[Question #561] Condom broke - chlamydia and gonorrhea - tested 47 hours after exposure

45 months ago
Hi Doctors,

I'm a 30 year old caucasian male living in a capital city in Australia. 3 and a half days ago I had protected oral and vaginal intercourse with a CSW. I had intercourse for under 5 minutes and when I withdrew I noticed that the condom had broken and my penis was completely exposed. I washed up immediately. I asked her about her health status and she said she was 100% clean, and that she had regular tests every 3 months. She was a private worker, in her mid-40s (also caucasian). She was not a streetwalker and I didn't get the impression she was a drug user. She insisted on protected oral and intercourse before the incident and advertises this also.  

I understand HIV is an extremely low risk. I'm worried about the odds of contracting chlamydia or gonorrhea. I was tested for both of these at a local sexual health clinic 47 hours following the incident. Both results came back negative. I've not have any symptoms. 

I've read some a lot of information online and I feel that my odds for contracting anything are under 1%. I know infection is unlikely even if she had something, and it's unlikely that she did anyway. 

My main concern is the accuracy of these tests after 47 hours. I'm hoping you can help put my mind at ease. I'm reading a lot of info that says 3 days to a week for accuracy. 

It's difficult to avoid unprotected sex with my usual partner at this time and doing so would raise suspicion. Doctors, if you were in my situation, would you think it was OK to recommence unprotected sex with my usual partner? 

I'm sick with worry and hoping you can help ease my mind. 

I intend to be retested in a week and again in another 3 months. 

Thank you for your time. 

Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to our forum. I'll be pleased to answer your questions about this unfortunate event.  FYI condoms do break about 1% of the time- when you combine this with the fact that most people, even most CSWs do not have STIs and the relative inefficiency of transmission of STIs following a single exposure, they remain far and away the best and most effective means of preventing STI acquisition.

In the instance you describe, you have done everything right.  You ask your partner about her status and got tested.  That your partner was a professional is also to your benefit as most professionals take appropriate and effective precautions to make sure they are not infected or, if they do become infected, to get treated in a timely fashion.  If she were infected, estimates are that your risk for infection following a single exposure is about 1 in 5 - these estimates are based on studies performed years ago focused on gonorrhea but remain the best data there are; there are no similar data for chlamydia.  Your question about how long it takes for a test to be positive is more difficult to answer and is likely to vary according to the organism you are considering.  There are data that indicate that gonorrhea are typically detectable 36-48 hours following infection so I suspect that your gonorrhea test results are completely reliable.  There are fewer data for chlamydia and chlamydia has a slower life cycle than gonorrhea so testing at 47 hours following exposure (and possible infection) may not be completely sensitive BUT, when considered in combination with all else I have mentioned above is further strong evidence that you were not infected.  Personally, were I you, I would not worry further and would not seek further testing.  However, if you want to be 100% sure that you were not infected, another test at this time would provide complete accuracy.

I hope this comment is helpful to you and will alleviate some of your concerns. Take care. EWH

---
45 months ago
Thank you so much, doctor. My wife and I are trying for a baby and I've just been told that tonight I need to have sex. 

I take it from your response that the chances are so minimum that this should be fine to go ahead with and not worry any further? Are we talking 1/1000?

I've also been told that Chlamydia takes a week to show symptoms and that 50% of cases in men are asymptomatic, is thus correct?

The advice I received from the sexual health clinic was that I really should wait until another week and a retest... 

I feel that most sexual health advice is a lot more conservative than the advice given by yourself and Dr Hansfield but I'm guessing that's just worse case scenarios.

If you could reassure me that I can continue sex with my wife immediately I'll be very happy and you can close this thread.

It goes without saying that I feel terrible and will never do this again. Thank you once again, Doctor.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Correct, , I see no reason to abstain from unprotected sex with your wife at this time.  You are correct that chlamydia can take a week or more to become symptomatic and that over half of infected persons are asymptomatic BUT the tests are positive well before symptoms occur.  I think your sexual helath clinic is being overly conservative.  EWH
---
45 months ago
Hey Doc,

Thanks so much for your kind reassurance. I've recommenced unprotected sex with wife. 

I've noticed a small redish mark on the shaft of my penis. Looks like a bump. I assume I'm probably just freaking out. 

Can you please tell me about the other possible risks? Herpes/HPV? Are symptoms like this likely to show at the 5 day mark? 

Thanks for your time. I hope I'm just panicking and this shouldn't be a concern... 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

As you know, we are limited by Forum Guidelines to three responses per question, thus this will need to be my last response.  Should you have further questions, you will need to start a new question.

As I indicated before, this was a low risk event.  The STIs which cause lesions are HPV, herpes and syphilis.  This is too early to possibly be HPV (a genital wart) or syphilis.  As for herpes, what you describe is not suggestive of HSV and this too is a little early for the appearance of a herpes lesion but within the realm of possibility as the appearance of HSV lesions as sometimes not "typical".  The lesion of HSV would more typically be multiple and associated with local discomfort at the site.  The lesions would be expected to evolve to form small vesicles ("water blisters").  My other suggestion is that this could be something that has been present and given your concerns over this exposure, is something that you are only now noticing.  could that be a possibility?  If you are really worried, the best thing you could do would be to have an experienced clinician take a look and make an assessment. If tested is needed (and testing can be performed on any lesion, not just blisters or open ulcers), the bet test for HSV is a PCR test.  Blood tests for herpes have no role in the diagnosis of acute lesions such as this.

I hope this is helpful. EWH

---
45 months ago
Thank you, Doctor. I think I was just imagining things. All looks like it's normal today. Still no symptoms. 

I will take your advice, seek no further testing, and put this behind me. 

You are doing an incredibly important job. Thank you and best wishes. 

44 months ago
Hi doc,

I'm so sorry to ask yet another question but hoping you could let this one slide through. 

I am wondering why you said that you see no reason why I can't resume sex with my wife, despite the fact that it's unlikely Chlamydia would show up 48 hours after the incident. 

Wouldn't there still be that risk?

Did you say that because you think the risk is so small it's not worth worrying about, or because you feel that Chlamydia may show up after such a short window?

Thank you, I'm sorry to take up so much time. 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

I informed you the third response was the final one.  I will briefly address this question but then will close the thread as it appears to be the best way to help you follow Forum guidelines. 

The risk is so small that there is no reason to worry.  EWH

---