[Question #5042] What to do?

24 months ago

Firstly, I am utterly disgusted with myself as I have cheated on my wife with a colleague from work.

What makes it worse is that I was so drunk we didn’t use a condom – initially just using foreplay, unfortunately she then climbed on top of me and forced my penis inside, once inside I stupidly didn’t stop. I didn’t ejaculate inside, and she has said she took a morning after pill the next day. Unfortunately, the situation gets worse as me and my Wife are about to start trying for a baby, my Wife has pill but we are using condoms as we want to wait until after a big family trip before getting pregnant. 

I also suffer from anxiety, which establishes itself as catastrophising. I would appreciate some guidance on the STI risks of this encounter.

  1. I am a 32 YO male, faithful to my partner until now
  2. Colleague is in her late 30’s, married with 2 children. I don’t know her sexual history but she has been trying to sleep with other colleagues recently
  3. She also said she was adventurous when it comes to sex
  4. We engaged in foreplay, hands only for 30-45 mins followed by 10-15 of unprotected vaginal sex. I am 90% sure that all ejaculation was outside
  5. After 1 week I have no symptoms, rashes or lesions
  6. Due to my anxiety I started taking Oxytetracycline last night

Questions

  1. What should I get tested for?
  2. How long should I wait to get tested?
  3. I don’t want to have to tell my wife as I love her so much, the guilt is tearing me apart inside but I can’t see any benefit to ruining her life and our relationship if I don’t have to. Should I tell her due to the lack of protection or is the exposure risk sufficiently low, bearing in mind we will be using condoms for the next 6-8 weeks?
  4. Should we delay trying for a baby and if so, for how long? This means I will have to tell her but maybe I should given the potential risks?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

This sounds like it could have been a fairly high risk exposure for STDs, if your description of your co-workers sexual behavior is accurate. But still, the chance of any STD generally is low for any single exposure. Even among the highest risk women and straight men, at any time only a few percent have a transmissible STD. And not having symptoms after a week is reassuring:  most STDs cause symptoms within that time. It can take longer for some, such as chlamydia and nongonococcal urethritis (NGU) (up to 2 weeks). And still longer for syphilis, but syphilis is so rare in such persons that there's little need for worry. Also, HIV is nearly zero risk in this situation.

It was a mistake to take the antibiotic. The main effect is to make diagnosis more difficult for all bacterial STDs -- i.e. you could have acquired gonorrhea, chlamydia, NGU, or syphilis and have delayed or false negative testing. Definitely do not take any more doses. The tests for these infections still are likely to be valid after only 1-2 doses, but after that you could be screwed (pun intended!).

To your specific questions:

1) Tested for gonorrhea, chlamydia, syphilis, and HIV. The chance of gonorrhea is extremely low, since almost all infections cause obvious symptoms within a week, but better safe than sorry. Chlamydia can have later symptoms -- and many cases never cause symptoms at all; that's the highest risk in this situation. As noted above, the chance of either HIV or syphilis is extremely low.

2) For gonorrhea and chlamydia, get tested ASAP, preferably today or tomorrow. The standard test -- either on a urethral swab or urine -- is valid any time more than 4-5 days after exposure. But having taking the oxytetracycline, you must be tested within a day or two for a valid result. After that, negative tests will be increasingly difficult to interpret. Blood tests for syphilis and HIV should be done at 6 weeks.

3) I agree there is no need to say anything to your wife, at least not yet. Within a few days, you'll know the results of gonorrhea and chlamydia testing. If negative, as expected, it is safe to have unprotected sex. While there's a theoretical possibility of HIV or syphilis, these are so unlikely that you shouldn't hold off on that account. (Aside from infection risk, some persons in your situation inform their partners of their indiscretion -- for emotional and relationship health. But this is a personal decision only you can make and I have no advice about it one way or the other. But if you decide to do it, it makes sense to wait until you've been tested for gonorrhea and chlamydia.)

4) Assuming the gonorrhea and chlamydia results are negative, I see no need to delay attempts at conception. Good luck with it!

Also consider asking your co-worker to be tested. You may find she is just as concerned about STD risks as you are, or at least willing to test. If she tests negative for all these, you'll know you could not have been infected. In that case, both of you could be tested now for gon, chlam, HIV, and syphilis -- no need for delayed testing later.

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

HHH, MD
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24 months ago
Dr Handsfield, many thanks for your detailed reply it is much appreciated.

Unfortunately due to delays in gettting my account set up and posting my question the comment re the antibiotics is somewhat out of date. It was clearly another bad decision, thanks anxiety, but I actually started taking these approx 3 days ago. How long before I can now get an accurate test result for Chlamydia?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
You should still be tested ASAP. If negative for gonorrhea and chlamydia, you'll never know for sure whether or not you were infected. But if positive, that result will be reliable. In any case, the longer you go, the less likely testing will show anything, even if you were infected.

At this point in time, you might as well continue the antibiotic to complete a full week. If you do that, there will be no point in ever being tested for syphilis:  even if you were exposed, the drug will have aborted any chance of infection and testing will never be positive. But the chance of syphilis is so low that this is all moot anyway. You still should have an HIV test in a few weeks, however.
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24 months ago
Hi Dr

Been doing a little follow up reading and research here, dangerous i know but mostly using the other responses on the site, and i'm a little confused.

In other situations the test results, following a speculative course of antibiotics, are negative due to the antibiotics having cleared the infection (my anxiety ridden intention) and therefore the issue is not knowing whether you had the infection in the first place rather than a false negative?

If this is the case am i better to finish the course of Oxytetracycline and wait 3-4 weeks to make sure there is no infection?

Or should i still stop taking and wait longer to be tested?

Either way my only concern is for my wife's health and well being and trying to protect that any way I have to. Please note that we are currently using condoms due to her recently coming off the contraceptive pill so any sex would therefore be protected, until we start trying for a baby, which maybe we should now delay?

Thanks again for all of you advice and the wonderful job you do for so many on this forum.




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
"In other situations....":  Mostly correct. While on treatment, it is coneivable that a negative test could be false, i.e. suppression of the infection without cure. However, this probably is rare with the standard DNA tests, although there has been no actual research on this. This is more a problem with chlamydia culture, which is almost never used by most labs. Assuming a negative test result, you can be sure you were not infected at the time of the test, but no way to know if infection had been present and resolved. 

There's no right or wrong in this situation. If it were me personally, I would stop treatment now and then maybe be tested in about 2 weeks. No need to wait 3-4 weeks.

I understood your conception plans and answered this question in my initial reply. I see no need to delay.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.
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