[Question #7107] Risk of asympotic STD and HIV

10 months ago
Hi Doctors, I want to say I thank you for all that you are doing for everyone here. 

Background:
I'm a straight guy. I've been having unprotected oral sex and protected sex with asian escorts by appointment for around 10 times from 2018 June to 2019 Dec. The last time I had sex was protected oral and protected vaginal sex with a stripper in 2020 mid February. Throughout the time period (2018 June to 2020 mid February), I have had unprotected oral sex and protected vaginal sex with my girlfriend. Neither of us showed any symptoms even till today. A FEW times, I inserted into my gf's vagina unprotected for short periods of time, but always end with a condom when it comes time for orgasm.

I had a full panel STD test at the end of 2020 June (Jun 29th). It was a urine test for chalmydia/gonnarhhea, and a HIV ag/ab combo test with a tube of blood from my arm (I don't know if it's 3rd or 4th generation or if it's a rapid test, but it's a tube of blood). Everything came back negative. 

Questions:
1) I'm afraid that I got asympotic chlamydia/gonarrhea from 2018 June to 2020 Feb, and I somehow passed it to my gf asympotically (again, never orgasmed inside her, but I did begin by inserting without a condom), and then miraculously my body got rid of the infection right before my blood test on 2020 June. I've been seeing a few cases of asympotic chalmydia/gonnarrhea passing back and forth between partners.

2) I didn't ask the doctor what generation HIV test it was, so I wonder how accurate it is? Given my last sex partner outside of my relationship was with a stripper in 2020 mid-Feburary. The test result just calls it HIV ab/ag combo test, and it was with a tube of blood from my arm. 

Thank you in advance!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
Welcome and thanks for your confidence in our services. Directly to your questions.

1) You needn't worry. You do not have asymtomatic gonorrhea or chlamydia. First, don't confuse asymptomatic (lack of noticeable symptoms or problems) with diagnostic tests. They aren't hte same. The tests for gonorrhea and chlamydia are equally effective in detecting either symptomatic or asymptomatic infection. Your negative test results prove you aren't infected. Second, neither gonorrhea nor chlamydia -- asymptomatic or not -- persists more than a few weeks, maybe a few months. The immune system clears them within that time. Conceivably a chlamydial infection acquired last February could still be present, but defintely not gonorrhea. Finally, asymptomatic urethral gonorrhea is extremely rare anyway. Lack of pus dripping from the penis, all by itself, is nearly proof gonorrhea is absent.

2) The Ag/Ab test is synonymous with 4th generation. (Ag/Ab is the definition of 4th gen.) They are conclusive any time 6 weeks or more after the last exposure. So your negative result in June proves you aren't infected.   

So all is well. And these comments settle your concerns. Let me know if anything isn't clear.

HHH, MD
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10 months ago
Thank you doctor. 

One last question, and it's a general knowledge question. If the body gets rid of Chlamydia/gonnarrhea infections on its own, how come there are websites (official ones like cdc) saying that asymptotic chlamydia can last for a year or two? 

Oh and also...what are the chances that I passed it to my gf and she's a silent carrier now?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
This is a good question -- in part because it's more complicated than might be expected, because of unique factors in how chlamydia causes infection and the immune responsae to it. The upshot is that there actually isn't very much data on this.

First, most infections are cleared by the immune system with time. People recover from colds, influenza, COVID-19, measles, pneumonia, and hundreds of other infections. It just takes time -- longer for some infections than others. For most infections, antibiotics speed clearance, often dramatically; and therefore prevent complications. But long before antibiotics were developed, gonorrhea generally self-cured within a few weeks in men and a few months in women. Chlamydia wasn't known until more recently, but the large majority of infections are cleared within a few months -- as for gonorrhea, probably faster in men's than women's genital tracts. But exactly low long is hard to know. The ideal answer would come from not treating a few hundred infected folks and see how long it takes to clear up -- which obviously is not ethical and such research will never be done. So we're left with studying small numbers of people infected, who don't show up for treatment for a few weeks or months, then return and get retested. Obviously this is haphazard; and when someone still has infection say a year later, it's usually not possible to know if they had it all that time or it cleared and they were then reinfected.

Analyzing the flawed and hard to interpret data leads most experts to believe that almost all chlamydial infections are gone within a year in women and several months in men. There is a single documented case of a woman whose genital chlamydial infection apparently persisted for 4 years, but that appears to be a very rare exception. 

From all you say, there doesn't seem to be any reason to suppose you had chlamydia. If you did, and it's now gone, then before it was cleared you could have infected your partner -- either your girlfriend or any other partner. "Silent" carriage of chlamydia (asymptomatic infection) is quite common. This is one reason that all sexually active persons (outside mutually committed monogamous relationships) should be tested from time to time. For that reason, it would make sense for your gf to be tested for chlamydia and other common STDs (gonorrhea, HIV, syphilis) if that hasn't been done before. But not because of your sexual history, which is nothing unsual in terms of STD risk. As noted above, "silent carrier" has nothing to do with diagnostic tests. The standard tests will detect chlamydia if present, silent or otherwise.
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10 months ago
Thanks Doctor. For my final follow up question, I guess I want to get your opinion or qualifying the risk of me catching chlamydia, passing to my gf, clear on my own, testing negative, and gf also never had any symptoms of chlamydia/any other STD. Given that, in my opinion, my only risk is unprotected oral from appointment escorts with protected vagina sex. 

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
That sequence of events has no possibility of reality. Let it go. If you remain uncertain, I suggest you first re-read (carefully!) my replies above. 

That completes the two follow-up questions and replies included with each original question, and so ends this thread. I hope the discussion has been useful. Best wishes and stay safe.
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