24 days after potential exposure, I went for a chlamydia blood test, a gonorrhea/chlamydia urine test and a t pallidum ab syphilis test at a well-known lab. The direct-order lab test service said that the t pallidum is an early diagnosis test that is about 99% accurate at 14 days post-exposure, but there is no mention of this on cdc or elsewhere on the web - not even on their own website.  All tests results were negative. Can you confirm that they are conclusive 24 days after potential exposure - especially the t pallidum ab test? The service claims to get their stats direct from CDC.

Also, I ordered a home swab test kit for chlamydia and gonorrhea from a big-box retail store. I swabbed throat, anus and sent in another urine sample (it was a package deal, so why not retest? ).  Would it be safe to say that I am now clean for performing insertive, vaginal sex and will be clean for oral sex upon receiving the throat swab results? Not interested in anal. What's my degree of certainty?

Should I also do an HIV or other test? I read that my risk for other STIs is negligible. I know my status was negative beforehand and I've been vaccinated against Hep B.

Oral sex can be considered safe sex, even unprotected. It's not completely free of STD risk, of course, but STD transmission is quite a bit less frequent than vaginal or anal sex, with low risk for all infections and virtually zero risk for some, such as HIV. Add a condom to the picture and the risk of all STDs can be considered truly zero, or so close to zero that no testing (and no worry) is the consistent advice of all experts. Your symptoms don't concern me:  a stye clearly is unrelated to all this, and I would interpret a sensation of "swollen tonsils" as insignificant, perhaps anxiety increasing notice of trivial symptoms or even normal body sensations that otherwise wouldn't be noticed.

So I would not have advised testing at all, and certainly not the repeat tests that apparently are underway. False positive results are rare, but in this situation, a positive but false test result is much more likely than the possibilty you were infected. In addition, the gonorrhea/chlamydia urine test is meaningless:  you can't acquire these infections oraly and have them show up in urine or in an anal swab. The genital tract and rectum can only be infected by direct exposure. Chlamydia blood tests are useless:  positive results mean an infection any time in the past, but not necessarily at the time of testing; and false negative results also are common. (STD experts rarely ever advise chlamydia blood tests.) The chance of syphilis from this exposure was nil, but your negative test at 3.5 weeks is reassuring, although it takes 6 weeks for 100% conclusive results. I am unaware of data from CDC or elsewhere that any syphilis test reaches 99% sensitivity after only 14 days. As already implied, I see no reason for the additional tests you have done, but you can be confident the results will be negative.

As for HIV, any man having even occasional sex with other men, and no matter how safely, should be tested for HIV from time to time. Assuming this was a one-off event, however, it's really not necessary unless you would like to be tested for additional reassurance. If such exposures occur from time to time, and especially if they are frequent, then annual testing would make sense. But not because of this particular exposure.

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

HHH, MD

Here comes the second guessing:  I'm not sure if there was an invisible tear in the condom or if fluids made their way onto it because it was lubricated and moving a lot.  I would guess that some fluids did find their way to the surface and my throat. There could have been very brief skin contact between genital areas too as we moved around. I also noticed that I had chapped lips beforehand and my slightly "swollen tonsils" that come and go are sometimes accompanied by that dull feeling like the onset of a cold (on and off for weeks). Do any of those alter your advice at all? Should I not test for herpes? Is a home throat swab test pretty accurate?

Finally,  I'm concerned about the "t pallidum ab" test, since it was sold as an early detection test with high accuracy after 14 days. Supposedly, these stats eminated from the CDC. Is the testing company spreading misinformation? Can you enlighten (all of us) on the merits of such testing as a form of early detection? Are the CDC stats publically available and easily accessible? 

Thank you, again for your advice. 

Although conjunctivitis is listed as a manifestation of chlamydia, gonorrhea, or herpes, it's really rare as an STD. I think I've seen maybe 2-3 cases in my 40+ years in the STD business.

There is no such thing as an "invisible tear" that can allow exposure to STDs. And of course secretions can "find their way" along the skin of the penis, but probably not to the urethra or head of the penis. This rarely result in any STD; and in any case, probably no scretion creep occurs after oral sex. (Pretty hard to expose the skin above a condom by oral sex.)

I have no experience with home collected throat swabs for gonorrhea. You should be able to determine the test technology. If a nucleic acid (DNA or RNA test, i.e. NAAT), then it should be highly accurate.

I can't say whether the company is "spreading misinformation". If so, I doubt it is intentional (the FDA penalties for false advertising of medical products are severe). But anyway, you shouldn't focus on the syphilis test as the best evidence you didn't catch syphilis. Use of a condom plus lack of an obvious syphilitic sore (chancre) of your penis together amount to 100% assurance you didn't catch syphilis. That's why I said you didn't need testing for it, and why you can assume your future confirmatory test at 6 weeks will also be negative. Ditto for any and all other STDs from this event. This is why you can continue sex with your regular partner(s) in the meantime.