[Question #6049] Concerned about STI

17 months ago
Hello,
Female in her 30s. I have given unprotected oral sex to a guy two days ago.. and there was some genital to genital contact for about 30 seconds (he tried to get it in, if you will pardon my french) before I stopped him and asked him to put on a condom.

What am i at risk for here?  

I want to get myself tested regardless of your reply. How quickly can i do so and expect to get an accurate diagnostic? I live in a country where they do PCR tests on a 10 STI panel (including ureaplasma and mycoplasma). My main concern is frankly herpes as there is no cure.

Thank you for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome back to the forum. I reviewed your recent discussion with Terri about herpes. As she said there, the risk of any STD -- not just herpes -- was very low from the exposure you have described.

There is minimal risk from genital apposition without penetration, primarily for the STDs transmitted primarily by skin-to-skin contact (herpes, HPV, syphilis) --  but even here, the risk is very low. As for performing fellatio (oral-penile contact), the main risks are for oral gonorrhea or herpes, and in theory for syphilis, although syphilisi s rare in in most heterosexual men in industrialized countries. (You don't say exactly where you are -- feel free to let me know, as it might influence my thoughts about syphilis risk.) On the other hand, in your other thread it seemed the "oral sex" you performed was brief and mostly involved contact with his scrotum and not penis, in which case there was no risk at all. Feel free to provide more detail about it.

As for testing, I don't see any need for the 10 test panel. Undoubtedly that normally is a combination tests on blood and vaginal swab or urine. But you aren't at risk at all for most tests in the panel. There certianly was zero risk for Ureaplasma, which isn't even an STD -- just a normal genital bacteria. If the mycoplasma test is for M. genitalium, at least that's an STD -- but most genital mycoplasmas (e.g. M. hominis) is also normal and harmless. As Terriy informed you, there is simply no point in testing for HSV in this situation:  there is almost no chance you were infected with HSV, and the HSV blood tests have problems -- a negative result won't necessarily prove you don't have it, and a positive result also may be unreliable, or will just indicate past infection unrelated to this event.

In summary, if you get any testing at all, I would recommend a throat swab for gonorrhea (which will usually include chlamydia automratically, although oral chlamydia is rare) and blood tests for HIV and syphilis, but the blood tests are pointless until 6 weeks after the event. Alternatively, if you're in touch with your partner, you could ask him to be tested. If negative, you'll know you were not exposed.

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

HHH, MD
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17 months ago
Thank you Doc for your quick reply. I really appreciate it and the great work you guys do on this forum. It is mind opening and sheds lights on so many issues I've been concerned with over the years.

The question that Terri had answered pertained to a separate incident. I'm not sure if you were aware of that fact or if it would change your assessment of today's concerns. Also, to answer your question, i live in the United Arab Emirates (i don't think syphilis is prevalent here at all).

I'd like to test for gon and Chlamydia in any case. How soon can i do so? It's been 57 hours since the encounter.

Also thank you for alleviating my concerns about ureaplasma. My OBgyn had told me to ignore when i tested positive for it (a few months back) and i wasn't sure if that was the proper course of action. Would my body have cleared it after a while in its own? In your expert opinion? 

Thanks again.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Thanks for clarifying:  indeed I thought this concerned the same exposure.

2+ days might be a bit too soon for reliable testing by throat swab. However, in a day or two (4 days after the event) would be fine.

Your ureaplasma may or may not have been cleared. Probably not, but it doesn't matter. At any point in time, at least half of all people, male and female, will test positive. It probably comes and goes, often but not necessaily always from sexual contact. Even when treated with antibiotics active against ureaplasma, usually it's back within a few weeks or months. There hasn't been detailed research on the exact mechanisms of infection, natural course, or immune response -- precisely because symptoms are rare and complications unknown. It should be viewed as an entirely normal bacteria colonizing the genital tract -- along with hundreds or thousands of others.
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17 months ago
Thank you Doc. I have gone ahead and gotten tested (throat and vaginal swabs). As you have predicted, both came back negative except for my ureaplasma parvum, which is still there. 
Along with Gardnerella vaginalis with RC of 1.19.

The clinic recommended Levoflaxin for five days as well as flagyl. Do you agree w this course of treatment?

Finally, i want to make sure they performed the throat swab correctly; they swabbed the sides and top of my mouth and not the back of my throat. They assured me that was enough. Was it? Could this lead to false negative if that’s not the proper way to test?

Thanks again for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Normally oral testing is done by swabbing the bak of the throat, but even with the mouth only, the test is unlikely to miss gonorrhea if present.

I don't understand your clinic's advice about metronidazole (Flagyl) and levofloxacin. G vaginals and U. parvum are normal bacteria that do not require treament. Discuss with the clinic.

That completes two follow-up quesitons and replies and theefore ends this thread. I hope the discussion has been helpful.
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