[Question #6237] Posted question 6030

69 months ago

Doctors:

As I indicated in question 6030 I had unprotected vaginal and oral sex with a caucasian female for extended duration - Dr Hook felt that there was no need to test unless there were symptoms of the STI's (trich-gono-chlymidia) - he indicated the risk of getting HIV from this one incident should not be a concern for me - so I took his advice and used a condom with my new partner - female age 45 Hispanic - so we had protected vaginal sex - this occurred on October 23rd - on October 31st which continue today I began to feel like I have to urinate but cant seem to get that need abandon when I do - I can not say that I feel pain or have a discharge and it does not hurt when I ejaculate - I do feel as if there is for lack of better word irritation in my uretha and it feels warm - I know condoms worn appropriately - which it was and did not bust - act as a barrier against (trich-gono-chlymidia) - it seems to me it would be to many days of no symptoms to present themselves with the 6030 incident and I would imagine that this last incident for me to have been exposed would be bewildering - I have read that you could have trich and show no symptoms and it can remain for a long time and you not show any symptoms - so I am going to get tested for these three - if I were to test positive for either of these 3 - would my chances that I contacted HIV change ? I did finger her vagina and then put a condom on - not sure that would make any difference - but anyway like for your thoughts and I appreciate you taking the time to respond and the work that you do !

H. Hunter Handsfield, MD

69 months ago

Welcome back to the forum. Thanks for your continuing confidence in our servcies.

Sensations like incomplete bladder emptying, urgent urination, "warm" sensations, etc -- without urethral pain or discharge -- are not caused by any STD. At your age, you could well have a prostate or bladder issue, which are common as men age beyond 45-50; or genitally focused anxiety due to your concerns about STDs and HIV. In fact, these could interact: if you have incipient or partial bladder outlet obstruction or bladder irritation, anxiety could make it worse. And indeed it is also too long from the exposure described in your other thread.

I think it is reasonable for you to be tested for STDs, not because I believe there is any likelihood of a positive result, but because the negative results probably will be more reassuring than anything I or Dr. Hook can say based, no matter how expert we are. As for your "if I test positive" question, I suggest we deal with that in the event of a positive result. It would mean you were in theory at risk for HIV, but the chance you caught HIV still would be miniscule. In any case, whenever someone is tested for any STD, most clinics and doctors would include HIV and syphilis blood tests -- so you should plan on those tests as well as urine testing for gonorrhea, chlamydia and trichomonas. And as Dr. Hook advised, why not also ask your partner to be tested? You may find she is as worried about STDs as you are.

Finally, fingering (vagina, anus, or anywhere else) carries no risk for HIV or other STDs, and the details of how you applied the condom -- before or after fingering -- also makes no difference. (And if both of you are tested and negative for everything, you can safely forget about condoms anyway, assuming neither of you has other partners as your relationship continues.

Bottom line: you are at little or no risk of STD or HIV and can expect negative test results. But see a doctor about your urinary symptoms if they continue.

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

HHH, MD

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69 months ago

Dear Drs.

First let me say thank you both for allowing this forum and - I am pretty sure that I understand your advice

The unprotected sex placed me at risk for STI's including HIV - but since I showed no symptoms up to 40 plus days - no burning or discharge upon urination and no sickness i.e. - ARS - in that time frame then - I could not have gotten any of these (trich-gono-chylamidia) - and the chances that one is infected with HIV and does not get sick is pretty remote -not 0 but approaching 0

The second incident - where a condom is worn and remained in tact acted as a barrier - and the chances that these symptoms are related to any STI - is pretty remote - not 0 but approaching 0

In other words the first incident placed me at a much higher risk than the second

Also in theory if one does get and STI why does the possibility to transfer HIV increase ? - but regardless if the test for any of the other STI's is positive and having gone 40 days and not experiencing any sickness then the the chances that I would have acquired HIV would not be o but pretty much approaching 0

Also since there is no pain upon urination and no discharge than what I am experiencing could not be a std - is this why you believe my test will be negative?

I definitely understand the anxiety and the focus on STI's and HIV for me - been that way for a long time - but the reality is if you choose to have sex - wearing a condom allows for the best prevention

Patrick

H. Hunter Handsfield, MD

69 months ago

You correctly understnad the risks and my advice, except that asymptomatic infections can occur. For 100% assurance, you could still have a urine gonorrhea/chlamydia test. But I definitely don't recommend trich. Such testing is rarely done or recommended in asymptomatic men. I believe your tests will be negative because a) most women aren't infected, b) when they are, most exposures do not result in transmission of the infection, and c) absence of symptoms. None of these factors by itself is conclusive, but the combination of the three adds up to very little chance you are infected.

STDs cause inflammation, and inflammatory cells deposited at sites of infection are more susceptible to HIV if exposed. However, the magnitude of the effect is small; having gonorrhea or chlamydia roughly doubles the risk of catching HIV if sexually exposed. Double really doesn't mean as much as it sounds. If the risk of HIV is, say, 1 chance in a million as for many heterosexual exposures, doubing raises the risk to 1 chance in 500,000: still virtually zero.

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69 months ago

Dear Dr.

I have submitted a urine specimen to test for gono and chylamidia and also trich - so if I were to test positive for trich - could I have had this for years and not necessarily related to any recent sexual experience - I ordered the test through quest on the order it says chlamydia/N. gonorrhoeae RNA, TMA

Trichomonas Vaginalis RNA Qualitative TMA, Males - (These test appropriate?)

I am sure that if I do test positive for gono and chylamidia - I should take the treatment - how about if I test positive for trich - should I take the treatment as well or just disregard ? Also what does one take to cure for gono and chlmadia as well as trich and for how long do you take it and can you drink beer on these medications - (big game BAMA Vs LSU) this weekend - hate to not have a few beers! So if I do test positive can I wait till Monday to get it taken care of so I can drink beer this weekend - I wont be having sex for sure till I take care of this if its positive

I can live with the fact of 1 in 500k or 1 in a M as far as hiv knowing that I had no sickness and knowing what you and Dr Hook have advised - I realize this is my last question - but would like to share my test results with you - so I shall - also all these test were ordered by me and have not spoken with my Doctor for privacy purposes

H. Hunter Handsfield, MD

69 months ago

We don't really know how long trich can persist in males. Perhaps years (as in women), but this has never been studied. I suggest not speculating on possible sources of infection until and unless you have a positive result, which is unlikely.

Of course if positive treatment will be necessary. But also no point speculating on treatment unless one or more infections is found and deal with it then. If you're worried about alcohol and metronidazole for trichomonas, it's not an issue. The business about MTZ not mixing with alcohol is non-existant, despite all the warnings about it you'll find online. An upcoming revision of the CDC's STD guidelines, due in 2020, will specifically state that there is no need to avoid alcohol when taking MTZ.

There is no need to share your negative test results on the forum. All we would do is symbolically nod wisely and agree the results are negative. But I'll leave the thread open in case of the very slim chance of a positive result. Please no more comments or posts until you have the results of all three tests.

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69 months ago

As you say most do not have std's and the most exposures do not result in transmission and absence of symptoms - with this combination adds up to a very little chance of infection - the tests were all negative as you say - I plan for sure to use a condom - It appears from what I read they are upwards of 99% effective for HIV - a little less for the other STI's - Is this due to primarily studies? I have heard of the study between partners with one that had HIV and the other that did not - where as the other sti's such as herpes and the others sti that can be passed through skin contact - where a condom can not can completely cover the genitalia ? Also if 1% of the US population or approximately 3.3 m have HIV and 70% are male and on average hiv for vaginal sex is 1 in 2500 then just using a conservative 50% are female the wouldn't the odds for heterosexual vaginal sex be like 1 in 2500 = .0004 and 50% of 1% or .005 .004(.005) = .000002 be like a 1 in 500,000 chance ? So even if condom did break seems that chance is even lower - understand it can happen - so for sure I will wear condoms

Thanks for your insight!

H. Hunter Handsfield, MD

69 months ago

Glad to fear of your negative test results (and of course not surprised).

An estimated 1.1 million Americans have HIV, not 3.3 million. Otherwise your calculations seem OK, although I haven’t rechecked the math.

Condoms are less effective for some STDs, those transmitted skin-to-skin (HSV, HPV, syphilis because of skin contact above the condom. For those transmitted through genital fluids (e.g. gonorrhea and chlamydia), condoms probably are just as effective as for HIV. However, more codon failures may occur than for HIV because these two STDs are inherently hundreds of times more transmissible than HIV.

Whatever rationale or calculations you use, I endorse your intent to use codons for any non-monomagous vaginal or anal sex. Good move!

That ends this discussion. I hope it has been helpful. Please note that repeated questions about the same sort of exposure or topic are not permitted. This being your second, it will have to be your last along these lines. Thanks for your understanding.

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