[Question #5662] Testing question

21 months ago
Good morning, Dr’s

I have multiple sexual partners and almost always use condoms. I also test frequently. The only std I’ve ever had was NCNGU from oral sex. 

Roughly 17 days ago I had an encounter with a couple. My exposure was unprotected oral and vaginal sex with the female (they are a married couple). I did not have any contact with the male. 

In a panic I took some antibiotics the next day: 1 g azythromycin and 100 mg doxy. (I know this probably wasn’t smart). 

The couple insist I have nothing to worry about but also haven’t been tested recently.  They are active swingers and say they always use condoms. 

My questions are: 
1) I plan to test in a couple weeks for all stds. I have not had any symptoms. I’ve read conflicting advice around herpes testing. In the absence of symptoms, is it advisable to test via an IGG test given the possibility of a false positive? And moving forward should herpes testing be included in my routine testing in the absence of symptoms? 
2) Is it safe to assume that the dose of antibiotics i took would have effectively aborted any possible gonorrhea, chlamydia, syphllis etc? Again i realize this wasn’t wise but I panicked because I broke from my consistent condom use . 

Thank you for your guidance
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to the forum.  I happened to be on the site at about the time your question arrived and so you are receiving a response somewhat more quickly than is typical.  I congratulate you on your (mostly) commitment to safe, condom protected sex.  I agree with you that your most recent, unprotected exposures probably was not the best and that the likelihood of infection is low but not zero.  I suspect we both wish you had not taken the antibiotics- that will just cloud this issues.  As for your specific questions:

1. We strongly recommend against serological (blood) tests for herpes.  The currently available tests can take 3-4 months to become positive, are prone to false positive and, for HSV-2, false negative test results.   Further, unless you have been tested in the past, a positive test will not help you to know when you were infected.  I would not suggest HSV testing unless you have symptoms.
2.  A single dose of doxycycline would not necessarily do much of anything with your risk for infection.  the azithromycin would prevent chlamydia and some gonorrhea but perhaps not all (gonorrhea is becoming increasingly resistant to antimicrobial agents.

Bottom line:

If you are still asymptomatic, it is unlikely that you are infected although the azithromycin you took could, at least theoretically cloud the picture.  If you are at all concerned, testing might be a good idea although, I do not feel strongly about this recommendation and anticipate that, if you test, the results will be negative.

I hope this perspective is helpful.  EWH
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21 months ago
Thanks for the reply, Dr Hook. 

Regarding the herpes testing, all of my previous tests have included igg tests for both hsv 1/2 and always been negative. So, I’m fairly confident that my only possible exposure would be my latest escapade. 

All of that said, can I feel confident that I didn’t contract herpes from this event being that I haven’t had any painful blisters , flu like symptoms etc 17 days out? I understand that many people do not have symptoms l.   But I’ve been like a detective looking for clues :) I guess I’m asking - how can I ever know if I have it? 

I suppose I should also test for HIV just to be safe. 
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for the additional information on prior tests.  That you have had prior negative tests makes having a false positive test somewhat less likely but does not eliminate the risk entirely.  That said, I am still not a fan of regular blood tests for HSV and would not encourage it for you unless you develop symptoms.  Since most symptoms of newly acquired genital herpes occur within 10 days of exposure and you are beyond that, you are unlikely to have develop them.

I should add that our back of the envelope estimate is that, if your partner did not have lesions at the time of your exposure, even if she did have HSV at the time of sex, your risk for infection would be less than 1 in 1000.  EWH
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