[Question #7352] High risk exposure.

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57 months ago
I recently had a high risk expsoure with a transsexual. Granted I know this person well. (She is on Prep) Unprotected oral both ways, Mostly protected anal. However upon finishing condom was not on when I pulled out. She freaked initially, I had verifiable proof I was free of any stds. So she was said oh then thats fine cause I'm clean as well. And get tested regularly. But I'm skeptical of taking someone at their word. I talked to an online doctor.. I do not have insurance and was absolutely terrified. As I have a girlfriend. I got a prescription for suprax and azithromycin, taken 4 days after exposure. I did not have any symptoms of a urethra infection. 9 days later after taking the antibiotics, I  had unprotected sex with my girlfriend. And then 2 days later after that. The second time she bled after sex. She did say she felt that she was drier than usual, and might have got a tear. I am freaking out if I gave her something. Now I'm no stranger to infections of the urethra. I am getting tested the health department j. A couple weeks. My question is should I be extremely worried i gave her something. 
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H. Hunter Handsfield, MD
57 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

You really needn't be worried. First, the evidence is strong your trans partner/friend doesn't have any active STDs. Second, withdrawing the penis from a condom that remains in place in the rectum (or vagina) is sitll considered completely protected sex -- so you really weren't exposed. Had you come to my clinic in this situation, we would not have treated you. That said, if you were incubating gonorrhea or chlamydia, they would have aborted the infection -- further guaranteeing you weren't infected. Finally, minor vaginal bleeding is very common in healthy women; STDs can cause it, but are much less common than other causes.

Honestly, I would not have recommended you be tested. But since you've apparently already done it, just sit tight and expect a negative result. (Make sure they know about your apparent duplicate urethra. Whenever you're tested for gonorrhea and chlamydia, urine testing could miss an infection if urine doesn't pass through the infected channel.

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

HHH, MD
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57 months ago
Thank you. I appreciate the reassurance. I dont exactly know when the condom slipped off. Im more worried of the possibility of Chlamydia vs Gonorrhea. For i have had Gonorhhea twice in my life and both times showed symptoms in the duplicated urethra less than 48 hours after exposure.  However when I was 16 I am now 29. I did have Chlamydia. The only symptom I had was the tube on one of the testicles swelled really bad. That was 3 days post exposure.. Extremely painful. So I guess my next question would be if I were infected with either of them based on my history. Would it be likely I would display symptoms again, or not?
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H. Hunter Handsfield, MD
57 months ago
Gonorrhea almost always causes overt, easily recognized symptoms. Chlamydia is generally milder and more frequently assymptomatic, but most urethral infections are readily apparent. In any case, if you had been infected, you were cured -- by cetriaxone in the case of gonorrhea, azithromycin for chlamydia. Reallly nothing more to worry about.---
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57 months ago
Thank you. To close it out. One last thing. Lot of different information on this on the web. Is Trichomoniasis prevelant in men who have sex with other men? Also thank you all for being here. I appreciate you all so much.
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H. Hunter Handsfield, MD
57 months ago
There have been few systematic studies of trichomoniasis in MSM, but all the available information indicates it occurs rarely if ever. Trichomonas is evolutionarily adapted to the vagina and not often carried in the rectum and virtually never in the mouth. Hence there are no sources for trich to infect the urethra in MSM. The only risk for urethral infection is vaginal sex with female partners.

Thanks for the thanks. I'm glad to have helped. Take care and stay safe -- both sexually and from coronavirus.
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