker?).

You imply but don't say directly that the blood seems to be coming from your penis, right? You are correct this is rarely due to STDs. Urinary tract injury is a more common source, e.g. from off road biking, horseback riding, etc; or a bladder/urethral stone (but that would be very painful). Repeatedly squeezing the penis to look for discharge usually doesn't cause bleeding, but I suppose that's possible -- so I would suggest hands off. If there is no discharge that appears all by itself, e.g. staining your underwear, you can be confident you have no STD involving the urethra. 

To your specific questions:

1) The azithromycin probably would have cleared either gonorrhea or chlamydia, so there is no point in retesting for them. A negative result now will only mean you have no infection at this time, regardless of what might have been present earlier. Don't waste your money. (Oops -- now paying attention to the update info: I guess you were already tested. But it isn't possible to have immediate results. There are no available accurate rapid tests for gonorrhea and chlamydia that give results while you wait.)

2) Correct; see above.

3) Standard practice (e.g. in STD clinics) is that routine testing includes gonorrhea, chlamydia (already done) and blood tests for syphilis and HIV,  about 6 weeks after the exposure. The chance of either of these is exceedingly low, but could be a bit higher depending on the nature of your extramarital partner (see above).

My only other advice is you could have saved yourself a lot of worry if you had used a condom. Something to keep in mind if and when similar opportunities or circumstances come up in the future.

I hope this has been helpful. Best wishes--  HHH, MD
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40 months ago

Thanks for your reply.  In answer to some of the points you made, the partner was a married middle age lady on a works function whom I met in a hotel bar in UK. The 'episode' was very brief, maybe a maximum of 15 minutes over a few hours.  Apparently it was not a regular occurrence for her to do this.

The additional test I have had today was carried out here https://www.better2know.co.uk/page/instant_results . Results were available within 30 minutes both negative however I am 2 days early re the 14 day incubation period. This was a swab insert and then wait for results.

 Final questions as I acknowledge there is a limit.

1, I tested 3 days after exposure - Negative - would this have been conclusive? (Regular urine sample - 48hrs to hear back)

2, Would you be comfortable with the test that has been carried out today in conjunction with the previous test and the azithromycin

3, Bearing in mind back ground of the 'partner' after reading this and other forums once I got the negative I was not going to consider further testing - Would you agree?

Trying to get back to normal and not alarm or alert my wife whilst trying to keep her safe........


Thanks


40 months ago
Sorry - the blood appears to have come from penis - happened twice 6 days apart, last time over 48 hours ago.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Thanks for the clarifications/questions. You describe a partner at low risk for STDs. The frequency of either gonorrhea, chlamydia, or anything else in a married women in the UK, beyond age 30, is exceedingly low -- and especially so if such encounters are not "regular occurrences". And she is at virtually zero risk for HIV or syphilis.

I stand by my comment about rapid tests for gonorrhea and chlamydia. As you found, such testing is marketed and offered on line, but that doesn't change the fact that such tests are terrible; they miss at least 10-20% of infections, maybe up to 40%. Only standard, lab-based tests -- like the ones you had initially -- are ever used or recommended by STD experts. You got sucked in on that one. (That said, research on rapid testing is ongoing, and it's posslble one of them will prove useful, and I can't say for sure that this hasn't already happened. But I doubt it. If such a test worked well, it would be big news in the worldwide STD scientific community.)

1) The first test was valid. Slightly early for chlamydia, but still 3 days would pick up almost all infections. And for sure OK for gonorrhea.

2) For gonorrhea and chlamydia, I'm comfortable with the combination of a) a virtually zero risk exposure, b) negative test at 3 days, and c) azithromycin. With those factors, the chance you are infected is zero. The most recent test doesn't change my judgment one way or the other, because you can't get to a lower risk than zero!

3) For sure you don't need further testing for urethral STDs. However, if the blood reappears again, especially if it shows up in the absence of squeezing the penis, it should be professionally evaluated either by your GP, a urologist, or one of UK's excellent NHS GUM clinics. As for syphilis and HIV testing, the risks are zero for practical purposes, so it's up to you.

I see no reason for you to not resume unprotected sex at home. While of course from this distance I can make no guarantees, if I were in your situation, I would never have stopped having unprotected sex with my wife.
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40 months ago
Thank you for responding promptly it is much appreciated 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
You're welcome. I'm glad to have helped. Now that you're registered with ASHA (of course with a firewall that keeps this discussion separate from that registration), and if happy with the services you've received, consider making an additional contribution to ASHA.

This thread is now closed. Best wishes and stay safe.
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