[Question #478] Questions involving gonorrhea and chlamydia and HPV.

38 months ago
Dr Handsfield and Dr Hook. I had a sexual STD Exposure 5 months ago. I tested out to 16 weeks for HIV, HepB, HepC and Syphillis all wich were negative.( we discussed this on a different question and you both assured me these tests were conclusive. My Exposure was unorotected receptive anal with a partner who said he was HIV- and STD free. After about 3 weeks from this episode I noticed rectal pain, a white discharge on my stool and very painful during a bowel movement and sometimes a little blood on my stool. after about 2 months of this I went and had a rectal swab done which came back positive for gonorrhea and chlamydia. I was treated with a shot and 2 pills. The symtoms went away within a few days. I went back at 4 weeks from treatment and had another swab done which came back Neg. Since I've had bouts of constipation and loose stools and abdominal cramps and lots of passing gas. My questions are 1). Is there anything else I should be tested rectally for( sexually)? 2). Is HPV something I should worry about from this one time Exposure? 3). I've had mild IBS in the past could this Exposure have caused it to get worse?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome back to the forum. Thanks for your confidence in our services. Directly to your questions:

1) Herpes and syphilis are the only other potentially likely infections from this exposure. Syphilis has been excluded, and in any case would have been aborted by the gonorrhea/chlamydia treatment. Your symptoms don't suggest herpes at all.

2) Anal HPV is common in men who have anal sexual exposures. There are no data at all on the risk for any single exposure, but it's probably low. And anal HPV is fairly common even without sexual exposure, mostly from self-inoculation in people with genital HPV (which occurs in at least 90% of sexually active persons). All in all, your risk of having anal HPV is probably no higher on account of this one exposure than it would be otherwise. Get professionally examined if you ever develop anal bumps or sores, but that probably won't happen. Otherwise, I wouldn't worry about it.

3) Your symptoms certainly are typical for IBS. I doubt this exposure or your gonorrhea or chlamydia would cause increased IBS symptoms. OTOH, you probably know well that emotional and psychological factors can exacerbate IBS. So stress and anxiety over your sexual exposure and the rest might be the explanation, but not the STDs per se.

I hope this has helped. Best wishes--  HHH, MD


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38 months ago
Yes, Dr Handsfield I figured stress had a huge impact on alot of my symptoms. I've prob never been more stressed out in my life. I've always been faithful to my wife for the last 15yrs we've been together and never worried about HIV or other std's so this was a first and last experience for me. I did have a couple more questions. Mostly out of curiosity.1) When did you start using the 4th generation HIV test in your practice In Seattle? Did u use it when it was first made available or wait until it was FDA approved. 2) Do u expect the CDC to lower the window period from its old 3-6 months mark in the near future. I only ask out of curiosity and respect. I think you and Dr Hook are  the most qualified experts that I know of anywhere in the US. I've heard only good things and appreciate all u do for us worried wells. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
The 4th gen tests became available a few years after I was no longer director of the Seattle public health STD clinic. They were not used before FDA approval, unless maybe in research studies going on at the time. I can't speculate whether CDC might someday take a less conservative stance on their routine advice on time to conclusive test results, but probably not in the near future. CDC already states that a large majority of infected persons have positive results by 4 weeks.

My last general advice is to do your best to separate the emotional aspects of a sexual decision you regret and STD/HIV risks from that decision. They aren't the same. Deal with the former as you need to, but you owe it to yourself to manage the latter with calm, cool analysis and logic.That includes ignoring EVERY "yes but" or "could I be the exception" thought that comes to mind. You will not be.

Thank you for the kind words, although I reject that Dr. Hook and I are "the most qualified experts". Don't confuse having an online mouthpiece with expertise. There are plenty of unreliable resources (in health or any other area) online.

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38 months ago
Thanks Dr Handsfield I have a few last questions. 1) I know you've mention that there are few things that affect HIV tests and that the 4th generation test are foolproof 4 weeks or more after Exposure. There was a report in the NEJM in 2005 about an individual who had Hypogammaglobulimia who didn't test positive on a ELISA even after a year.1) If a 4th generation test were used in this testing would it have still considered conclusive after 4 weeks? 2) I've never really been that sick all my life and have never been tested for CVID. There were a few years back when I got chest infections during the winter and had to use an antibiotic inhaler for a month. I've had one sinus infection this year where I used an antibiotic, but that's about it. Do you think I should get tested for a CVID of any kind? I'm 35yrs old.3) I've had 6 HIV 4th generation tests along with 3 HIV RNA TMA tests in the last 5 months from Exposure surely these would have picked up any abnormal antibody production correct? Thanks Dr Handsfield
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
1) Yes. That's the whole reason for development of combined antigen/antibody testing and why the 4th gen Ag/Ab tests are superior. If antibody doesn't develop, antigen will still be detected. In fact, the strength of the Ag component would probably be even greater.

2) The large majority of people with hard to treat bacterial infections do not have CVID or any other identifiable immune deficiency. And most people with CVID are seriously ill for life, starting in childhood. So this seems unlikely.

3) You have been rather grossly overtested. It is impossible to have HIV and have all these tests negative. As just discussed, if somehow your antibody production were impaired, the Ag component of the 4th gen tests would have made them positive; and the RNA tests would all have been positive as well.

It is far beyond time for you to accept the repeated, reasoned, science-based reassurance you have had, probably from your own doctor(s) as well as on this forum. If you remain doubtful, professional counseling might be in order. It simply is not normal to have such difficulty accepting such realities. I suggest it from compassion, not criticism. And for goodness' sake, stop testing for HIV -- and I would also suggest you swear off any further internet searching about it.

That concludes this thread. Please don't start another on this same exposure and testing. Thanks and best wishes.

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