[Question #5834] General concerns

20 months ago
Hello Dr’s, just over 3 weeks ago I had a misstep at an Asian massage location in NYC with a female worker. I’m a heterosexual married mid 30’s male. The encounter involved me giving brief oral (30 seconds max), receiving protected oral, protected vaginal and very brief unprotected vaginal for no more than 30 seconds too. I have not experienced any symptoms besides anxiety over my poor decision. I did a urine test for gono/chlam  after 6 days which came back negative and a HIV RNA after 12 days that came back negative too. This was a 1 off situation and my worries/question are what are my risk of possible other STD’s? I have foolishly never been tested before so this is all new to me. I’ve read plenty of other threads and based upon answers I’ve read it would seem that my risk are low but not zero.

So I guess the real question is should I still be tested? (Was thinking about a 10 panel at a full 6 weeks)

What’s the possibility of herpes, HPV, syphilis from a 1 time exposure with no symptoms?

Should I be worried about anything else STD wise? 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Welcome to our Forum.  I'll be glad to comment, first providing some more general comments and then following with specific comments related to your recent testing:

General Comments:
1.  This was a relatively low risk event.  Most commercial sex workers do not have STIs and even when persons are infected, the risk for becoming infected is rather low.
2.  Few STIs are transmitted or acquired through oral sex.  There are no proven cases in which HIV have been acquired from receipt of oral sex or from performing oral sex (cunnilingus) on an infected woman.  
3.  While it is logical the a shorter exposure should be lower risk for infection, the fact is, unprotected exposures are unprotected exposures.  
4.  Worrying about HPV is a waste of time.  Over 80% of sexually active Americans who have not had the HPV vaccine already have HPV. The infection typically clears by itself, without therapy over a period of months to several years when persons acquire it.  For men there are few consequences and no approved tests.

Specific Comments:
1. Your gonorrhea and chlamydial tests at 6 days provide definitive results, proving that you were not infected.  A question however- did you also have a throat swab test for gonorrhea?  If not, there is a (mostly theoretical) risk  that you could have acquired gonorrhea of the throat when you performed oral sex on her.
2.  Your HIV RNA PCR test is well over 98% sensitive at 12 days.  While some experts would suggest a repeat test using the standard, 4th generation tests 4-6 weeks after exposure, I have never seen such a test become positive after a negative RNA test.  Personally, I would not worry.
3.  Herpes- no symptoms at 3 weeks, no need for testing.  Blood tests for HSV are specifically recommended against in this situation because of problems with false positive and false negative results.  
4.  Syphilis, very, very unlikely.

So, do I see a need for further testing, no.  You should be fine.  Hope these comments are helpful. EWH
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20 months ago
They did not give or offer a throat swab. When I explain the encounter to the dr at the urgent care they even said that they didn’t feel testing was necessary but let me do the urine test either way. Do you think I should still have the throat swab test? Would I have any symptoms if there was an issue? Again, after 3 weeks everything feels normal at this point to me... 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Optimally, when you tested, they should have offered it even though infection was unlikely.  Gonorrhea of the throat is typically asymptomatic. If I were you I would not bother to test at this time but if you are anxious or nervous there is no reason not to test.  If you do, I predict your test result will be negative.  EWH ---
19 months ago
Good morning Dr. Hook,

Well my anxiety got the best of me so over this past weekend I went back into the clinic and asked for the antibiotics simply out of an abundance of caution. They gave me a 1 time dose of 4 pills at once (Zithromax 250mg) and some sort of injection (the injection wasn’t printed on my discharge paperwork and I forgot to ask what it was). They did give me another urine test too but did not offer the swab. I expect results back today or tomorrow but since the first ones were negative I expect these to be too. The only symptoms I have been experiencing would be tenderness or slight irritation on my inner thighs and on the head of my penis along with the shaft. The head of the penis looks slightly more pink than normal but not sores at all. There are also no sores anywhere else on my penis or scrotum. I did notice 2 other things, one is a small piece of what looks like dry skin on the shaft but that was noticed just a few days after exposure. From what I read if it was a wart it takes several weeks to to months to show up. Last thing noticed just yesterday is a small red spot that is tender in my pubic area that has a hair coming out of it. I would honestly chop that up to an ingrown hair which I get from time to time. They typically go away in a few days when they come up...

Anything further you can think of with this additional info? My assumption is if I had any basic bacterial infections is that the antibiotics would have cured them, correct? Please let me know if my symptoms are something to be worried about or just my anxiety getting the best of me. I’m still on the fence for further testing but the possibility of false positives give me anxiety too! :-/
19 months ago
Just to clarify where I have the irritation on my thighs and other areas there are no visible rashes. 
19 months ago
Sorry, 1 last thing to add would be frequency of having to urinate. It comes and goes and I can hold it but it feels like I have to pee frequently. No issues when going (burning etc.). 
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Final responses.  My sense is that you are "on the lookout" for signs of STI and are noticing normal variation in the appearance of your genital regions which would have gone unnoticed were you not worried. Further, it is well known that when one is looking for unusual sensations, what happens is that otherwise normal sensations that would typically been overlooked are noted.  This is particularly relevant to the sensations you have noted on your thighs and the observation of dry skin and possibly increased pink coloration of the head of your penis.  You are also correct hat if you were going to develop a wart, it would take months (no just weeks) to see a lesion.  

Urinary frequency is not a sign of STI.  It is a sign of anxiety.

The treatment your received (likely unnecessarily) was likely a combination of ceftriaxone (the shot) and azithromycin (the pills) which are recommended therapy for gonorrhea and chlamydial infections.  

At this point following treatment, further testing would be a waste of time and money.  This ends this thread.  EWH
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