[Question #613] Std risk

44 months ago
Hi there. About a week ago I did something very foolish and had protected sex with a prostitute. We had intercourse and she gave me oral. I've read that condoms are almost 100 percent for Hiv and other STDs but not so much for syphilis and herpes.  It was a one time thing. Should I be tested? And if not can I resume normal sexual relations with my wife? Thank you for your time.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome to the Forum and congratulations on your safe sex approach to your casual sexual encounter. I'll be pleased to provide you with some information which I hope will help you plan your next step.  Here are the facts:

1, Most commercial sex workers do not have STIs.  The likelihood that  CSWs have STIs depends on the sort of CSW you had sex with.  Disheveled CSWs picked up on the street have higher STI rates than CSWs seen in brothels or who work as call girls.  STIs are bad for business and most CSWs tend to be pretty careful about protection and getting checked.

2.  Most unprotected exposures to infected partners do not lead to infection.  Most STDs transmission rates when exposed to an infected partner are between 20 and 30% per sex act.  There are exceptions, HIV and herpes for instance are transmitted less frequently, only 1 infection per 21000 unprotected exposures for sex with an HIV infected partner.

3.  You used a condom (for both sex acts I presume) and condoms are excellent protection from acquisition of STIs, making your risk for gonorrhea, chlamydia, trichomonas, and HIV virtually zero as long as the condom was used throughout the sex act and did not break (breakage is typically obvious with condoms- when the fail, they break wide open).    While they are not perfect protection against syphilis and herpes because transmission might occur to uncovered parts of the penis, they still reduce the already low risk of infection greatly.

4.  You remain asymptomatic.  If you had acquired gonorrhea or chlamydia, symptoms would have begun by now.  For herpes symptoms typically take a bit longer (10-14 days).  syphilis, which is very unlikely because it is rare and hard to transmit can take up to three weeks for lesions to occur but is still most unlikely.

So, overall, based on the facts I have presented, your risk for infection is very, very low.  Testing is a personal choice and might give you peace of mind but, from my perspective is probably not needed.  Using the same train of thought, I would not be concerned about unprotected sex with your wife either. Obvious these decisions are up to you- I hope the information I have provided is helpful to you.  EWH

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43 months ago
Thank you for the information. I went to my doctor and had the tests done. However for 3 days after the exposure I took 3 pills of 500 mg of Amoxicillin 1 a day . This was 2 weeks before my tests. Would this hamper the results at all? Especially the syphilis test?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Your risk for syphilis from the exposure you describe is close to zero and the amoxicillin you took would, if anything, have prevented syphilis if exposed.  Please try to stop your needless worry.  EWH---
43 months ago
So just to clarify the Amoxicillin wouldn't mask the results. A negative would be a true negative?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Correct  EWH
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43 months ago
When I saw my doctor to ask for my tests, I forgot about the 3 pills of amoxicillin . I know you said it will be a negative result, but I had sex with my wife on the fourth day. I should find out my results next week.  When I tell my Doc about the amoxicillin will he want tests for my wife as well. I've read it takes about a week for antibiotics to clear the system . I hope this doesn't sound too confusing
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Your results will be reliable.  When your tests are negative, as I am confident they will be, this will prove that your wife is not at risk and does not need testing.  I hope this clarifies things.  EWH
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43 months ago
Thank you Dr Hook. My results were negative. I'm still concerned that I took the syphilis test to early (15 days). In Alberta Canada they use the Eia test. What is the reliability and sensitivity for that test after that amount of time?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Our Forum Guidelines permit three replies for each client.  This is your 5th and the question is repetitive.  The sensitivity of the test in your case is irrelevant since in the unlikely circumstance that you were exposed to syphilis, the amoxicillin you took would have completely reliably prevented syphilis from developing.  There is no need for further testing.  Should you choose to test further (a waste of your time and money), I can assure you that the test will still be negative, showing that you were not infected by the exposure you have described.

This will end this thread.  If you still have further questions you will have to pay again and start a new question.  EWH

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