[Question #5150] What to test and how soon?

25 months ago
Dear doctor,
I had a new incident of sexual exposure last Friday night. Which is approximately 3 days ago. 


I had a sexual exposure with a girl, she was an escort. I was really drunk and passed out on the bed and she woke me up.  We kissed heavily, and she gave me oral sex without a condom. I remember using a condom when I had vaginal sex with her, because when I woke up I saw the condom with semen in it. 
The thing is that I was really drunk that I don’t remember whether I used it from the beginning or half way through. 

My question is, what should I test for? And how soon should I test?

Thank you
25 months ago
Part 2) 
Also to mention I have a red spot under my penis head. I’m not sure if it is a pimple or an irritation because I masturbated last night. And I feel like a weird sensation under my jaw and neck. Is it too soon to get symptoms?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
Welcome back. But this is your ninth question in two months, all of them following exposures with little or no risk. This is going to have to be your last question of this sort. We are not a site for analysis of the risks associated with every new sexual exposure, especially if the exposures are low risk as covered in previous replies. 

Receiving oral sex is low risk for all STDs and zero risk for some. We never advise testing after any particular oral sex exposure unless there are symptoms that suggest a new STD or other special circumstances, like a partner known to be infected with a particular STD. And despite your uncertainty because of alcohol, the evidence is strong that the vaginal sex was condom protected. In addition, escorts -- by which I mean expensive female sex workers who work by appointment (as opposed to brothel workers, bar pick-ups, etc) -- generally are believed to be at low risk for having active STDs. Typically they know the score, get tested frequently, and their partners usually are low risk men (guys like you). Finally, no STD is a likely cause of the red spot on your penis, and certainly not of discomfort in the jaw and neck.

So my advice is to give it another 3-4 days to see if more worrisome symptoms develop (e.g. penile discharge, painful urination, penile sores). If not, I do not recommend testing. However, I understand that anxious persons often are more reassured by negative testing than by professional opinon, no matter how expert. So if you decide to be tested, it's fine with me. In that case, I suggest a urine test for gonorrhea and chlamydia, which is valid any time more than 4-5 days after exposure; and blood tests for HIV and syphilis, which should be done at 6 weeks.

As implied above, the forum discourages repeated questions on the same topic or exposure, or type of exposure. You should expect that future new questions along these lines will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 


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


HHH, MD

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25 months ago
Thanks for your reply. 
Doctor your professional opinion is highly respected and I follow it. What I meant about the jaw discomfort is that it might be swollen lymph node. Also to say I have one swollen node in my left armpit. 

How about testing for hsv 1 and 2? Hpv? Candidas? And others.. what is the time line for such stds? 

I am speaking to a girl, and I’m thinking to have something serious with her. So before doing so I want to clear myself of everything if there’s anything. 

Thanks doctor. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
If there's not an obvious swelling, the discomfort isn't from a lymph node. And no lymph node can become inflamed this soon after exposure. And it was your genital area that was exposed, not your mouth and throat. You can't get HIV symptoms sooner than 8-10 days after exposure.

I have stated the only STDs for which I would recommend even consideration of testing. I would strongly recommend against testing for the others you mention. Candida is not an STD and you can assume you already have it on your skin, in your intestines, and perhaps the genital area. Candida is an entirley normal compotnent of the various bacteira, viruses, yeasts, and fungi that inhabit us.

I don't know what you mean by "I'm thinking to have something serious with her". If you discuss the situation with her, it should be senstive and not accusatory; should not indicate you have anything that suggests you caught anything; but that you're concerned and would be happy to pay for STD/HIV testing if she would be willing. You have absolutely no case and no moral right to say anything different. That said, if she agrees to be tested, then it should be only for gonorrhea, chlamydia, syphilis, and HIV. If those are negative, you'll know for sure you weren't exposed. But you really shouldn't be so concerned anyway. I explained the reasons above.
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25 months ago
Dear doctor 

So I spoke to the girl and she accepted to get tested. I tested her for hiv combo and it was negative. Tested for hep b and c both negative. 

As for hsv1 and hsv2. She tested positive on both IGG. And negative on both IGM. 

Syphilis still pending. 

Please advice what I should do next?
25 months ago
Update


Dear doctor 

So I spoke to the girl and she accepted to get tested. I tested her for hiv combo p24 and it was negative. Tested for hep b and c both negative. 

As for hsv1 and hsv2. She tested POSITIVE on both IGG. And negative on both IGM. 

Syphilis RPR is negative. 

Please advice what I should do next?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
25 months ago
My advice above was that if she were to be tested, it should only be for gonorrhea, chlamydia, HIV, and syphilis. It was a mistake to ask her to be tested for HSV. First, the tests are not completely reliable. Almost certainly she has HSV1, but more information is needed to know if she has HSV2 -- the type of test and the numerical value. Even if she has HSV2, however, your risk is low:  in absence of an outbreak, the chance of transmission during a single episode of unprotected vaginal sex is rougly once for every 1,000 encounters. Since a condom was used, the chance you caught it was even lower, one chance in several thousand. Further, in order to understand your risk, you would need testing now, to see if you already are positive for HSV1, HSV2, or both. If you don't do that, it will be impossible to interpret future HSV testing to see if you were infected despite the low odds. For those reasons, I suggest just dropping the whole herpes concern. No more testing for either of you.

Testing her for hepatitis B and C also was unnecsssary and not recommended.

The useful tests in your partner are the neggative RPR and HIV test, proving you were not exposed and could not have caught either syphilis or HIV. You don't need to be tested yourself, unless you would like to do it anyway for extra reassurance. If so, have an antigen-antibody HIV blood test and syphilis blood test 6 weeks after the exposure.

You don't mention gonorrhea and chlamydia. If she had a urine or vaginal swab test that was negative, you're done. If not, you can have a urine test yourself, which is valid any time more tna 4-5 days after exposure.

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